Erectile Dysfunction: Answering the Questions You’re Afraid to Ask
About 1 in 10 adult males suffers from erectile dysfunction on a long-term basis. It is also a topic that many men feel embarrassed to talk about. This podcast features Dr. David Levy of UM Charles Regional Medical Group – Urology, who answers the questions many men are afraid to ask but should! Not only do we discuss what it is and how to treat ED, but how to talk to your partner, how to deal with depression that it may cause and how to prevent it.
Featured Speaker:
Dr. Levy graduated from Washington University in St. Louis in 1985. He received his Doctor of Medicine degree from Chicago Medical School and completed his General Surgery Internship and Urology Residency at University Hospitals of Cleveland, Case Western Reserve University. Following his residency, Dr. Levy completed a fellowship in Urologic Oncology at the MD Anderson Cancer Center in Houston, Texas. He was Clinical Associate Professor of Surgery/Urology at the Cleveland Clinic where he worked for 12 years prior to joining Chesapeake Urology and UM Charles Regional Medical Group – Urology.
Learn more about David Levy, MD
David Levy, MD
David Levy, MD is a urologist at UM Charles Regional Medical Group – Urology. He is an experienced physician who is the author of 30 scientific manuscripts and 16 book chapters, the founding editor of a board-reviewed book on urology, has been listed as a Top Doctor numerous times and is an accomplished speaker. Dr. Levy is a recognized expert in prostate cryosurgery, an outpatient curative prostate cancer procedure. He has been sought out as a referral source for minimally invasive prostate cancer therapy as well as radiation failure prostate cancer therapy. Additionally, he is a cancer nutrition specialist and believes nutrition is a key component to cancer care.Dr. Levy graduated from Washington University in St. Louis in 1985. He received his Doctor of Medicine degree from Chicago Medical School and completed his General Surgery Internship and Urology Residency at University Hospitals of Cleveland, Case Western Reserve University. Following his residency, Dr. Levy completed a fellowship in Urologic Oncology at the MD Anderson Cancer Center in Houston, Texas. He was Clinical Associate Professor of Surgery/Urology at the Cleveland Clinic where he worked for 12 years prior to joining Chesapeake Urology and UM Charles Regional Medical Group – Urology.
Learn more about David Levy, MD
Transcription:
Erectile Dysfunction: Answering the Questions You’re Afraid to Ask
Scott Webb: Welcome to Live Greater a health and wellness podcast brought to you by the University of Maryland Medical System. We put knowledge and care within reach. So you have everything you need to live your life. Fullest. This podcast is sponsored by UM Charles Regional Medical Center. I'm Scott Webb and there are certain topics that men generally don't love to discuss. And one of them is definitely a erectile dysfunction. Enjoy me today to help men to know that ed is common and treatable as Dr. David Levy. He's a urologist at UM Charles Regional Medical Group, Urology. So doctor, thanks so much for your time today.
As I was thinking about our conversation, I was making a little list of the things that men generally don't love to talk about. And no matter how hard I tried ED or erectile dysfunction, just was always at the top of my list. So as we get rolling here, what is, or what causes erectile dysfunction?
Dr. David Levy: What you say is quite true. It's often time men are, reluctant to get into that, but the most common things that really impact on erectile dysfunction in our society are some of the most common. Prevalent things that we see throughout and that's high blood pressure, heart disease, diabetes. And as society has evolved over time in dietary patterns, diabesity the epidemic of diabetes and. overweight, just parlay into numerous health risk factors, but the most common things for erectile dysfunction are really, diabetes, blood pressure and, cardiovascular disease. And that really permeates throughout the population.
So we end up start seeing this, in guys, in their early fifties, we have about 29% incidents of men,, age 50 to 59 that have erectile dysfunction. And what erectile dysfunction really means is erection that is not suitable for satisfaction in terms of function. So they're varying degrees of that. You can get. Varying levels of an erection in terms of increased blood flow, with rigidity, sufficient for penetration or without rigidity. And the varying degrees of satisfaction, are different for men depending on what their needs are.
So in men, in their early fifties, again, almost about a third of the population has some form of erectile dysfunction. It may not be complete lack of function. But it may be, dissatisfaction with how well they perform. And we do see them in the office, not uncommonly. And when guys get into their 60 to 69 years age bracket, it's over 40% of patients overall across the country. It's North of 20 million men that are affected with this.
