Erectile Dysfunction and the Other “Bones” That Are Important

I would like men to think of erectile dysfunction as a harbinger of other chronic diseases like heart disease, diabetes, kidney failure, high blood pressure, elevated cholesterol levels and also bone disease or osteoporosis.

A recent study from Taiwan 4,460 men aged 40 years and older diagnosed with erectile dysfunction from 1996 to 2010 with 17,480 randomly selected age-matched patients without ED.  The research found that osteoporosis developed in nearly 6% with ED and 3.65% in men without ED.  Men who had ED had a 3 times more likelihood of developing osteoporosis when compared with men who did not have ED.

Osteoporosis is a metabolic bone disease in which the bones become brittle and porous escalating the rate of bone loss and increasing the chance of a fracture of the hips and spine.

The researchers think that the men with ED had a lower level of testosterone which is necessary for bone strength and development.  Another explanation offered by the authors is that chronic, low grade inflammation can damage the lining of the blood vessels and perhaps lead to a decrease in the blood supply to the penis which is necessary for an erection to occur.  The same inflammation can also cause the bones to fail in calcium rebuilding of bone and thus lead to osteoporosis.

Finally, there is the theory that there is alternation of the vitamin D with decreased levels in men with ED.  With less vitamin D there is a risk of alternations in the lining of the blood vessels especially those that supply the penis and lead to ED.  Decrease in vitamin D also alters bone metabolism and may result in osteoporosis.

Bottom Line: Men with ED should be check for the co-morbid conditions such as heart disease, diabetes, high blood pressure, hormone deficiency and also have tests to be certain that men do not have osteoporosis.

Statins, Cholesterol and Erectile Dysfunction

Statins are a group of medicines that can help lower the level of cholesterol in the blood.  Having a high level of cholesterol is potentially dangerous, as it can lead to a hardening and narrowing of the arteries (atherosclerosis) and cardiovascular disease (CVD) such as coronary heart disease, chest pain, heart attacks,  strokes, and even erectile dysfunction\impotence.  Cholesterol that narrows the blood vessels can decrease the blood flow to the penis thus making it difficult to achieve and maintain an erection adequate for sexual intimacy.

Before taking statins, every man or woman should give strong consideration to lifestyle changes such as losing weight, exercising regularly, limiting alcohol consumption, and consider smoking cessation.  All of these actions can decrease the cholesterol levels.  All of these lifestyle changes can also improve sexual function.

Bottom Line:  Elevated cholesterol levels are deleterious to your health.  Consider lifestyle changes before starting statins.  Your erections and your partner will thank you!

ED SOLUTION AU NATRIEL

Erectile dysfunction affects over 30 million American men.  Most of the men are looking for a solution, perhaps a pill to solve their problem.  Viagra, Levitra, and Cialis do work.  However, they are very expensive and not available in the generic format at this time.  So let’s look at other options, even natural supplements that may be effective.

 Ginseng

While a study published in the Journal of Urology found that men taking Korean red ginseng saw significantly improved erections compared to their placebo-popping counterparts, the American Urological Association Clinical Guidelines Panel feels this trial group of 45 men is too small to validate its clinical efficacy. In addition, Korean red ginseng can cause added health issues for men who have heart disease, mood disorders, or immune system disorders.

L-arginine

Taking a supplement of this amino acid can help increase blood flow both to the penis and the heart, While there’s no medical guarantee it will work like Viagra, Levitra, or Cialis, L-arginine is known to increase levels of nitric oxide, a gas that relaxes muscles and increases blood flow, and is involved in maintaining an erection.

Zinc Supplements

Zinc supplements are not shown to help, but a healthy lifestyle with an excellent diet — anything good for the heart — will be good for the penis. Perhaps the best advice is to lose weight, to exercise, and to stop smoking.

Acupuncture, Hypnosis, and Yoga

Anything that helps reduce stress and improves awareness of your body or calms you down is worth trying.  For some people, acupuncture can help in situations where stress, anxiety, or injury is the cause of ED.

Horny Goat Weed

Pills, powders, and teas are made from an extract of this plant, also called Epimedium, which has long been used in traditional Chinese medicine. Some animal-based studies show that it may increase nitric oxide, which is involved in maintaining an erection, but there is no conclusive scientific evidence that it has benefits in humans.

