[Two Pronged] Who to turn to for erectile dysfunction?

Rappler’s Life and Style section runs an advice column by couple Jeremy Baer and clinical psychologist Dr Margarita Holmes.

Jeremy has a master’s degree in law from Oxford University. A banker of 37 years who worked in 3 continents, he has been training with Dr Holmes for the last 10 years as co-lecturer and, occasionally, as co-therapist, especially with clients whose financial concerns intrude into their daily lives

Together, they have written two books: Love Triangles: Understanding the Macho-Mistress Mentality and Imported Love: Filipino-Foreign Liaisons.

Dear Dr Holmes and Mr Baer,

Hello, I’m Art, 34, just got married last year. My wife is 33 years old.

Just this year, my wife and I decided to quit my job in the Middle East to be with her and to start a family. I’m currently staying with her here in the US but for a limited time only since my wife and I are still fixing our status to stay here permanently, and hopefully to have a baby soon.

But there’s a problem Dr. Marge, I’m experiencing erectile dysfunction.

I felt it frequently every time we’re about to engage in sex. I read some articles about it. I just don’t know if it has something to do with my illness. I have asthma and allergy since I was a child and up to now, I take prescribed medications by the doctors, like nasal sprays and oral steroids frequently. I assumed my erectile dysfunction has something to do with these medications. I’m also thinking that this dysfunction has something to do with my hair loss. I keep on shaving my hair for 10 years now to make it even since there are only few hairs remain on top of my head. I just want to ask you Dr. Marge if there are solutions to my problem.

My wife and I are planning to consult a doctor but we don’t know if it’s a medical doctor or a psychotherapist. Kindly have time to answer my letter.

Thank you and regards.

Art

Dear Art,

Thank you for your message.

While it is natural for people to attempt self diagnosis, especially now that the internet is the source of so much readily available information, it is comforting that you are considering consulting a medical doctor or therapist for your erectile dysfunction (ED) problem.

Given your medical history, it would seem prudent to visit a doctor/urologist first if only to rule out any connection between your medication and your ED.  Any connection between steroids and/or nasal sprays and ED is definitely a matter for a medical professional and definitely not “Dr Google” or advice from friends.

Also worthy of analysis is when your ED first started. If it has been a lifelong problem, then a link to sprays and steroids is plausible. If however, it is a more recent development, that link seems more tenuous 

As for your hair loss, I have always been told that baldness was a sign of virility, but as the source of this information was invariably a bald man, credibility was in short supply. If, however, you have also lost all your pubic hair, then perhaps this is something else to mention to the doctor.

I leave it to Dr Holmes to shed light on the psychological aspects involved here.

All the best,

JAF Baer

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Dear Art,

Thank you very much for your letter. This is one of the most difficult letters for me to answer because there are so many ways to deal with your ill-defined problem.  Ill-defined in that it tells us nothing about when your ED started, how it started. If it started suddenly and you still have erections when you masturbate, watch porn and/or early morning when you wake up, then this suggests your ED is mainly psychological. 

However, if it started suddenly, and is global (that is, you do NOT have erections under the circumstances listed above) then it is more than likely that your ED is mainly physical. 

So definitely you should consult a medical doctor since it is always good to first make sure the problem is (or is not)  biophysical or physiological since the overwhelming research (the links will be listed so you can read them for yourself, hopefully in greater depth) suggests that ED has to do mainly with the man’s physical health.

Recent research published in The Journal of Sexual Medicine found that one in four men seeking help for erectile dysfunction is younger than 40. Explains Charles Walker, M.D., assistant professor of urology and cofounder of the Cardiovascular and Sexual Health clinic at Yale University. Dr Walker continues: “Men prefer to believe it’s all in their head, and women often put the blame on their sex life i.e. ‘it’s me’ or ‘he’s having an affair’-but these excuses are often never the cause” 

The actual culprit: his health.

Vasculogenic erectile dysfunction means his lack of erection is due to a blood flow issue, as opposed to erectile issues caused by neurological, psychological, or endocrinological complications.  In other words, dearest Art, your ED is a huge predictor for major health concerns like heart disease, diabetes, and high blood pressure.

Dr Walker continues: “The arteries in the penis are just like the arteries all over the rest of the body, only slightly smaller,…so if there is a blood flow issue happening here, perhaps to due to plaque buildup, then it’s only a matter of time before he starts noticing issues with his heart.” 

Dr. Walker is not the only one who says this either.  From across the pond,  the British Society for Sexual Medicine has issued Guidelines on the Management of Erectile Dysfunction in Men (2017) 

There is now overwhelming evidence that ED is strongly associated with cardiovascular disease, such that newly presenting patients should be thoroughly evaluated for cardiovascular and endocrine risk factors, which should be managed accordingly.

Patients attending their physician with chronic cardiovascular disease should be asked about erectile problems. There can no longer be an excuse for avoiding discussions about sexual activity due to embarrassment. 

Sexual activity is associated with benefits to cardiovascular health and improved well-being. A certain degree of cardiovascular fitness is required for sexual activity, irrespective of the type of treatment required to make intercourse possible. 

The major risk in sexual activity is therefore from the disease, not the treatment. 

Interestingly, both the Brits and American seem to underscore that a primary health doctor or even a urologist may not be the best person to see when you have ED, because, to quote DR Walker, “they don’t always have familiarities with the penis and may not understand the physiology as much as they should. What’s more, a primary care doctor will likely just prescribe him Viagra  and the user eventually builds a resistance to the pills and they do nothing to reverse the process.” 

Because you have told me nothing really important regarding your life, may I suggest you read this.  

This article suggests you have had experiences in the past that may have ratcheted up your stress or anxiety levels (that may mainly happen when you are about to have sex) that contributes to your ED.  These experiences do not have to do with sex abuse or anything remotely sexual.

Finally, your questions regarding steroids, nasal sprays, and baldness can easily be answered on google. The trick is to go to legitimate websites like the Mayo Clinic, Harvard Health, and Web MD, and compare what they say. 

Good luck!

MG Holmes

– Rappler.com 

Need advice from our Two Pronged duo? Email twopronged@rappler.com with subject heading TWO PRONGED. Unfortunately, the volume of correspondence precludes a personal response.