Scott Webb: You say, nearly 30%, a third. Population. And I didn't even realize that it was that high. And sounds to me like when you're treating erectile dysfunction, treating ED, really what you need to do is treat the underlying causes or underlying, risk factors. Am I hearing that right?
Dr. David Levy: So that's part of it, because it's not infrequent that someone comes in with the complaints that they're having difficulties and you can't find a reason. Why is that? Well, the guy comes in, he's healthy. Otherwise he's working a regular job. He may be anything from an engineer to a lawyer, to a construction worker doesn't matter, but they may not have any health risk factors at all. Well, why is that an issue? Because there are a multitude of things that go into. This phenomenon that creates an erection for function. You have to have increased blood flow.
You have to have the right psychological frame of mind. It has to be in the right environment. So there are numerous factors aside from diabetes or high blood pressure or heart disease in one fashion or another that impact on erectile dysfunction, psychological factors play a massive, role in this. So guys can come in perfectly healthy, normal blood tests, normal testosterone levels, no smoking history, no diabetes, but they are having significant issues.
Well, stress factors, how the kids are doing in school, what the financial situation is, what the job related stress is, what the relationship stress factors are. Any of those things can have ramifications in terms of, erectile dysfunction. So while you can put your finger on, okay, this is a cause, and this is a cause, and this is a cause, a lot of times we don't have any identifiable factor that we can actually correct in the medical office.
Scott Webb: I wanted to ask you too, along those lines, we're sort of digging down deep here to really get to some things. I'm sure there's a great deal of depression in men who are suffering from ed and maybe they put off speaking to their primary because it's a difficult subject, right? Or they, put off seeing a specialist like yourself. So maybe you can talk a little bit about that, that sometimes what we think something is, there are other ramifications, right? So there may be psychological reasons why, men are suffering from ED. And then if they are suffering from ED that may bring on some depression, maybe you can sort of tackle that for us.
Dr. David Levy: Without question that happens. And also an extension of that is the stress that can come on in a relationship from something like this, because the guy may not have any idea of what's going on, why he's having a problem. And then the partner can interpret it as it's their fault. And there's a problem with them in the relationship. And this can cause all kinds of issues. So I have always been a strong advocate that when something like this surfaces go and see the Doc and even come in as a couple to, have the discussion because it's too often that it creates a significant amount of stress in the relationship.
And sometimes that can have very negative effects on the relationship when the man really doesn't have any idea of what the issue is. Like I said, it could be a work related stress issue and when they get home, they just can. Detached from that kind of stress or something, in the home environment with, like I said, how kids are doing in school, how the kids are doing financially or any of these things can cause ramifications that can lead to these issues. So depression definitely, you see it, it can be a cofactor, in the problem.
As significant as heart disease or high blood pressure or diabetes. So all of these things can be significant factors. And the medications that we have available to us are not panaceas. I mean, the medications aren't a hundred percent Cialis, Lavetra and ,Viagra, and these oral medications that are out there and they can buy them on the internet. Sometimes you don't know what you're getting, but oftentimes you can find, The medications on the internet. So the expectation is, oh, I'll take the pill and I'm gonna be fine.
And everything's gonna work. Well, nope, it doesn't . So you take the pill and it may work six or seven outta 10 times you take it, but three or four times. Out of 10 that you take the pill, it's not gonna work, so they're not a hundred percent. The misconception that you come into the office, or you find something on the computer where you can buy the medication and you get it delivered and okay, problems fixed. No, it doesn't work that way. And, I see a lot of people who come in having gone through that kind of experience and they come in and they said, I took the pills and they didn't do anything. Well, it happens.
Scott Webb: Yeah. I see what you're saying. Yeah. It's like, we all are sort of familiar with these pills. You're discussing these, sort of magic pills, but they're not really magic and they don't always work. And so it sounds to me, you know? In addition to being a urologist and a medical doctor, you have to be a little bit of a therapist as well. Maybe working with the man, working with couples, trying to diagnose, really get at the heart of things. So when we think about the treatment options or. Whether it's really a, situation where ED can really be cured. Is it more managing it, is the goal always to cure? There's a lot to unpack there and maybe you can help us do that.
