Erectile Dysfunction: Incidence Rate Linked To Type and Severity of Coronary Artery Disease

Erectile Dysfunction and Men

An Italian study of men with erectile dysfunction and coronary artery disease (CAD) has shown for the first time that the rates of dysfunction differ according to the type and severity of the disease.
It is low among men who have acute coronary syndrome (ACS), mainly acute myocardial infarction with one blood vessel affected� � - for example, who have had a sudden heart attack without a background of furred-up arteries� � - but high in those with chronic coronary syndrome (CCS), mainly effort-induced angina pectoris and involving many arteries narrowed by atherosclerosis.
They have also shown in their study of nearly 300 men, that among CCS patients who had both ED and CAD, 93% reported symptoms of erectile dysfunction (ED) between one and three years before experiencing angina, with two years being the average time.
Their findings are reported on line (Wednesday 19 July) in European Heart Journal[1], journal of the European Society of Cardiology.
The results have prompted the researchers, from the University of Milan and the University Vita-Salute Ospedale S. Raffaele, also in Milan, to call for long-term medical surveillance in patients with� � erectile dysfunction and multiple risk factors, but with no clinical signs of coronary artery disease. They say their research has fuelled the concept of erectile dysfunction as 'sentinel of the heart'.
Their warning has been reinforced in an accompanying editorial[2] by Dr Graham Jackson, consultant cardiologist at the Cardiothoracic Centre at Guy's and St Thomas' NHS Foundation Trust in London, UK.
"All men with� � erectile dysfunction and no cardiac symptoms need a detailed cardiac assessment, blood pressure measurement, fasting lipid profile and glucose, as well as lifestyle advice regarding weight and exercise," said Dr Jackson. "Those at cardiovascular risk ideally need stress testing and referral for risk reduction therapy, and advice with appropriate follow-up."

New Theory About Preserving Erectile Function After Prostate Surgery

Prostate Surgery
Erectile dysfunction after surgery to remove the prostate (radical prostatectomy) has traditionally been attributed to nerve damage that theoretically should heal over time.
But it can take as long as two years for the nerves to recover enough for a man to have an erection without the aid of drugs or devices. By that time, other damage may have occurred, according to an article in the latest issue of Perspectives on Prostate Disease.
The Harvard Medical School bulletin notes that when the penis is flaccid for long periods of time, it is deprived of a lot of oxygen-rich blood. Recent research suggests that this low oxygen level causes some muscle cells in the penis's erectile tissue to lose their flexibility. The tissue gradually becomes more like scar tissue, interfering with the penis's ability to expand when it's filled with blood.
Therefore, the traditional advice given to men -- to wait for erectile function to return on its own -- may not be adequate. Simply put, erections seem to work on a use-it-or-lose-it basis. To prevent the secondary damage that may occur if the penis goes too long without erections, researchers now think it's better to restore erectile function soon after prostate removal. Treatment options include using a vacuum pump device or taking erectile dysfunction drugs by mouth or by injection into the penis.
According to Dr. Marc Garnick, editor in chief of Perspectives on Prostate Disease and a Harvard oncologist, "Although the evidence supporting this 'penile rehabilitation' isn't perfect, you may want to ask your doctor about the options. Such early intervention may help increase the odds that you will regain erectile function."
Also covered in the 48-page report:
-- Alternative therapies for prostate cancer
-- Handling a prostate cancer relapse
-- Surgical options for benign prostatic hyperplasia
A year's subscription to Perspectives on Prostate Disease is available for $99 (for print and electronic versions; $89 for electronic only) from Harvard Health Publications, the publishing division of Harvard Medical School.

The Psychology of Impotence

Impotence

Looking at the psychology of impotence is a little like taking a trip down the Amazon during the wet season. It's a subject fraught with hidden currents, treacherous shallows and wide meanderings.
There is no doubt that Viagra, the little blue pill that revolutionized the treatment of impotence has had a profound effect on men who have erectile dysfunction. But simply finding a "quick fix" for impotence doesn't overcome other problems that may have been there before treatment began.
Overcoming impotence often gives men unrealistic expectations about their ability to immediately cure their emotional problems as well as their physical ones.

The Psychology of Impotence

Sadly it seems that for a large number of men, their ability to get an erection and have sex is viewed as an integral part of their masculinity and potency. It is� � no wonder that the onset of impotence, even when triggered by an underlying physical condition, can produce psychological problems that further impact on the impotence.
Performance anxiety is a very real issue for most men at one time or another. The fear of not being able to perform adequately, dissatisfaction with penis size, and self-consciousness about body appearance can all lead to the very thing that most men wish to avoid - failure to get an erection.
When this anxiety is coupled with the knowledge there may have been an occasional episode of impotence in the past, or when erectile dysfunction has been in existence for a period of time, this anxiety is multiplied. From a strictly physiological viewpoint, anxiety can effectively prevent a man from becoming aroused and getting and maintaining an erection.
Performance anxiety isn't the only issue men have to contend with. The highest risk category for the onset of impotence is the so-called "baby-boomers" - men born in the period from 1946 to 1964. Most of these men are in their peak performance years in terms of their job, status, family and financial success. And all these factors lead to an increase in stress levels and anxiety - one more reason for impotence to occur.
Taking a pill may temporarily overcome the impotence, but relieving the self-doubt and mental stress, which may have been brooding for any number of years, is harder to alleviate. The ability to regain quality of life by restoring sexual function is viewed by some men as a near miracle and by others with fear and trepidation.
It's important to honestly assess how you feel now and compare it to how you felt before the impotence treatment began. Easier said than done, but unless the negative feelings tied to the impotence can be viewed objectively, it's akin to the stories people who have gained a great deal of weight often say "I feel like a thin person trapped in a fat person's body". For men it's "I feel like an impotent man trapped in a body that now has full sexual function."
The psychology of impotence is about viewing your new life - with sexual function - as a new beginning, complete with all the new emotions that may be experienced. There's no point in trying to "recapture" your life the way it was prior to impotence, regardless of whether that was only months ago or many years ago. Time moves on, and trying to live out life the way it used to be is a sure-fire bet for failure.