Dr. Anne Truong, MD
ERECTILE DYSFUNCTION
Introduction
Erectile dysfunction does not have to stall your sex life. In fact recent studies show that many men enjoy healthy sex lives even well into their seventies and beyond.
Though it’s not surprising that erectile dysfunction (ED) continues to be a significant obstacle for both men and their partners, and not just in later life. Fortunately, there is a lot of help available and as more men than ever open up about their experiences with ED, men of all ages are beginning to realize it’s not something they have to be ashamed of or face alone.
While most people believe medication is the only option, it’s not the only way to re-energize your sex life. Simple lifestyle changes—embracing a healthier diet, adopting regular exercise, and losing weight—can go a long way toward improving not only your sex life but also your overall health. That’s because many underlying causes of ED—such as excess weight, smoking, a diet high in saturated fat, and lack of activity—can drastically increase your risk for serious health problems like heart disease, diabetes, and even cancer.
Treating your ED can actually help you live a longer and healthier life.
Although ED is a troubling issue that can stress relationships, sap self-esteem, and steal some of the joy from life, the odds of finding a solution that works for you are better than ever. A wide range of modern treatments are available and helping men all over the country take control of their sexual performance, and their sexual health.
ED does not need to spell the end of your sex life. It’s often easily reversed by using the correct treatments. When addressed, it may even provide an opportunity for a new beginning.
I know this ebook—The 5 Common, Costly Mistakes Men Make When Facing Erectile Dysfunction—will be valuable in improving both your erectile function and your general health.
Remember, ED can be treated effectively, and you can regain your sexual confidence.
Anne N. Truong, M.D. Board-certified physician and expert in men’s health
Mistake #1: Believing
Mistake #2:
Mistake #3: Hoping ED Will Go Away On Its Own
Mistake #4: Using
Mistake #1:
BELIEVING ED ONLY OCCURS IN OLDER MEN
Although erectile dysfunction (ED) is more common in older men, it can affect men of any age. There is nothing unusual about experiencing ED at any time in your life and like any other medical condition, ED can impact a man’s overall wellbeing. Whether the man is 40-years-old or 90-years-old, ED should be treated the same.
Many people are surprised to discover the prevalence of ED in men aged 40-70 years is 50% and for men between 20-40 years the prevalence is 25%.
Many men also believe that the causes of ED are primarily psychological when in fact physical problems cause 90% of ED while only 10% are psychological.
Medical conditions such as obesity (BMI >30), diabetes, kidney disease, high blood pressure, and heart disease can increase a man’s risk of developing ED. Even activities like smoking and drinking large
amounts of alcohol can contribute by restricting the blood vessels.
While it’s certainly true that more men experience ED after middle-age, many men develop ED when they are younger and put off treating the problem until it worsens with age.
Treating ED is most successful when it is addressed early so don’t make the mistake of ignoring it while you’re younger.
Mistake #2:
THINKING ED MEDICATION IS THE ONLY EFFECTIVE TREATMENT
Most men believe the only effective treatment for ED is medication like Viagra. The common ED medications such as sildenafil (best known as Viagra), vardenafil, tadalafil, and avanafil are all phosphodiesterase-5 (PDE-5) inhibitors. But we know they work much better in men with psychogenic impotence — which accounts for just 10% of cases.
All four PDE-5 inhibitors work by increasing the levels of cyclic GMP within the penile muscles. That cyclic GMP elevates nitric oxide levels, which then promotes an erection in response to sexual stimulation.
Most generic PDE-5 inhibitors are covered by insurance and easily accessible but they do have downsides that many men are unaware of.
Men who take nitrates, to treat angina, cannot use ED drugs. Plus alpha-blockers taken for hypertension and
benign prostatic hypertrophy can cause low blood pressure and impaired ejaculations when taken with common ED medications.
Even if they don’t interact with a prescribed medication there are still other issues that can affect the performance of PDE-5 inhibitors. These medications have to be taken on an empty stomach and sexual activity has to be planned one hour in advance—both of which can be inconvenient.
Eating a fatty meal before taking sildenafil (Viagra) and vardenafil (Levitra) can also reduce the drug’s effectiveness. You will have to wait two to three hours after eating a fatty meal before taking ED medications for them to be effective.