Dr. David Levy: I really don't think there's gonna be a cure. So I think managing it, you kind of hit the nail on the head there. So what the problem is here is for everything to work, you have to have increased blood flow that creates pressure that shuts off valves that drain the blood out. Okay. So you have to have blood flow in, creates pressure, shuts the valves, traps the blood in there, and then you can function. And at the appropriate time, the valves open up and the blood drains out.
That's how the medication, that's how the pills work. You take the pill, or you can give yourself a shot, which is enormously effective. It's about 99%. You give yourself a shot in the side of the penis with a really tiny needle. Eight minutes later, the medication works. 99% of the guys you're ready to go. So what happens is the medication causes a dramatic increase in blood flow, which creates pressure, which shuts the valves and the blood is trapped in there.
So you get good function and then the medication wears off the valves, open up the pressure's relieved, the blood drains out and you're back to a normal state, right? So there are a number of things that have to go right for all of that to work. And when, regardless of the pills, it doesn't always work out that way. And like I said, it's about six or seven outta 10 times. You have success with the pills, with a shot it's about 99%.
So both parties kind of have to be in on this in terms of dealing with it, for the most part, when there's a relationship and this is causing issues in the relationship. So oftentimes would prefer to talk to both people on the relationship. So everybody's on the same page and there's no pointing fingers and it's my fault. It's your fault. And I think that really helps relieve a lot of the stress out of the relationship that the relationship takes on stress. It's very difficult to avoid that. So I think there's great benefit in both people and the relationship being involved with managing this.
Scott Webb: Yeah, that doesn't seem like the appropriate word, just managing it. And it's a interesting thing, medicine, so your job is to treat the thing. So in this case, we're talking about ED right? Treating that, but in treating that and diagnosing it and working with the man, working with couples, you know, you could bring back a relationship that's suffering. You could help a man or a couple with depression related to ED. It's a lot on your plate, doctor.
Dr. David Levy: That's a 100 percent accurate.
Scott Webb: Yeah. I think the end game here is to get this conversation going get men to reach out, get them to speak up, get them to see someone like yourself. So as we wrap up here, when we think about ED, what would be your final thoughts and takeaways, whether it's encouraging men to speak up or how relatively easy it can be managed, I'll leave it to you in your words. Put a period at the end of the sentence, doctor.
Dr. David Levy: Absolutely, when this kind of thing surfaces for an individual, the best thing to do is, you know, pick up the phone and make an appointment with somebody who's gonna be adept at helping you out with this because there are too many ramifications down the road that this can parlay into that can have really negative effects on relationships, going forward. And it's something that should be addressed and there are good treatment options that are very effective.
And, I think not only the benefit. In terms of physically for performance, but the benefits psychologically you can't understate what that's gonna be for people to be happy and, be at peace going forward in their relationships and in their daily life.
Scott Webb: Thanks doctor, Thanks so much for your time. You stay well.
Dr. David Levy: Thanks very much.
This episode is sponsored by, UM Charles Regional Medical Center dedicated to offering acute healthcare and preventative services to generations of families in Charles County and surrounding communities. UM Charles Regional Medical Center providing excellent care in Southern Maryland for over 80 years. And find more shows like this one at umms.org/podcast. And thank you for listening to Live Greater, a health wellness podcast brought to you by the University of Maryland Medical System. We look forward to you joining us again.
Erectile Dysfunction: Answering the Questions You’re Afraid to Ask
Scott Webb: Welcome to Live Greater a health and wellness podcast brought to you by the University of Maryland Medical System. We put knowledge and care within reach. So you have everything you need to live your life. Fullest. This podcast is sponsored by UM Charles Regional Medical Center. I'm Scott Webb and there are certain topics that men generally don't love to discuss. And one of them is definitely a erectile dysfunction. Enjoy me today to help men to know that ed is common and treatable as Dr. David Levy. He's a urologist at UM Charles Regional Medical Group, Urology. So doctor, thanks so much for your time today.
As I was thinking about our conversation, I was making a little list of the things that men generally don't love to talk about. And no matter how hard I tried ED or erectile dysfunction, just was always at the top of my list. So as we get rolling here, what is, or what causes erectile dysfunction?
