Erectile Dysfunction: What It Really Is And How To Treat It

erectile dysfunction that's what we're talking about today welcome to talking with docs I'm Dr Paul salzow I'm Dr Brad weaning and I'm Dr Richard Casey Dr Casey thank you very much for joining us today Dr Casey's urologist at our hospital he's also uh the CEO of a research company yes cmx check out their website um and he's here to talk about erectile dysfunction which is an important topic to talk about because you know it's something that people might feel uncomfortable about you might not bring it up to your doctor and it's pretty prevalent too about

50 of all men over the age of 60 have Ed five zero five zero wow okay so okay so erectile dysfunction so someone's having symptoms what are going to be the symptoms how do we Define exactly what erectile dysfunction is well erectile dysfunction is the inability to obtain or maintain an erection sufficient for sexual activity okay okay and most most of the patients come in with some difficulty on that gradient either they have difficult be getting an erection at all or they lose interaction while they're having sex with their partner okay so there's your main

symptoms obtaining and maintaining yeah right that's the symptom so if you're worried about it it's okay to talk about it with your physician yeah I mean it's very common it happens well fifty percent of men over 50 have difficulties men of all ages will have difficulties and in general about one in five or six times most men will have an episode where they're having some difficulty or isn't as good as they remember sure okay so someone has these symptoms they go to their family doctor is the family doctor gonna talk to them and treat them

are they gonna send them on to someone that's expert like you it depends on it depends on your family doctor a lot of men uh equate testosterone with Ed and the two are rarely related right but so they go to the family doctor the family doctor will check their drug history but uh most of the time family doctors certainly in Canada will refer patients to health care specialist who has an interest in Ed okay okay so here you are you get refer to Patient comes in we've talked about the symptoms that they have the inability

to obtain and maintain the erection and now what happens when they come in well we you get a proper sexual history you want to know what his sex life was before he had difficulties does he have a partner uh what does his partner say about it because you know the the best person to talk about if a guy is having sexual issues is to talk to his partner because his partner experiences it and often knows a lot about what might might be causing it in uh then you than you'd think you're pointing at me there

then Brad we're Partners in the office I just wanted to clarify I make no assumptions yeah yeah yeah yeah so uh so you get a good sexual history and um then you look at the drug history are they taking medications the big one is antidepressants right I mean I think there's antidepressants in the drinking water in this town but uh a lot of men are on it and that they have significant issues with Ed from antidepressants and you look at the usually the cardiac history are they are they extensive they had angina or they're being

treated for heart disease these things are helpful that they're going to help us direct therapy so we want to get a clear idea but again there's always a big psychogenic or psychological component because imagine if you've had difficulty getting an erection for whatever reason the next time you approach your partner you're going to be anxious and nervous okay so I was uh reading not for self-diagnosis but for preparation for this video well I mean judging by your 50 uh over 50 years one two three one of us and I was reading that Edie is a

risk factor associated with things like cardiovascular disease cerebral even mortality about 50 of guys who present the emergency room was a cardiac event will have developed Ed within two years prior to that event so what I tell young men and often we see guys when I say young young men are 50 years old 50 to 60. thank you very much thank you welcome if they present to the family doctor with Ed that their doctors should think of their cardiac risk factors and evaluate them appropriately see that alone is something that should make you think that

this is something that should be talked about more if it does have association with things that can affect your lifespan and the reason that he's saying that is because the blood vessels that feed your heart lead to a heart attack or a stroke are the same types of vessels that feed your penis the penis is a little bit smaller uh the the sorry not the penis but the penile vessels are a little bit smaller so it tends to be about a couple years before that right so it's an earlier warning sign yeah we we like

to think of the good good point the penis is an early warning system for the heart okay or a general barometer for your health take a think about it if I had to ask a patient one question to find out what their General Health was like without knowing anything else about them I said what's your sex life like if they have a good sex life then we know emotionally they're probably intact because they're able to have sex with someone yeah and their vascular system is in good shape because they're getting good erections that are able

to perform that their exercise tolerance is probably okay okay so penis is a warning system for the heart exactly we mean that physiologically not romantically as some people might think okay okay so now someone's in your office and what's the what's the discussion well the discussion is you do a cursory examination you see because some some men will have abnormalities of their penis Peyronie's disease which is a fairly common condition where they get penile angulation usually that comes up in the history so after cursory examination the discussion is um you know can we change your