Pomegranate juice

Antioxidants in berries help nitric oxide last longer in the bloodstream, which is where the pomegranate myth began. However, there is no scientific proof that drinking this antioxidant-rich juice can actually help with erections.

Bottom Line:  I wish I could report that these supplements are the Holy Grail and can help men restore their erections so that they will be able to successfully engage in in sexual intimacy with their partners.  However, the jury is out; and although these options are not likely to be harmful they probably won’t solve most men’s erectile dysfunction.

Your Bike May Cause Your Erections To Take a Hike

There are many cause of impotence or ED but one of the most common in younger men is bike riding. This blog will discuss the relationship of bike riding to ED and what can be done to prevent problems with bikers erections.

Bicycle seat neuropathy is one of the more common injuries reported by cyclists. The injuries and symptoms are due to the cyclist supporting his or her body weight on a narrow seat, and they are believed to be related to either vascular and\or neurologic injury to the pudendal nerve.

A wide frequency range has been reported for bicycle seat neuropathy, but it is believed to be underreported.

 A study of cyclists who ride for long period of time noted that 22% reported symptoms of either numbness or pain in the pudendal area. 21% reported penile numbness, with 6% cyclists reporting symptoms that lasted longer than 1 week. In addition, 13% reported symptoms of impotence, some men having experienced symptoms for longer than 1 week, and a smaller number reported impotence lasting longer than 1 month.

The cause of bicycle seat neuropathy has been attributed to several different events. One study hypothesized that compression of the pudendal nerve as it passes through the Alcock canal causes the condition. The Alcock canal is enclosed laterally by the ischial bone and medially by the fascial layer of the obturator internus muscle. The pudendal nerve exits the canal ventrally, below the symphysis pubis, and innervates the penis and perineal regions.

Long-distance cycling results in the indirect transmission of pressure onto the perineal nerve within the Alcock canal. Bicycle seat neuropathy is due to temporary and transient injury to the dorsal branch of the pudendal nerve secondary to compression of the nerve between the bicycle seat and the symphysis pubis.

Bicycle seat design (eg, shape) may be the major extrinsic factor for the development of bicycle seat neuropathy. Results of computer modeling showed that wider bicycle seats that support the ischial tuberosities or sit bones decrease pressure on the perineal area. Other studies have also demonstrated the effect bicycle seat design has on penile blood flow.

A recreational or elite cyclist who complains of numbness or impotence after cycling is the typical presentation of bicycle seat neuropathy. The amount of time the athlete spent cycling before the onset of symptoms is variable; however, studies have focused upon longer distance, multiday rides. Use of a stationary bicycle has also been reported as a cause of bicycle seat neuropathy.

Medical issues and complications include continued injury or insult to the area, resulting in continuation of the neuropathy and long-term sequelae such as impotence. Reevaluate the patient after making changes to the bicycle or riding style or after decreasing the training volume to ensure that improvement in symptoms is occurring. Continued symptoms despite changes in the bicycle seat position and training volume may indicate a different source of the symptoms and should warrant reevaluation by the physician.

The mainstay of treatment of bicycle seat neuropathy is the adjustment of the bike seat and bike position, such as tilting the nose of the seat down or lowering the seat height to relieve pressure off the perineum. Other recommendations include having the rider change the style of riding (eg, change positions more frequently or stop riding more frequently).

Newer bicycle seats with a split nose or a center cutout may also help to reduce the prevalence of neuropathy by limiting compression on the perineal area (see below). Some of the newer seats reduced perineal pressure by approximately 50%.

Bottom Line: Bike riding is a very popular form of exercise and recreation. However, long rides can affect a man’s potency and increase the risk of ED. I suggest that if you experience numbness after a long bike ride that you check your seat and speak to someone at the bike shop about a new seat that takes the pressure off of your sit bones so there is less compression of your nerves and blood supply to the penis.

What Women Need To Know About Their Partner’s Health

Women are drives of healthcare. They are responsible for helping to see that their partners take good care of themselves. My wife makes an appointment for my annual physical exam each year and accompanies me to the doctor to be sure that I explain all of my concerns and that she has the instructions for the recommendations and follow up. I don’t think my situation is unique as most women not take care of themselves but also the healthcare of their partner. This article will discuss 5 conditions that can impact a man’s health and should come to the attention of a physician\urologist.