Dr. David Levy: What you say is quite true. It's often time men are, reluctant to get into that, but the most common things that really impact on erectile dysfunction in our society are some of the most common. Prevalent things that we see throughout and that's high blood pressure, heart disease, diabetes. And as society has evolved over time in dietary patterns, diabesity the epidemic of diabetes and. overweight, just parlay into numerous health risk factors, but the most common things for erectile dysfunction are really, diabetes, blood pressure and, cardiovascular disease. And that really permeates throughout the population.
So we end up start seeing this, in guys, in their early fifties, we have about 29% incidents of men,, age 50 to 59 that have erectile dysfunction. And what erectile dysfunction really means is erection that is not suitable for satisfaction in terms of function. So they're varying degrees of that. You can get. Varying levels of an erection in terms of increased blood flow, with rigidity, sufficient for penetration or without rigidity. And the varying degrees of satisfaction, are different for men depending on what their needs are.
So in men, in their early fifties, again, almost about a third of the population has some form of erectile dysfunction. It may not be complete lack of function. But it may be, dissatisfaction with how well they perform. And we do see them in the office, not uncommonly. And when guys get into their 60 to 69 years age bracket, it's over 40% of patients overall across the country. It's North of 20 million men that are affected with this.
Scott Webb: You say, nearly 30%, a third. Population. And I didn't even realize that it was that high. And sounds to me like when you're treating erectile dysfunction, treating ED, really what you need to do is treat the underlying causes or underlying, risk factors. Am I hearing that right?
Dr. David Levy: So that's part of it, because it's not infrequent that someone comes in with the complaints that they're having difficulties and you can't find a reason. Why is that? Well, the guy comes in, he's healthy. Otherwise he's working a regular job. He may be anything from an engineer to a lawyer, to a construction worker doesn't matter, but they may not have any health risk factors at all. Well, why is that an issue? Because there are a multitude of things that go into. This phenomenon that creates an erection for function. You have to have increased blood flow.
You have to have the right psychological frame of mind. It has to be in the right environment. So there are numerous factors aside from diabetes or high blood pressure or heart disease in one fashion or another that impact on erectile dysfunction, psychological factors play a massive, role in this. So guys can come in perfectly healthy, normal blood tests, normal testosterone levels, no smoking history, no diabetes, but they are having significant issues.
Well, stress factors, how the kids are doing in school, what the financial situation is, what the job related stress is, what the relationship stress factors are. Any of those things can have ramifications in terms of, erectile dysfunction. So while you can put your finger on, okay, this is a cause, and this is a cause, and this is a cause, a lot of times we don't have any identifiable factor that we can actually correct in the medical office.
Scott Webb: I wanted to ask you too, along those lines, we're sort of digging down deep here to really get to some things. I'm sure there's a great deal of depression in men who are suffering from ed and maybe they put off speaking to their primary because it's a difficult subject, right? Or they, put off seeing a specialist like yourself. So maybe you can talk a little bit about that, that sometimes what we think something is, there are other ramifications, right? So there may be psychological reasons why, men are suffering from ED. And then if they are suffering from ED that may bring on some depression, maybe you can sort of tackle that for us.
Dr. David Levy: Without question that happens. And also an extension of that is the stress that can come on in a relationship from something like this, because the guy may not have any idea of what's going on, why he's having a problem. And then the partner can interpret it as it's their fault. And there's a problem with them in the relationship. And this can cause all kinds of issues. So I have always been a strong advocate that when something like this surfaces go and see the Doc and even come in as a couple to, have the discussion because it's too often that it creates a significant amount of stress in the relationship.
And sometimes that can have very negative effects on the relationship when the man really doesn't have any idea of what the issue is. Like I said, it could be a work related stress issue and when they get home, they just can. Detached from that kind of stress or something, in the home environment with, like I said, how kids are doing in school, how the kids are doing financially or any of these things can cause ramifications that can lead to these issues. So depression definitely, you see it, it can be a cofactor, in the problem.
As significant as heart disease or high blood pressure or diabetes. So all of these things can be significant factors. And the medications that we have available to us are not panaceas. I mean, the medications aren't a hundred percent Cialis, Lavetra and ,Viagra, and these oral medications that are out there and they can buy them on the internet. Sometimes you don't know what you're getting, but oftentimes you can find, The medications on the internet. So the expectation is, oh, I'll take the pill and I'm gonna be fine.
