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Erectile Dysfunction: Help is Available

According to the American Urological Association, erectile dysfunction affects more than 30 million men in the United States and is especially common in men who have had prostate surgery, and/or are dealing with diabetes, high blood pressure, high cholesterol, and obesity.

Often, men who have an issue with their sexual abilities may be reluctant to speak with their physician, feeling quite embarrassed even discussing it.

Here to discuss ED, treatment options and why men shouldn't be hesitant to discuss ED with their physician is Dr. Jaspreet Singh. He is a board certified urologist with St. Luke’s Cornwall Hospital.
Erectile Dysfunction: Help is Available
Jaspreet Singh, DO
Dr. Jaspreet Singh is a board certified urologist. He obtained his medical degree from the New York College of Osteopathic Medicine and completed his clinical internship at Brookdale University Hospital and Medical Center followed by general surgery and urologic surgical residencies at Albert Einstein Medical Center, and Hahnemann University Hospital. Dr. Singh has also completed clinical externships at Memorial Sloane Kettering Cancer Center and the Children Hospital of Philadelphia during his residency.

Learn more about Jaspreet Singh, DO

Melanie Cole (Host): According to the American Urological Association, erectile dysfunction affects more than 30 million men in the United States and is especially common in men who have had prostate surgery or are dealing with diabetes, high blood pressure, high cholesterol or obesity. Often men who have an issue with their sexual abilities may be reluctant to speak with their doctors, feeling quite embarrassed even discussing it. Here to discuss erectile dysfunction, treatment options available and how men should not be hesitant to discuss this with their physician, is Dr. Jaspreet Singh. He is a board-certified urologist with St. Luke’s Cornwall Hospital. Welcome to the show Dr. Singh. So, what is erectile dysfunction?

Dr. Jaspreet Singh, DO (Guest): Yeah, hi Melanie. Thanks for having me. Erectile dysfunction, I think most of us have heard about it but many of us don’t talk about it. It is the consistent inability to achieve or sustain an erection that is suitable for sexual intercourse.

Melanie: And what are some of the most common causes that you see?

Dr. Singh: You know there are many different causes of which I typically see day to day, the most common causes being diabetes, being overweight, perhaps a history of smoking that affects circulation, blood circulation and other things just we may have no control over. Things like taking medications for high blood pressure.

Melanie: So, Dr. Singh, first of all, men don’t want to discuss this, and their partners may be the ones to want to get them in to see you. What things would you like to tell the partners to say, you know it’s time to see a doctor about this?

Dr. Singh: Yeah, as most of us know, men are really not that good with addressing their medical health, most men. That’s often the challenge I have as being a urologist who addresses not only female issues but more often with the male patient and it often takes years before somebody comes through the door and with erectile dysfunction, it’s more than just a diagnosis. It is something that affects the confidence of a man and as you just stated, that it affects the – it is embarrassing to come and talk to somebody about this.

And that’s one thing my particular approach is to make it comfortable as comfortable as this topic can be to talk about. If you have a doctor who has a true passion in treating erectile dysfunction; that emanates through the satisfaction that a guy has when he leaves my office. The main issue here is not only is a man changes with his health as he gets older, or other medical issues like we just talked about diabetes or high blood pressure, but it also affects the personal relationship that a man will have with his partner and what typically happens and this is what I see day to day is a man will find difficulty getting an erection and due to that lack of confidence; will then not engage even in the day to day flirting as you may say or having fun with his partner. And the reason why that happens is that most guys view sexual intimacy as a way of performance and if a man cannot perform, he avoids that situation because he doesn’t want to be let down and that often is the biggest challenge in treating erectile dysfunction is to address that issue.

So, when a guy comes in, although he understands that there are changes to his erections, what he doesn’t want to face is the fact that he has lost his confidence in bed. And that’s one area that you have to overcome in addressing this disease and it is a disease and most guys will put it off and say that it is in their head is why they are having this, it’s you know my medical doctor has been trying, he has given me medications and it is just not working, I’m not meant to have it, it is maybe in my head. And I often even hear as much as it kills me to hear this, I have patients saying you know, I have been married for 30 years, maybe I’m just not attracted to my partner and that is not the case. So, the biggest challenge that I often find in treating this is that although most of us have heard about what erectile dysfunction is; is to address the fact that you have to overcome the lack of confidence so that we can help revitalize that and make that man complete again.

Melanie: That’s a wonderful approach to this delicate situation, so how do you diagnose whether it is something that would require counseling, lifestyle modification, all of those kinds of things as opposed to medication or surgical intervention?