Erectile dysfunction is often a sign of something more serious. About 70% of ED cases are caused by existing medical conditions, such as high blood pressure, diabetes, high cholesterol or heart disease. The more advanced these diseases are, the more at risk a man is for ED. In most cases, ED is treatable. If you loved one has ED, encourage him seek medical care.

Prostate cancer is the second most common cancer in men. About 1 in 7 men will be diagnosed with prostate cancer. The number jumps to 1 in 5 if he’s African-American and 1 in 3 if he has a family history of prostate cancer. Men should know their risk and talk to their doctors about whether prostate cancer screening is right for them.

Male infertility is more common than you think. In about 40% of infertile couples, the male partner is either the sole cause or a contributing cause of infertility.

If he has blood in his urine, pay attention. This can be a sign of a urinary tract infection, kidney stone, enlarged prostate or an early sign of bladder or kidney cancer. All men who have blood in the urine should see their doctor\urologist.

Testicular cancer is the most common cancer in men ages 15-35. Although there is nothing to prevent testicular cancer, if the cancer is caught early, there is a high cure rate. Signs of testicular cancer include persistent pain or a bump in the testicular area.

Finally, if they are going to the bathroom more than three times each night, they should be seen by a doctor. This could be a sign of a prostate or bladder problem, or potentially something more serious.

Bottom Line: Men have unique medical problems and women can be so helpful in directing men to a healthcare provider. I hope this article should be kept in mind regarding your male loved one’s medical health.

Want to Avoid ED Erectile Dysfunction? Get Off the Couch!

A number of studies have suggested that physically active men have lower rates of erectile dysfunction than couch potatoes,

A new study published by the Journal of Sexual Medicine (J Sex Med 2015;12:1862–1864) checked those results by measuring how much their subjects actually moved.

692 men between the ages of 50 and 85 were fitted out with motion trackers, like a FitBit, for up to a week and asked to report, among other data, their erectile function over that time period.

The study found a strong correlation between the time men spent moving and erectile function: for every additional 30 min each day the men spent in moderate-to-vigorous physical activity, their odds of developing erectile dysfunction dropped 43 percent.

Bottom Line on preventing ED: Two words-GET MOVING.

WHAT’S KEEPING YOU AND YOUR ERECTIONS DOWN?

Millions of American men suffer from ED or erectile dysfunction. For young men having difficulty achieving an erection, here are some common causes:
Stress : Among men in their teens, 20s and 30s, most cases of ED are linked to psychological issues. Anxiety and stress are a major factors especially if these are factors right before sex. Many young men who are inexperienced feel pressure to perform the best sexually and also have concerns about size. This stress can lead to performance anxiety. This buildup of stress can cause an influx of adrenaline or epinephrine which can inhibit an erection.
Too much bike riding : Now, just to be clear, if you’re an avid biker, it doesn’t mean you’re going to develop ED. But if you experience numbness as you ride within the first few miles or after biking marathons you may be causing long-term damage. Below the prostate (and what directly rests on the bicycle seat) are the nerves responsible for bringing blood the penis, which is what happens during an erection. Try getting fitted for a better seat if you’re experiencing this.
Medicines : Cold medications like Sudafed contain pseudoephedrine, which acts as epinephrine in the body and decreases the ability to achieve an erection. It increases your body’s natural fight or flight reaction and makes your body think you’re scared of something. The effects of the drug aren’t permanent.
Partying : Drinking and recreational drug use may also serve as a proponent of ED. Alcohol is a depressant and relaxes you but can cause the inability to perform. Cocaine for example, will lower your testosterone levels.
Cancer treatments : If young men have been diagnosed with testicular cancer or another cancer and are being treated with chemotherapy and radiation may lower testosterone levels which affect blood flow to the penis. Radiation can also directly damage the lining of the blood vessels or cause nerve damage.
Diabetes and high blood pressure are other causes of ED because diabetes impacts the body’s ability to produce nitric oxide. Another major factor is being obese or overweight. Anything that’s bad for your heart is bad for your penis. Blood vessels are tiny in the penis and if they’re clogged the blood won’t flow there. Eating right and exercising makes everything work better.

1. STOP SMOKING

Heart problems aren’t the only issue keeping men down. Erectile dysfunction is commonly caused by stress, medications, partying, cancer treatments, or even bike riding.