ED medications can also cause numerous side effects. Some of the most common side effects of PDE-5 inhibitors like Viagra include:
Headache
Flushing in the face, neck, or chest
Upset stomach and indigestion
Abnormal “blue vision”
Nasal congestion
Back pain
Muscular pain or tenderness
Nausea
Dizziness
Rash
Diarrhea
PDE-5 inhibitors can also have more serious side effects, including:
Change or loss of vision
Ringing in ears or hearing loss
Chest pain or irregular heartbeat
Shortness of breath
Lightheadedness
Malignant melanoma
Swelling in the hands, ankles, and feet
Pulmonary hypertension
Aside from the worrying side effects there are many other reasons ED medications are not a long term solution.
Even if you’ve had success getting or keeping erections while using medication like Viagra, you may notice it doesn’t work as well after two to three years. Viagra can lose its efficacy over time, due to changes in your body or changes in your health, such as blood flow decreasing due to plaque build-up in your arteries.
ED medication also does not address the blood flow problem from your groin to your penis, it just helps keep the blood in the penis. Viagra does not help you get aroused, it only helps improve the blood flow to get an erection.
Remember erections occur when there is an overall increase of blood flowing into the penis.
An erection starts when the brain sends neurotransmitter (signal proteins) chemical messages to the arteries of the penis to increase flow.
The arteries open wider, which then allows the spongy tissue at the penis to be engorged and this engorgement of the tissue compresses the veins that stops the outflow of blood. The blood is then trapped in the spongy tissue of the penis—called the corpus cavernosum—and as the blood builds up it expands the penis and creates an erection. When the blood drains out to the veins, the penis becomes flaccid again.
In order to have the required increase in blood flow, these four crucial steps must take place as follows:
First, the nerves in the pelvis must send neurotransmitters (signal proteins) to the arteries of the penis, directing increased blood flow.
Second, the arteries must respond to the command from the nerves by dilating and widening to allow for increased blood flow.
Third, the erectile spongy bodies of the penis must be compliant, able to stretch out, and elongate to accommodate the increased blood flow. The veins of the penis must allow for an increase in blood flow by closing their drainage valves to keep blood in the penis.
If there’s a problem with any of these four steps on the way to an erection, medication won’t be able to solve the problem.
Additionally, ED medications do not work if you have:
Diabetes or prostate surgery, because of damaged nerves
Significant blockages in the blood flow in the penile artery for atherosclerotic heart disease (plagues)
Peyronie disease, nodules in the penis that cause it to bend
Venous leak in the penis
Anxiety, depression, stress, or relationship problems that cause psychogenic impotence
Taking ED meds is a lot like taking medication like oxycodone for pain. It may work in the short term but not long term. The drugs disguise the problem causing ED rather than treating the root cause. If you don’t address the cause of ED then it will continue to get worse even if ED medications are used.
The most successful ED treatments address the root cause of the problem rather than masking the symptoms.
Mistake #3:
HOPING ED WILL GO AWAY ON ITS OWN
Men often convince themselves that their ED is just a passing phase which will resolve on its own. Nothing is further from the truth.
The definition of ED is the ongoing inability to achieve or maintain an erection that’s sufficient for satisfactory sexual performance. Symptoms can also include struggling to maintain an erection for long enough to complete intercourse or an inability to orgasm or ejaculate.
A man is considered to have ED when these symptoms occur regularly (more than half the time).
Erectile Dysfunction is often a symptom caused by an underlying condition because it is closely connected to so many other systems in the brain, including circulation and hormones.
And it is not a rare condition.
ED may affect as many as 30 million men and can
increase with age. In fact, ED says a lot about the overall health of a man. Think of it as your check engine light, a warning that your health may need some attention.
A large national study by the National Health and Social Life Survey found that sexual dysfunction is more prevalent among men in poor physical and emotional health.
Their findings showed ED has a high association with heart disease, hypertension, diabetes, and those taking associated medications. The study included 1053 men, at least 30 years old, with at least one of the risk factors for ED such as high blood pressure, high cholesterol, smoking, metabolic syndromeXXX, heart disease, diabetes, depression, lower urinary tract problem, obesity, and a waist circumference greater than 40 inches.