And everything's gonna work. Well, nope, it doesn't . So you take the pill and it may work six or seven outta 10 times you take it, but three or four times. Out of 10 that you take the pill, it's not gonna work, so they're not a hundred percent. The misconception that you come into the office, or you find something on the computer where you can buy the medication and you get it delivered and okay, problems fixed. No, it doesn't work that way. And, I see a lot of people who come in having gone through that kind of experience and they come in and they said, I took the pills and they didn't do anything. Well, it happens.
Scott Webb: Yeah. I see what you're saying. Yeah. It's like, we all are sort of familiar with these pills. You're discussing these, sort of magic pills, but they're not really magic and they don't always work. And so it sounds to me, you know? In addition to being a urologist and a medical doctor, you have to be a little bit of a therapist as well. Maybe working with the man, working with couples, trying to diagnose, really get at the heart of things. So when we think about the treatment options or. Whether it's really a, situation where ED can really be cured. Is it more managing it, is the goal always to cure? There's a lot to unpack there and maybe you can help us do that.
Dr. David Levy: I really don't think there's gonna be a cure. So I think managing it, you kind of hit the nail on the head there. So what the problem is here is for everything to work, you have to have increased blood flow that creates pressure that shuts off valves that drain the blood out. Okay. So you have to have blood flow in, creates pressure, shuts the valves, traps the blood in there, and then you can function. And at the appropriate time, the valves open up and the blood drains out.
That's how the medication, that's how the pills work. You take the pill, or you can give yourself a shot, which is enormously effective. It's about 99%. You give yourself a shot in the side of the penis with a really tiny needle. Eight minutes later, the medication works. 99% of the guys you're ready to go. So what happens is the medication causes a dramatic increase in blood flow, which creates pressure, which shuts the valves and the blood is trapped in there.
So you get good function and then the medication wears off the valves, open up the pressure's relieved, the blood drains out and you're back to a normal state, right? So there are a number of things that have to go right for all of that to work. And when, regardless of the pills, it doesn't always work out that way. And like I said, it's about six or seven outta 10 times. You have success with the pills, with a shot it's about 99%.
So both parties kind of have to be in on this in terms of dealing with it, for the most part, when there's a relationship and this is causing issues in the relationship. So oftentimes would prefer to talk to both people on the relationship. So everybody's on the same page and there's no pointing fingers and it's my fault. It's your fault. And I think that really helps relieve a lot of the stress out of the relationship that the relationship takes on stress. It's very difficult to avoid that. So I think there's great benefit in both people and the relationship being involved with managing this.
Scott Webb: Yeah, that doesn't seem like the appropriate word, just managing it. And it's a interesting thing, medicine, so your job is to treat the thing. So in this case, we're talking about ED right? Treating that, but in treating that and diagnosing it and working with the man, working with couples, you know, you could bring back a relationship that's suffering. You could help a man or a couple with depression related to ED. It's a lot on your plate, doctor.
Dr. David Levy: That's a 100 percent accurate.
Scott Webb: Yeah. I think the end game here is to get this conversation going get men to reach out, get them to speak up, get them to see someone like yourself. So as we wrap up here, when we think about ED, what would be your final thoughts and takeaways, whether it's encouraging men to speak up or how relatively easy it can be managed, I'll leave it to you in your words. Put a period at the end of the sentence, doctor.
Dr. David Levy: Absolutely, when this kind of thing surfaces for an individual, the best thing to do is, you know, pick up the phone and make an appointment with somebody who's gonna be adept at helping you out with this because there are too many ramifications down the road that this can parlay into that can have really negative effects on relationships, going forward. And it's something that should be addressed and there are good treatment options that are very effective.
And, I think not only the benefit. In terms of physically for performance, but the benefits psychologically you can't understate what that's gonna be for people to be happy and, be at peace going forward in their relationships and in their daily life.
Scott Webb: Thanks doctor, Thanks so much for your time. You stay well.
Dr. David Levy: Thanks very much.
This episode is sponsored by, UM Charles Regional Medical Center dedicated to offering acute healthcare and preventative services to generations of families in Charles County and surrounding communities. UM Charles Regional Medical Center providing excellent care in Southern Maryland for over 80 years. And find more shows like this one at umms.org/podcast. And thank you for listening to Live Greater, a health wellness podcast brought to you by the University of Maryland Medical System. We look forward to you joining us again.