June 24, 2018
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Erectile dysfunction: A sign of trouble that a little blue pill may not fix

By Dr. William Sturrock, Special to the BDN

Did you know that men in the United States still die an average of six years before women?

The reasons have something to do with those commercials you’ve seen depicting a man and his wife sitting side-by-side in bathtubs gazing out into the sunset. But not in the way you might think.

Despite great advances in public health over the past two centuries — which have seen life-expectancy rise from 36 years in 1770 to the current average in the U.S. of 78 years (80 for women, 74 for men) — at every decade of life the death rate of males in America is significantly higher than that of females.

Researchers have speculated at the possible causes: the genetic benefits of having two X-chromosomes, the potential protective effect of estrogen (or evil of testosterone), differences in risky behavior and bad habits and the reluctance of many men to seek early or preventive medical care.

Although these multiple factors may affect longevity, improving the health of a single organ system could increase most men’s chances of both a happier and a longer life.

What is this vital organ system? Does it have anything to do with the men’s health issue most advertised today?

Only sort of. If you answered the vascular system, also known as the circulatory system, you’re right. Although normal sexual functioning requires coordination between emotional, neurological and vascular systems, research now tells us that when things go wrong with the male systems prematurely, it’s usually from the build-up of plaque in our blood vessels.

The health of our vascular system, whether it’s cardiac, cerebral or genital, is the unifying concept identified by experts as the most important health concern for men in the 21st century.

How could this be more of a problem than cancer and death due to accidents or violence? Statistics published by National Cancer Institute show that a man’s chance of dying prematurely between the ages of 65 and 75 from heart disease or stroke is four times the combined risk of dying from bowel cancer, prostate cancer and accidents.

What is the connection between these premature vascular deaths and erectile dysfunction? Sexual dysfunction often is an early warning sign that a man’s vascular system is in trouble. We now know that for men between the ages of 30 and 40, decreased erectile function predicts a sevenfold chance of premature heart disease, compared to healthier peers.

Frequent failure in the bedroom, especially at an early age, should be taken as seriously as an episode of chest pain. The worst thing a medical provider can do is to simply prescribe the “little blue pill” without addressing the underlying reasons for that vascular failure.

Many men need four prescriptions in this scenario: help with smoking cessation, nutritional changes, an exercise plan and “the little blue pill.”

Unlike the random factors that can influence cancer or accidental death, our lifestyles and behaviors have more of an effect on whether we develop vascular disease. If one develops symptoms, including erectile dysfunction, it is not too late to seek treatment. Diabetes, elevated lipids, hypertension and other factors may be improved with medication and significant lifestyle changes.

What has been missing for men is a real public health effort to de-stigmatize the conversation about these issues, just as women have benefitted from open talk about cervical and breast cancer. Men need to be more comfortable talking with their health care providers every year about their vascular health on all fronts. Providers need to become more capable at putting men at ease with these conversations.

Sadly, men in the U.S. report being more comfortable talking with their barbers than with their physicians.

To really improve men’s health, we need physicians with a dedicated interest in all facets of men’s health. Erectile dysfunction is only one issue among many.

We may be lucky to be alive at this time in human history, with all of the advancements in medical knowledge and treatment that we have gained. However, we still have some work to do to help our sons and grandsons live as long and satisfying a life as our daughters and granddaughters.

This column is the first of three by Dr. William Sturrock about men’s health issues. Sturrock is Eastern Maine Medical Center’s men’s health consultant at Urologic Surgery of Maine in Bangor.

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