86% of men were not even aware they had ED when they took part in the study and completed the International Index of Erectile Function (IIEF) questionnaire (see table below).
We now know that ED is a warning sign of potential heart disease in the following 7-10 years. As these conditions cause a restriction in blood flow, the penile arteries are affected first because of their small size in the body compared to the heart artery.
Men should be concerned when they have ED, and it is wise to treat the cause of ED and prevent it from getting worse. Their life may depend upon it.
According to the Centers for Disease Control and Prevention (CDC), heart disease is the top killer when analyzing data from males of all age groups and ethnicities. Between 70% and 89% of sudden heart attacks are experienced by men and cardiovascular disease (heart disease) is the top cause of death in men.
ED also causes anxiety, frustration, and feelings of inadequacy which often lead to depression or aggression. As a result, relationships can suffer as well.
Ignoring the symptoms of ED is the worst thing you can do. Instead, it is crucial to have open communication with your partner.
Most cases of ED stem from physical factors rather than psychological ones, but ED itself can cause mental and emotional issues which affect both men and their partners.
Treating ED can alleviate many serious conditions and reduce relationship stress.
Mistake #4:
USING AN ONLINE DISPENSARY TO ORDER ED MEDICATION
While ED is a very common complaint, many men are still too embarrassed to seek help from their medical provider and so they attempt to treat the problem themselves by ordering ED medication from an online dispensary.
Trying to treat ED this way by ordering medications online is dangerous and often doesn’t provide the result desired as ED is so commonly caused by another underlying medical condition.
It’s like ignoring chest pain and going online to try and treat it yourself.
A consultation with a sexual health specialist doctor (MD or DO) evaluates your medical history, symptoms, medication, and performs an examination to look at your heart, lungs, glands, pulses, genitals, and prostate areas. The specialist will give you questionnaires like the IIEF
to evaluate the severity of ED and the ADAM questionnaire to assess testosterone deficiency.
They should then arrange for you to have a laboratory evaluation (measurements of total testosterone, estradiol, DHT, prolactin, thyroid, blood sugar, lipid panel, vitamin B12, vitamin D, insulin, and clotting factors) and a penile doppler dynamic ultrasound with prostaglandin stimulation to evaluate arterial and venous flow in the penis.
ADAM (Androgen Deficiency in the Aging Male) questionnaire about symptoms of low testosterone.
This basic questionnaire can be very useful for men to describe the kind and severity of their low testosterone symptoms.
05. YES NO
Have you noticed a decreased “enjoyment of life”?
06. YES NO
Are you sad and/or grumpy?
07. YES NO
Are your erections less strong?
08. YES NO
Have you noticed a recent deterioration in your ability to play sports?
09. YES NO
Are you falling asleep after dinner?
Has there been a recent deterioration in your work performance?
10. YES NO
If you answer Yes to number 1 or 7 or if you answer Yes to more than 3 questions, you may have low testosterone.
A thorough evaluation is not possible when you use an online dispensary, and bloodwork and penile doppler ultrasound are often not completed. The online visit is short and medication focused with little effort to evaluate the root cause of your ED. Without treating the cause your ED will continue to worsen until one day, you realize the drug does not work as before. Your bedroom performance becomes
completely dependent on the medication and so does your self-confidence.
A thorough evaluation allows you to address the root cause of your ED giving you a better chance of successful treatment.
There are six systems that can cause an erection: the brain (emotions), nerves, hormones, penis muscles, blood flow, and blood vessels.
Treating one or all of these systems can reverse ED which is why a thorough evaluation and testing is needed to determine which of the systems involved should be treated.
Additionally, a healthy diet, exercise, seven hours of sleep, maintaining a healthy weight (BMI less than 30), avoiding toxic habits (smoking, excess alcohol, recreational drugs), and stress reductions can maintain long term performance.
The good news is that with the right treatment ED is reversible and treating the symptoms early leads to faster results.
There are also more aggressive treatments available that can be used for severe ED. Including Platelets Rich Plasma (your blood), Low-Intensity Shock Wave Therapy, and Testosterone Hormone Replacements. These treatments help restore blood flow and healthy muscles to support erections.
