Men\’s Health Week

In my family practice office, it is common for either partner to bring up concerns about the other\’s health. Sometimes, this includes concerns around difficulty getting or maintaining an erection. During this year\’s Men\’s Health Week, I want to bring light to a common and treatable condition called erectile dysfunction.

According to the Canadian Urological Association, erectile dysfunction is the ongoing and often inability to get or keep an erection in order to allow satisfactory sexual activity for at least 3 months (3).

In a study of 3921 Canadian men, aged 20-88, the prevalence of erectile dysfunction was 49.4%. The biggest risk factor in this study was having heart disease or diabetes. After that, being at high risk for heart disease or having high fasting blood glucose were also risk factors, as was metabolic syndrome (1).

Metabolic syndrome (MetS) is a health disorder that, left untreated, greatly increases the risk of many chronic illnesses. MetS is diagnosed when a patient has three of the following conditions:
high blood pressure, high blood glucose level, high triglycerides, low HDL-cholesterol, large waist circumference (≥ 102 cm in men, 88 cm in women; ranges vary according to ethnicity)

Many family doctors will ask about symptoms of difficulty getting or maintaining an erection at office visits, but if not, think about bringing it up at your next doctor\’s appointment.

Next, what will likely happen is I will ask many more questions to help me figure out if your symptoms are being caused by erectile dysfunction, or another urological disorder.

👉history of heart disease (stents, heart attack, prior stroke, bypass surgery)

👉risk of heart disease (high blood pressure, high cholesterol)

👉current diabetes

👉psychological factors (untreated mental health concerns, stress, low libido)

👉medications (certain high blood pressure and heart medications, anti-depressants, 

👉substances (marijuana, smoking, excess alcohol use)

👉low testosterone syndrome

👉history of spinal cord injury/surgery, previous head trauma or brain injury

Blood work will help to confirm risk factors, and diagnose low testosterone syndrome if necessary. 

Testosterone levels are best checked early in the morning, and I often repeat to confirm they are low. 

Treatment is aimed at the underlying cause (4)

✔ adjust medications 

✔ work with your medical team to help you reduce/quit smoking cigarettes and marijuana

✔ reduce your alcohol intake within guideline (max 14 standard drinks/week for males)

✔ get your cholesterol and blood pressure under control

✔ keep your weight and lifestyle healthy to reduce chance of metabolic syndrome
✔ your doctor may consider a trial of a medication [There are 3 PDE5 inhibitors currently approved in Canada: sildenafil (ViagraⓇ), vardenafil (LevitraⓇ), and tadalafil (CialisⓇ)]
✔ you may need a referral to a urologist, a doctor specializing in this disorder

Learn More:

References:

(1) Grover SA, Lowensteyn I, Kaouache M, et al. The Prevalence of Erectile Dysfunction in the Primary Care Setting: Importance of Risk Factors for Diabetes and Vascular Disease. Arch Intern Med. 2006;166(2):213–219. doi:10.1001/archinte.166.2.213 Link

(2) Metabolic Syndrome Canada (website)

(3) Canadian Urological Association Guideline 2015 Erectile Dysfunction (website link)