Before "ED" became common parlance, "it" wasn't much talked about or understood and was referred to as impotence, a word with shameful connotations. That term has largely been replaced by erectile dysfunction and reflects increasing acceptance about a condition that will affect most men in their lifetime — the inability to produce or maintain an erection for sexual intercourse.
Now widely regarded as a highly-treatable condition — thanks, in large part, to the advertising blitz of pharmaceutical companies — erectile dysfunction has been the subject of heavy research, resulting in substantial medical advances. And 2013 has been a landmark year for commemorating many of them: the 15th anniversary of the Food and Drug Administration's approval of Viagra — the first oral medicine to treat erectile dysfunction — along with the 30th anniversary of penile injections and the 40th anniversary of penile implants.
At the forefront of the field, Irwin Goldstein, director and president of the San Diego-based Institute for Sexual Medicine, talks with U.S. News about the latest thinking on erectile dysfunction and what consumers should know. Here is some of his insight and advice:
[Read: U.S. News Sexual Health Center: Treating Erectile Dysfunction.]
1. Viagra is a safe drug, but beware of knockoffs.
Viagra is "the most studied drug on the planet," says Goldstein, who was the lead author in an early study of the drug, published in May 1998 in the New England Journal of Medicine. Viagra's mainstream success, however, has led to an explosion of counterfeit activity online, in which drugs have been found to contain dubious and dangerous ingredients, such as commercial paint and printer ink. According to Goldstein's research with Pfizer, Internet suppliers claiming to sell authentic Viagra shipped counterfeit drugs 77 percent of the time. Consumers buying drugs online should be sure the pharmacy is accredited by the Verified Internet Pharmacy Practice Sites of the National Association of Boards of Pharmacy, he advises.
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2. Erectile dysfunction may indicate other health problems.
"We call it the canary in the coal mine," Goldstein says. "It is an early glimpse of the health of your vasculature." The condition becomes more prevalent with age, affecting 30 percent of men at age 30, 40 percent at age 40, 50 percent at age 50, etc., he says. As he explains it, blood vessels can clog with age, resulting in weaker blood flow to the penis. Among men who have had a heart attack, 80 to 90 percent will have had erectile dysfunction. While erectile dysfunction largely stems from vascular trouble, a man's psychological, neurological, hormonal and muscular health may all play a role, Goldstein says.
3. Get help, and get healthy.
Often, a man's partner can detect an issue before he can, but talking about it doesn't always happen. Goldstein suggests a partner should broach the subject frankly, like so: "I love you, but you're not as hard as you used to be. You need to see a doctor." And when you do see the doctor, don't simply ask for or accept a prescription for one of the standard drugs for erectile dysfunction — such as Viagra, Levitra and Cialis. Demand a full workup to check your blood pressure, cholesterol and glucose levels, and focus on getting healthy, he says. "It should be a warning that you're on the wrong path going forward as you age."
Exercise, weight loss and a healthy diet can all help improve these issues, but Goldstein warns against bicycling, which can cause erectile dysfunction. He also notes the opportunity for support for the emotional toll this can take by seeing a family or marital therapist such as those trained through the American Association of Sexuality Educators, Counselors and Therapists.
[Read: Teaching Your Kids About Sex: Do's and Don'ts.]
4. More support is becoming available ... for men.
According to Goldstein, there's been "an explosion" of research focused on male sexual dysfunction in recent years. For example, he's the principal investigator in two trials for a new drug, avanasil, which is taken upon engaging in sexual activity. That's unlike current medications, in which you "take the pill and hope your partner will have relations." But when it comes to women's sexual health, "not a single drug has been government-approved for women," he says, adding that there's a "meager" amount of literature on women's sexual health problems.
While many of the treatments for men will, ideally, help their female partners, there's at least one effort underway geared toward improving the sexual health of both men and women — an antidepressant called vilazodone that has substantially lower sexual side effects than similar drugs, Goldstein says, calling this an "enormous breakthrough" for "men and women who suffer from the tormenting issues of depression."
5. Talk about sex.
Part of the shame that surrounds erectile dysfunction stems from the lack of conversation and education about sex, Goldstein says. "Your parents don't talk about it. The schools don't talk about it [and] doctors aren't educated," he argues. "Basically, you go onto the Internet to learn pornography ... That's the educational process of the United States." The way Goldstein sees it, sex is simply "another biological process, except everyone's all wound up about it." And that gets in the way of critical education about safe and healthy sex.
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