lifestyle now to help you but I'm not going to make a patient wait for three years and start exercising and drop 20 pounds and stop smoking before we treat them so generally if their interest in sex is good we would go to a What's called the pd5 inhibitor something like Viagra or Cialis or Levitra so drug therapy is fairly quick with these patients okay and now so just quickly back to the lifestyle I think the important when you talk about is smoking so smoking is a direct cause of erectile dysfunction 100 right now I I

when when I first started practice and everybody was smoking Edie was was much more difficult to treat because these patients had significant vascular disease now we see less patients smoking but a lot of people are closet smokers sure so I I tell them biohazard I tell them to stop stop smoking and yeah um you know unfortunately as we all know most men won't stop smoking so we have to work around it okay Bob don't give up don't get marble channels based on life okay so you talked about these medications so you've now made the diagnosis

you talk to them about the treatment so how does treatment work is it is it a pill is it an injection the treatment is the the main stamp treatment or the What's called the pde5 Inhibitors that's an enzyme that these drug Inhibitors inhibits that allow the body to make more nitric oxide and nitric oxide is the vasodilator of our of our system but the the conversation usually goes I'm going to give you a prescription for some medications and what do you think the first question the guy asks me when do I take it yeah what

do you think what are the side effects how much does it cost and I and I usually say to them would you go home and ask your partner and tell your partner that that's the first question you asked me about this sure I tell them what's more expensive than uh not paying for Viagra I mean uh men are very cost conscious and uh probably one in five guys will not take the drug because the eight dollars a pill eight dollars okay so in Canada approximately eight dollars cheaper than a movie yeah and then when we

take it are you taking it are you taking it every day are you taking it how does it work so generally you take it in anticipation of sexual activity and that that that's different depending on what age you are most men who have been married for say 10 or 15 years know exactly when they're going to be sexual or they have a good idea you know and so I said take it when you know if it's within two or three hours take it immediately okay don't try to time it just before and again back to

the cost issue men are concerned they might take a pill and not get to use it and they've wasted eight bucks but that's that's life so you take it in anticipation of sexual activity usually on an empty stomach but it doesn't make a big difference okay and you can take it uh every day you can take it to once a week it works the same way whether you take it okay now Cialis which is another one of the drugs like Viagra has a longer Half-Life so it stays in your system longer so that's usually for

the younger patient who may be either more sexual and maybe it's anticipating sex on Friday night and then Saturday afternoon remember those days and so they would they would take it and there's some flexibility with it and the third way you can take a daily dose of a low dose of Silas like a blood pressure pill you take it every day right and I like that for diabetic men or men who have significant vascular disease because you get better erections when you're sleeping so it helps maintain the blood flow of the penis and heal some

of the vascular damage that it's occurred over the 30 or 40 years okay and on the eight bucks uphill eight dollars a pill don't focus on that price it's probably different depending on where you live but it just suffice to say the point is there's a cost associated with the medication and there's a big cost associated with not taking them okay of course okay so now guaranteed if if you have experience with these kinds of medications please leave some comments down below because guaranteed someone's going to ask if I take it am I going to

get an erection like what if I take it and then I'm go I have to go out now gotta go get groceries now am I going to get an erection no you might depending on what what aisle you're in in the grocery store but but no it doesn't you anyway especially in the vegetable aisle this guy is a plant-based right when I'm back at the meet somewhere okay but no the kale away all it does is enhance the body's natural response so you don't get unwanted erections okay you rarely I've never seen a man with

a prolonged direction from one of these pills so they're safe and they don't change your behavior and you really don't feel much different when you take it okay A little tidbit and the history of that medication was originally like a blood pressure medication or something wasn't it yeah the story goes is that they were doing a phase one study with these classic drugs and they were giving male volunteers injections and when the nurse gave the injections and then were laying on their back and when she came back to check their blood pressures they were all

laying on their stomach okay and she noticed that they were getting great erections and is that is that just right I don't know but it may it sounds like a fun and it seems like it would help the heart is there any evidence to say that there is 100 it's used for pulmonary hypertension in kids right and and it is a general vasodilator so and I I think they initially would were developing it as an anti-anginal agent okay right okay that's a little fun fact for you about the movie so but but these pills don't

work on everybody about 70 of men that we see with Ed will respond to these pills okay um you have to uh help help them with their expectations because one of the reasons for failure is they think I'm going to take it and have a great erection long life's going to be great again right and that's not often the case so once you set their expectations that it's going to work most of the time they need to be relaxed they need to try it a few times um and most of the time it will work