Smoking can cause blood vessels to narrow, which can have a detrimental effect on blood flow to sex organs. Similarly, smoking diminishes your stamina, limiting the amount of rigorous activity one can handle – which unfortunately can leave your partner wanting more.
2. WORK IT OUT
Notwithstanding my earlier comments about biking, moderate regular exercise has been shown to help improve blood flow to the sexual organs. Exercises focused on thighs, buttocks and pelvis are especially good for genital circulation. In addition, exercise boosts self-image and confidence. Anything that improves self-esteem will in turn improve libido.
3. LOSE WEIGHT
Study out of Duke, found that up to 30% of obese people seeking help controlling their weight indicate problems with sex drive, desire, performance, or all three. This is because being overweight can reduce blood flow and lower testosterone levels. High cholesterol as well as type 2 diabetes, both associated with being overweight, impact sexual performance. Both can cause penile arteries to shut down when arteries get clogged with fat deposits. Erectile dysfunction leads to decreased sexual desire and libido.
4. GINGKO BILOBA
Herbal remedies like tea or supplements derived from ginkgo biloba can have a positive effect on sexual desire and even orgasm. This age-old remedy is known to improve circulation, yet again enhancing sex.
5. TRY SOME LIBIDO-BOOSTING FOODS
Certain foods, like those high in zinc (think oysters!) can increase sperm production and testosterone- the hormone in men responsible for sex drive. Also, foods high in essential fatty acids like flaxseeds, sardines, and nuts help to increase testosterone production and increase libido.

This article was written by Dr. Samadi a board-certified urologic oncologist trained in open and traditional and laparoscopic surgery, and an expert in robotic prostate surgery in New York City.

ED May Be A Warning Sign For Heart Disease

The penis is a dangling stress test and may be a predictor of impending heart disease.

Most men would never make the connection between their penis and heart — but it exists. Men should think of their penis as a thermometer for the heart. When the arteries in one part of your body are clogged, you can expect arteries to be filling up with sticky cholesterol-like plaque in other parts of the body as well.

Heart doctors have long understood this concept, routinely ultra-sounding the arteries of the neck (carotids) to provide a barometer for the tiny arteries (coronaries) that supply the heart.

Now, a new study provides evidence that the penis is another crucial barometer of arterial disease. The study, published in the August 2015 issue of the Journal of Sexual Medicine, reveals that men with erectile dysfunction and depression are much more likely to go on to develop heart disease than those without ED.

A team of Italian researchers screened 1687 patients with erectile dysfunction and found that men with ED who were also depressed were much more likely to have a heart attack or angina. ED is clearly an alert to larger emotional and physical problems including heart disease.

Here’s the explanation of the penis-heart connection: The arteries that supply the penis are only able to provide a strong sustained erection when they are working perfectly. So ED is often an indication that something is wrong with your arteries, and since the arteries of the penis are smaller than the arteries of the heart (coronary arteries), they tend to get clogged earlier. ED usually occurs before heart disease occurs. The penis is a likely barometer, a canary in the coal mine, for impending problems in the coronary arteries.

Of course, ED can be caused by many different things, including low testosterone, medication side effects, and depression alone. Not all patients with ED have arterial problems or will go on to have problems with their hearts. But a significant number will. We recommend all men who begin having problems getting erections to see their doctor for a thorough total body examination. And the concept of formally screening men for heart disease on the basis of ED should be investigated further.

An ideal study would separate men into two groups; one with erectile dysfunction, and one without. Each group would be followed to see which men went on to develop heart problems and which didn’t. In the meantime, there is every reason to consider ED as a warning sign for heart disease and a window into problems in a man’s total health.
Impotence, aka erectile dysfunction, is not often the easiest topic to discuss but it affects more men than we likely realize. As many as 50 million men in the US and Europe suffer from impotence, or erectile dysfunction. Statistically, this number includes only about 5% of men less than 40 years old and up to 25% of men by the time they reach 65 years of age. By definition, impotence is the inability to get or keep an erection firm enough for sexual intercourse.
Erectile dysfunction is almost always referred to as an older man’s disease, but this just isn’t the case. About 26% of men under the age of 40 are affected by ED according to a study published in the Journal of Sexual Medicine.