Don’t risk your health and your sex life by using online dispensaries to access ED medications, having a full evaluation with a doctor who specializes in sexual health gives you the best chance of reversing ED.
Mistake #5:
IGNORING LIFESTYLE FACTORS THAT AFFECT ED
Medical interventions aren’t the only important elements of ED treatment. It's just as important to address lifestyle factors that play a role in ED.
Some common factors that can lead to conditions affecting blood circulation include:
Lack of exercise or activity
Smoking
Prolonged stress
Drinking excess amounts of alcohol
Having sex less than once a week (the penis muscles can weaken with lack of use)
Not getting enough sleep
Taking common over the counter medications frequently
By making some simple lifestyle changes many men find huge improvements in their ED.
Maintaining a healthy weight, staying active, eating well, and getting enough rest can have a powerful effect on ED.
There are certain medications and drugs that may cause erectile dysfunction in men—and you should talk to your health care provider if you’re concerned that a drug may be affecting your sexual performance.
Remember to always take prescribed medication as directed by your doctor and never stop or change your medication without their advice.
The following groups of drugs have the possibility of causing ED:
Antidepressants and other psychiatric medicines like amitriptyline, sertraline, phenytoin, and chlorpromazine
Antihistamine medicines (including those used to treat heartburn) like cimetidine, nizatidine, diphenhydramine, and promethazine
High blood pressure medicines and diuretics (water pills) like thiazides, beta blockers, Enalapril, and bumetanide
Parkinson disease medicines like Cogentin, biperiden, bromocriptine, and Sinemet
Chemotherapy and hormonal medicines like antiandrogens, busulfan, Cytoxan, and LHRH agonists
Opiate painkillers like codeine, Demerol, morphine, and Oxycontin
Recreational drugs like nicotine, marijuana, amphetamines, and heroin
Ensure you never stop taking medication without talking to your provider first as some medications can lead to life-threatening reactions if you do not take care when stopping or changing them.
WHAT TO DO IF YOU’RE EXPERIENCING SYMPTOMS OF ED
The bottom line is that ED is a serious problem that affects men of all ages and their partners but with the right approach it’s very treatable. There are a number of modalities and treatments available today that can offer you a focused, personalized treatment plan.
The best thing you can do is schedule an appointment with your sexual wellness physician to discuss your best options for treatment.
We invite you to book a discrete, complimentary call with our patient ambassador at Truong Rehabilitation Center to learn more about how Dr. Anne and her team can help you reverse your ED and reclaim your confidence so you can experience a more satisfying, meaningful sex life.
For over 20 years, Dr. Anne has helped over 7000 men regain sexual performance confidence to live their best life with meaningful relationships.
Dr. Anne is a board-certified physician with over 20 years of clinical experience. A physician, entrepreneur, and innovator who thinks outside the box, Dr. Anne is a recognized leader in men's health, particularly in regenerative medicine.
She is passionate about smashing the stigmas and shining a light on the truth about men’s sexual health, pleasure, and wellness so men everywhere can access the sexual health care they deserve. She believes in healing the cause of male sexual dysfunction — not just masking the symptoms — and shares her wisdom to teach doctors at conferences worldwide as part of her mission to make better intimate health care accessible to men.
Dr. Anne is a firm believer that sexuality is vital to a high quality of life at any age, but especially after 50. She evaluates and supports each patient from beginning to end to accomplish their individual goals, recapture their vitality, help them age gracefully, and live their best life.
Since 2000, Truong Rehabilitation Center offers
individualized, comprehensive treatment for those who want to achieve their best intimate self. Providing regenerative medicine for sexuality, aesthetics, and pain conditions with top-of-the-line technology for precision treatments.
Dr. Anne's commitment to her patients is uncompromised by the limitations imposed by insurance companies. When she takes on a patient, she dedicates herself to providing the best treatment plan that aligns with their goals. Her Vitality Warriors, as Dr. Anne affectionately calls her patients who want to live their best life beyond 50, trust her patient first approach and rave about the world-class service and professionalism she and her team provide.
No matter your age, Dr. Anne can help you enjoy the life you deserve, because she believes everyone should enjoy their intimate relationship beyond middle age. Book your complimentary discovery session with Truong Rehabilitation Center to discover how Dr. Anne and her