Erectile Dysfunction (ED)

When a man is sexually aroused, the arteries relax to let more blood flow into the penis while veins close up. Blood flowing to the penis gets trapped in a part called the corpora cavernosa. The trapped blood expands the penis and keeps it erect. The entire erection process that involves increased inflow of blood and decreased outflow is due to relaxation of smooth muscle tissues in the penile arteries (arterial smooth muscle) and the body of penis (trabecular smooth muscle). Once blood stops flowing in, with relaxation of the smooth muscle tissues the veins open again and the penis gets soft.

Symptoms may include: difficulty getting an erection; difficulty keeping an erection; less interest in sex (lower libido); and often, associated early (premature) ejaculation.

Physical and psychological issues can cause ED or a combination of both. Physical causes include: heart disease, atherosclerosis, high blood pressure, high cholesterol, type 2 diabetes, obesity, metabolic syndrome, Parkinson’s disease, and multiple sclerosis. Alcoholism, substance abuse, and sleep disorders can also cause ED, along with treatments for enlarged prostate and prostate cancer. Psychological causes include: depression, anxiety, other mental health issues, stress, and relationship issues. Some medications, such as certain antidepressants or antihypertensives, can cause ED.

ED may indicate underlying health issues such as cardiovascular disease, high blood pressure, or type 2 diabetes. At The Billups Center, we often detect early or undiagnosed diabetes, hypertension, and elevated cholesterol. If we learn a patient may have any of these conditions, we’ll refer him to the right specialist and stay in close contact with his specialist.

Risk factors include: type 2 diabetes, heart disease, obesity, long-term tobacco use that restricts blood flow, heavy alcohol or drug use, obesity, prostate surgery, radiation treatment for cancer, prostate issues, injuries to the nerves or arteries to the penis, certain antidepressants, antihistamines, blood pressure medications, pain medications, stress, anxiety, and depression. Long term bicycling can also cause ED temporarily or permanently and is of special concern, if there is associated numbness of the penis, perineum or scrotum.

As the causes of ED can be both physical and psychological, at The Billups Center, we look at all the factors that can impact ED when diagnosing a patient. We consider his medical and sexual histories, family health history, weight issues, nutritional habits, exercise level, alcohol and tobacco use, medications and supplements he’s taking. We perform a physical exam, run appropriate blood, urinary, and other relevant tests, such as Penile Doppler Ultrasound, when indicated. We help our patient get comfortable speaking frankly about his sex life so we can learn if stress, depression or anxiety is affecting him. As ED can also indicate underlying causes such as type 2 diabetes or heart disease, we are always ready to refer patients to the right specialists.

At The Billups Center, we take a big-picture view of treating ED and take great pride in a high rate of success for most of our patients. We work with each patient to put together the best treatment plan for him, including steps he can take to improve nutrition, weight control, and exercise. We consider his age, lifestyle, and possible drug-to-drug interactions. While pills to stimulate blood flow are viable for some patients, they may not be right for up to 50% of them. Treatment may also include injections of a vasodilator directly into the penile corporal body or use of an intraurethral suppository vasodilator. Both of these methods stimulate an erection by relaxing the penile smooth muscle tissues and subsequently increasing the inflow of blood, while decreasing the outflow. An external penis pump used with a constriction band, known as a vacuum suction device, is a mechanical option that may be right for some patients. Penile implant surgery is an excellent treatment option for the appropriate patient, after a comprehensive evaluation, education, and adequate trial of other medical therapies. For psychological concerns (chronic stress or anxiety) or relationship issues, we refer our patients to a qualified therapist or counselor with an interest in Sexual Medicine as part of his/her practice. For depression, we refer our patients to a psychiatrist who is familiar with impact of depressive illness on sexual health.

Yes. Nutrition and exercise impact conditions that affect ED, such as obesity, type 2 diabetes, high blood pressure, and cholesterol levels. Good nutrition and appropriate exercise can also have a positive impact on a man’s overall health and energy level, along with his self- confidence. We believe that poor or inadequate nutrition is a common root cause of many chronic medical conditions and plays a definite role in the development of ED.