Dr. Singh: So, first and foremost, I’m a doctor first and then a urologist and so when I see a patient who is coming in with changes in erections, you have to do the basic evaluation. And the changes in erections often that are medically related, not the stage fright that occurs with having a new partner or the 20-year-old that comes in saying you know doc, I’m in college and I couldn’t perform, that is not the definition of erectile dysfunction. We are talking about the progressive slow nature in the way that the quality of the erection is changed, perhaps the spontaneity of getting one or maintaining one or even the reduction of the rigidity that makes penetration difficult and so if that is the case, you know we address issues. You have to stop smoking. If you are overweight, you have to drop a few pounds. I have men all the time saying doc I’m getting older; my penis is shrinking. Unfortunately, I can’t tell you that is not the case, it is because there is more weight around the belly that is hiding the penis. You have to do things that are basic importance in having good health and exercising, cutting out the red meats and eating healthy. So, those are the basics. And if one is not doing that, I will spend the time in counseling the patient, saying listen you have to do these things, let’s come up with a game plan that doesn’t mean that we are going to hold off on treating the erection, but let’s get a comprehensive approach to this because ultimately, both of us; me as a physician and my patient want the best outcome of whatever intervention we choose.

Melanie: So, let’s talk about some of those interventions. We have all heard about the medications and Viagra and Levitra and Cialis on the market so, do these things work, for how long do they work? I mean can someone be on them if they need to be for years and when do you say well really medication is just not enough?

Dr. Singh: Yeah, great question. And so, the algorithm in treatment, at least in my hands is obviously, we just talked about addressing the lifestyle changes, the smoking cessation, those things. Then the – it’s not a next step, but at the same time I’ll talk to the patient about medications like Viagra, Cialis, and there are several of them on the market. The way these medications work, is they help improve the blood flow to the penis and there are two things that are necessary for an erection to be rigid enough for penetration. One is obviously the blood flow in but the second issue is that the penis needs to be able to trap the blood within itself and so if I can give you an analogy, it is almost as if though you are trying to fill a bucket of water and if the faucet is running on high flow, that bucket will never be filled if there is a hole at the bottom. And the same thing can happen with a penis. So, the first step being medications and all of them work very similarly and the success of which medicine is right for you all depends on ultimately, it’s the expectations whereas Viagra is a medicine that will stay in your system for 6-8 hours, so you take it as needed, the Cialis comes in a daily medication or a higher dose which allows up to 72 hours of that medication in your system. What the extended release allows is better spontaneity. So, you don’t have to time it. And everyone is different. Every couple is different.

So, as far as the success rate of medications two out of three men will notice an improvement to their erections with medication, one third will fail medication. The one thing that we don’t have control over are oftentimes the other medical issues that are related to erectile dysfunction. One being age, so that is working against us, as you get older, we can’t control that. Perhaps the continued management of diabetes, high blood pressure, these are all chronic issues. So, we cannot reverse those. And so, what happens is that these medications will eventually stop working and it’s not because that these medicines your body is getting used to the medicines, it is because of the other medical conditions are progressing that the improvement from the medications are less than what they used to be. But in general, the expectation is two to three – two out of three men to have an improvement and then eventually down the road, as one gets older, that success rate to drop.

Melanie: So, very quickly, give us a little summary of some of the surgical interventions, the vacuum device, any of these things that you can look to use for men, just a little brief overview.

Dr. Singh: Sure. The bottom line if medicines fail, I will give another try to – another medication. If that fails, what I do in the office is figure out what is going on. I have my patient come in. We do an ultrasound study. We figure out where the issue is. Is it a blood flow issue? Is it the inability for the blood to be trapped in the penis? Now the next step in the intervention, it really depends on the patient. Yes, these are all treatment options, vacuum devices, to help bring the blood flow into the penis, the injections into the penis; to me the best long-term fix if any guy who is struggling with erectile dysfunction is a surgical implant or penile prosthesis. For me, it’s a procedure that takes half an hour, in the operating room, yes as with any surgery, there is a recovery to it, but we are talking about long-term fix of these erections to allow my man to be in full control of the erections and achieve erections whenever needed, keep them as long as needed and have as many erections throughout the day as a guy wants.

Melanie: So, wrap it up then with your best advice about lifestyle modification, and really even possibly prevention, what you want men to know and you want them to know about coming in to see you to discuss all of these issues at St. Luke’s Cornwall Hospital.

Dr. Singh: Yeah, well what we have developed here at St. Luke’s Hospital, is a center that addresses men’s health. As we talked about, you have to get better control of your health, dropping the weight, stopping the smoking, exercising. Along with that, whether it is a trial of medications, whether it is surgery, what this department of urology provides is a full comprehensive approach in getting the confidence that the male patient is looking for and regaining his erections. Most doctors will treat diseases and leave it at that and miss treating the whole patient. The unique approach that we provide in our practice is to give our patients that comprehensive approach to address other issues and to revitalize that man that what he remembers himself being 20 years ago.

Melanie: Thank you so much, it’s really great information and so important for listeners to hear. This is Doc Talk, presented by St. Luke’s Cornwall Hospital. For more information, please visit That’s . I’m Melanie Cole. Thanks so much for listening.