It is important for physicians in general and cardiologists in particular to identify men with erectile dysfunction (ED) and, if necessary, encourage them to seek treatment, according to an editorial in the December issue of The American Journal of Cardiology.
Physicians should routinely inquire about their patients' erectile status because the diagnosis of ED may indicate progressive coronary or cerebrovascular disease as well as undiagnosed hypertension, diabetes or other disorders, according to Dr. Lawrence Levine, urologist at Rush-Presbyterian-St. Luke's Medical Center in Chicago and co-author of the editorial.
ED and cardiovascular disease share many important and common risk factors including diabetes, hypertension and smoking. If there is damage in the cavernosal arteries, the primary arteries supplying penile erectile tissue, that same damage is likely to occur in the coronary arteries.
"Physicians should take the initiative to ask the patient about his erectile status," said Levine. "Embarrassment is a significant factor that makes the patient less likely to volunteer the information." A study presented at this year's American Urological Association meeting supports this notion. In a survey of 500 men who were seeing urologists for reasons other than ED, 44 percent of them had experienced ED, but failed to tell their physician about the problem. The reason cited by 74 percent of these men was embarrassment.
To reduce the embarrassment often associated with ED, Levine suggests physicians can initiate conversation with their patients by being direct, forthright and nonjudgmental. If a physician is uncomfortable asking questions or feels the patient is sensitive to the line of questioning, the Sexual Health Inventory for Men (SHIM) is a valid and reliable questionnaire for physicians to use to initiate discussion, Levine said.
If there is a history of significant cardiovascular disease, the patient should undergo cardiac assessment before receiving any treatment for ED. According to Levine and Dr. Robert Kloner of the department of medicine at the University of Southern California and co-author of the editorial, treatments for ED can vary depending on the patient's ailments and treatment regime.
Because smoking is associated with an increased probability of ED, physicians should encourage patients to stop smoking by reiterating the risk that smoking poses to their sexual function. For some men, ED may be a more real and threatening prospect than the abstract future risks of heart disease or cancer. Last, there is growing evidence that sexual dysfunction is associated with significant mental and social health issues, including depression, anger, anxiety-related behavior, and antisocial activity, such as increased drug and alcohol abuse.
Approximately 30 million men currently experience partial or complete erectile dysfunction (ED).
Rush-Presbyterian-St. Luke's Medical Center includes the 809-bed Presbyterian-St. Luke's Hospital; 154-bed Johnston R. Bowman Health Center for the Elderly; Rush University (Rush Medical College, College of Nursing, College of Health Sciences and Graduate College); and seven Rush Institutes providing diagnosis, treatment and research into leading health problems. The medical center is the tertiary hub of the Rush System for Health, a comprehensive healthcare system capable of serving about two million people through its outpatient facilities and five member hospitals.