Bottom Line: One could guess that impotence at a young age could be the first sign of a potential heart attack later in life. So if you have difficulty with obtaining or maintaining an erection, speak to your doctor and consider getting a comprehensive examination including a thorough heart examination.

ED, Viagra and Melanoma-The Jury Is Still Out

Viagra remains one of the most popular drugs for treating erectile dysfunction or ED. The drug is quite safe and has been used by millions of men world wide. Recently there was a report of a relationship between Viagra and the potentially lethal skin condition, melanoma.

A potential link between erectile dysfunction drugs and melanoma may exist, but inconsistencies in the data make a cause-and-effect relationship questionable.
Men who had a history of using phosphodiesterase type 5 (PDE5) inhibitors (Viagra, Levitra, or Cialis) had a 20% greater risk of melanoma as compared with men who never used the drugs. However, the strongest association involved men who filled a single prescription for a PDE5 inhibitor. Total number of prescriptions filled did not significantly affect melanoma risk.
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Moreover, the PDE5 inhibitor-melanoma association pertained only to early-stage disease (stage 0-I), did not differ by type of PDE5 inhibitor, and was not limited to melanoma, as an increased risk of basal cell carcinoma was seen among users of PDE5 inhibitors. This was reported online in The Journal of the American Medical Association.

The findings are consistent with those of a similar study reported a year ago. However, the previous study was based on data that showed only whether a man had ever used a PDE5 inhibitor. Extracted from the Health Professionals Follow-up Study, the data were limited to the original PDE5 inhibitor, sildenafil (Viagra), and lacked details about use of the drug, such as the number of prescriptions filled.

The study was not able to prove cause and effect relationship. A longer follow-up and more detailed assessment of the dose and frequency of Viagra use at multiple times in the would be necessary for future studies.

In theory, a causal association between PDE5 inhibitor use and melanoma has biologic plausibility. Several studies have provided evidence of interaction between PDE5 and melanoma.

A Swedish study of the 435 men who used PDE5 inhibitors and developed melanoma, 275 had filled one or more prescriptions for sildenafil and 224 had filled at least one prescription for Levitra or Cialis.

Overall, men who used PDE5 inhibitors had a slight increase for melanoma versus nonusers. The risk of melanoma did not differ significantly across the three types of ED drugs.

Bottom Line: What’s my advice. Whether you use Viagra, Levitra, or Cialis, or not, I suggest you make use of plenty of sun screen. Nothing less than a SPF of 35. Also, if you are at risk for melanoma, i.e., are light completed, have frequent exposure to sun, then see a dermatologist at least once a year for a total body examination.

 

Male Health Month

June is Male health. Here are 10 health concerns for men:

1. Prostate cancer. Approximately 30,000 men die of prostate cancer each ear. All meds should undergo a baseline prostate specific antigen blood test at age 40. Men with a family history of prostate cancer, African American men, and veterans exposed to agent orange are at high risk. These men should consider getting screening each year beginning at age 40.

2. Benign enlargement of the prostate is also a concern for men after the age of 50. 50% of them between the ages of 50 and 60 will develop enlargement of the prostate which is a benign disease but affects a man’s quality of life.

3. Erectile dysfunction. Failure to achieve and maintain an erection can be caused by heart disease, diabetes, certain medications, lifestyle, or other problems. Effective drugs are available for treating this common condition that affects over 30 million American men.

4. Cardiovascular disease. Heart disease and stroke are often associated with high cholesterol and high blood pressure. Both can usually be controlled with diet and exercise, sometimes combined with medication.

5. Testicular cancer. Testicular cancer is the most common form of cancer in men between the ages of 20-35 and in most cases can be cured.

6. Diabetes. Men with diabetes or more likely to suffer from heart disease, stroke, kidney disease, vision problems and erectile dysfunction.

7. Skin cancer. Anyone who spends a lot of time in the sun is at risk for skin cancer.

8. Low testosterone. As men age, their testosterone decreases. This can called Andropause, a condition similar to menopause in women.

9. Colorectal cancer. Cancer of the colon and rectum can usually be treated if caught early.

10. Depression. Men are less likely than women to seek help for depression and are 4 times more likely to commit suicide. Help can take the form of medication, counseling, or a combination of both.

I know in New Orleans we have the attitude that “if ain’t broke don’t fix it”. That may apply to your car but not to your body. Take good care of yourself and see your doctor once a year for fine-tuning your health and wellness.