Roanoke Times
Copyright (c) 1995, Landmark Communications, Inc.
DATE: TUESDAY, August 8, 1995 TAG: 9508080083
SECTION: EXTRA PAGE: 6 EDITION: METRO
SOURCE: JANE BRODY
DATELINE: LENGTH: Long
Today nearly every man who is interested in having his sexual potency restored can be helped. Yet only about 5 million of the more than 30 million men with serious erectile problems have sought professional help.
Few men are willing to discuss problems of impotence, even with their sexual partners. To reduce the perceived stigma and embarrassment of impotence and encourage more men to seek treatment, urologists now refer to the condition as erectile dysfunction.
The problem is far more common than most men realize. According to the findings of one recent study of 1,290 men in Massachusetts, the incidence of complete impotence ranges from 5 percent among 40-year-olds to 15 percent among 70-year-olds. And, if those reporting moderate degrees of impotence are included, the numbers rise to 22 percent and 49 percent, respectively.
Yet, experts have found that if nothing interferes with the erectile response, men can remain potent and capable of enjoying sexual intercourse into their 90s.
Perhaps the most important development in the treatment of erectile dysfunction has been the nearly complete reversal of the long-held belief that in 80 percent of cases the problem was because of psychological factors.
It is now recognized that about 70 percent to 80 percent of cases have a physical cause and that emotional factors are common causes of impotence only among the relatively few young men. But even when a physical cause is found, emotional factors may compound the problem.
Another assumption that has been strongly challenged is that an inability to achieve a full erection or maintain it long enough to complete sexual intercourse is a natural consequence of advancing age.
It is now known that the increase in erectile dysfunction with age is not because of aging itself but because of health problems ranging from cardiovascular disease and surgery to the side effects of medications and hormonal aberrations that often go undiagnosed.
It has recently been recognized that the sooner erectile problems are properly diagnosed and treated, the more likely the treatment will be successful.
According to Dr. Irwin Goldstein, urologist at Boston University School of Medicine, an erection brings the oxygen-rich blood needed to maintain the healthfulness of the penile blood vessels and nerves that make erection possible. This means that the longer a man goes without an erection, the greater the damage to the lining of blood vessels, an effect that can eventually make erection impossible.
Proper diagnosis is critical to proper treatment. The problem may be correctable when the underlying cause is treated. Even when a correctable physical cause is found, emotional factors must not be overlooked.
Accordingly, at the Center for Male Sexual Dysfunction at Montefiore Medical Center in the Bronx, the man and his partner are interviewed separately. The Montefiore team has found that sexual partners seldom tell the same story of their sex lives and that in many cases the information obtained from the partner alters diagnosis and treatment. In addition, all patients should be fully evaluated for contributing psychological factors.
Dr. Arnold Melman, chief of urology at Montefiore and director of the center, said a diagnostic workup should include a thorough medical history and physical examination, including a measurement of blood flow through the penis, hormonal assays and a glucose test for diabetes. Special X-ray studies may sometimes be needed.
At the Montefiore center, the man's response to visual sexual stimulation is also examined.
An at-home test using a device called a Rigiscan is done to check for the occurrence of erections during sleep, which typically occur four or five times a night in men with a physically normal erection response.
The most common cause of erectile dysfunction in men over 60 is interference with blood flow by atherosclerotic plaques in the penile and/or pelvic arteries.
In fact, experts urge every older man who complains of erectile problems to undergo a complete cardiovascular workup, since he may be at high risk of suffering a heart attack or stroke. Diabetes is another common cause.
Critical nerves can be irreversibly damaged during surgery to remove a prostate cancer. Other nerve-damaging conditions that can lead to erectile dysfunction include multiple sclerosis, Parkinson's disease and injuries to the spinal cord or pelvis.
Hormonal abnormalities are a relatively uncommon cause.
More than 200 different prescription drugs can interfere with the erectile response, including some of the popular medications used to combat high blood pressure, psychosis and depression.
Long-standing habits can also contribute to erectile problems, especially smoking, excessive alcohol intake and the use of cocaine, which foster atherosclerosis and nerve damage.
When a man has difficulty achieving or maintaining an erection, his partner, particularly if she is a woman, is often at a loss as to what to say and do.
Caught between not wanting to make her man feel inadequate and wanting to maintain an active sex life, she may end up pretending that the physical act of intercourse is not important to her.
Such pretense can ultimately become a wedge between loving partners.
In a very helpful booklet, ``Male Impotence: A Woman's Perspective'' prepared for the Geddings Osbon Foundation of Augusta, Ga., Nancy Hanks, a registered nurse, counsels women: ``If having intercourse is important to you, admit it to yourself and to your partner. Don't pretend it doesn't matter.''
She also urges women to learn about the physical and psychological causes of impotence and to examine relationship issues that could be contributing to the problem.
A copy of this and other booklets produced by the foundation is available by calling (800) 433-4215 or writing to the foundation at P.O. Box 1593, Augusta, Ga. 30903.
by CNB