but if it doesn't there are other options for the okay okay other options let's go so this isn't working okay so you've tried that substitute of your first line lifestyle lifestyle modification of course in conjunction with pharmacotherapy with other ones any side effects anything any downs we always talk about medications and their side effects you tend to get stuff uh because again because it's the facial dilator you get a stuffy nasal passage okay you can get a bit of uh flesh in your face headaches headaches and you get the feeling that your heart is pounding

usually those side effects go away and they're not dangerous okay important okay so now I don't want a bit of indigestion sometimes okay all right so you've tried that you've tried the medication either you had a side effects or you could no longer take it or it just didn't work you're one of those 30 where it didn't work for you the next line of treatment next line next line tree there are injectables that you can use they're vasodilators again and you prostaglandin phentolamine these are blood pressure medications that are used in the ICU in in

the appropriate dose that we have pharmacies mix up for us you can inject the dose in the side of the penis and get a great erection for 45 minutes all right all right so we've got it's still chronic pharmacotherapy it's an oracle injectable yeah pharmacotherapy then they're injected right into the peanuts right in the side of the penis I've never met anyone say that's a great idea let me do this but I can tell you when one once men do it and it works it's great because they get a a good erection most of the

time they last for 45 minutes I don't know what they need 45 minutes for but the last one yeah okay so all right you know what you got to do yeah and there's a there's a bunch of different doses available so usually we can find a dose that fits with the patient but again a smaller percentage of those guys it will not work and you have to move on to more aggressive therapy okay quick question about it what about the people that have erectile dysfunction secondary to like prostate surgery or Consequences of having Advanced prostate

pathology is this something that is an option for them or not really because it's so different no no it's most men who have Ed secondary to pelvic surgery or cancer surgery or radiation it's a neurologic issue because the nerves are damaged from the surgery about half of them will respond to the oral agent so that's not a complete loss and it really depends on how active they were before sure if they if they had a good vigorous sex life before they're going to have a good figure of sex life after okay but this is an

important group and I see a lot of these patients and you can imagine a man has prostate surgery he's now has erectile dysfunction usually they're incontinent at the same time okay so he becomes a bit of a Hermit he withdraws from his friends he withdraws from his partner sure and I often get the um speaking of support groups I have the female Partners come by and say you know what do you have for me because I am living with a guy who doesn't touch me any longer so it's a problem but these injections work really

well okay for men who have cancer surgery and have Ed that's probably a fracture too which is an overlap with our pelvic practicing can lead to it as well sure can okay so you've got the pharmacotherapy the lifestyle pharmacotherapy both oral injectable and got anything else if that doesn't work if someone does not want them so there are external devices that the vacuum pumps and essentially it's a cylinder that you put over your penis and you draw venous blood into the penis and put a ring on the base of it it sounds grotesque when when

a young man hears it but older men um like it and it can produce a an erection sufficient for sexual activity and so vacuumed Powers but if you if you search the web most of these devices are wink wink trying to tell you that it's going to make your penis longer and it really doesn't do that it will give you an erection and then imagine if you're 85 years old you just want the erection up to as a sign that you're interested not really uh use it but vacuum pumps or flag like a flag hey

I'm ready okay yeah and and then there are penile implants which is a surgical solution okay that are good for all ages depending on their pathology okay and obviously with the inherent risks of and benefits of any surgical procedure yeah I mean the problem with penile implants are they they give you a good erection but most men are not as happy with it as they expect because they they imagine their penis always being a bit bigger always being a bit wider um and and so while we do a lot of implants the satisfaction rate is

not nearly 100 okay oh boy okay so there you have it erectile dysfunction hopefully we've normalized it to a certain degree that you feel more comfortable talking about it if you're suffering from it if you're over 50 or 60 there's a 50 chance you are talked about lifestyle tropical therapy both oral and injectable devices and surgical implantation what more do you want from us I don't know so that's all we got I think it's it's plenty that is not as plenty that's an amazing summary thank you Dr Casey for educating us and if you guys

like this video please like it subscribe to our Channel leave some comments about your experience down below it's funny that this video is way more longer than our like blood pressure or other life-threatening conditions because it's more important that's why coming from a urologist thank you very much thanks for everything you do and remember you are in charge of your own health