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Posted June 23, 2022 by Elizabeth Boes, D.O.Listen to this episode of the Healthy Vitals Podcast.
Scott Webb: Though erectile dysfunction and urinary incontinence can be difficult subjects for some men to discuss with their doctors, there are many treatment options for both. And my guest today wants all men to know the doctor's offices are safe spaces for men to discuss what's ailing them. And joining me today is Dr. Elizabeth Boes. She's a urology physician with Summa Health.
This is Healthy Vitals, a podcast from Summa Health. I'm Scott Webb. Doctor, thanks so much for your time today. We're going to talk about erectile dysfunction today, male urinary incontinence, and I've got a bunch of questions for you. As we get rolling here, what is erectile dysfunction or what are the causes of erectile dysfunction?
Dr. Elizabeth Boes: Erectile dysfunction is when a man is not able to achieve an erection that is either satisfactory to the patient or to the partner. And it may be impacting their ability to actually engage in meaningful sexual activity.
Scott Webb: Yeah. And I'm wondering when we think about who's at highest risk, right, or other behavior and lifestyle factors, basically I'm asking, you know, what are the causes of erectile dysfunction? Kind of go through these and maybe talk about who's at highest risk and so on.
Dr. Elizabeth Boes: About 50% of men over the age of 40 are at risk for some form of erectile dysfunction. Erections are all about getting the blood flow to the penis. So getting it where it needs to be, and then keeping it there. The men who we see most commonly who are at risk for erectile dysfunction may be men who are diabetic. Diabetes affects your blood vessels and it also affects the nerves. So it makes sense then that it can also affect your ability to achieve an erection. In addition, patients who have hypertension and are being treated with medications to bring their blood pressure down oftentimes have difficulties with erections. We see patients who have coronary artery disease or peripheral vascular disease who may have difficulties with erections. Sometimes it's related to medications that the patient needs to be on. And it's more important that the patient be on that medication, but that doesn't mean that there aren't options for us to treat them.
In addition, patients who have gone through treatments for different forms of cancer, prostate cancer specifically, but also other cancers involving the pelvis or any of the organs in the abdomen can potentially lead to erectile dysfunction. So for those patients, the pathophysiology as to why they developed erectile dysfunction might be a little bit different. It might be a side effect of the treatment that they underwent or from a previous surgical procedure that they may have had. So there's a wide range of men who are affected by difficulties with erections ranging from younger men in their 30s and 40s, to older men up into their 80s and 90s. I see a wide range of patients from all walks of life who are treated for erectile dysfunction.
Scott Webb: Yeah. So, medical conditions, medications, as you say, it's a wide range. Are there some behavior and lifestyle things as well that men may be sort of causing this unintended or unwanted consequence?
Dr. Elizabeth Boes: Yeah, certainly. So excess alcohol intake. Alcohol is a depressant. So a depressant means that your body is kind of suppressing a lot of its natural systems. So alcohol is something that can affect your ability to get an erection. Certain medications that you are prescribed we talked about, but also medications that you may not be prescribed. Marijuana is something that's very commonly used and it is legal in many states and is used for many different purposes nowadays, but it also has the ability to impact your body's ability to get an erection. In addition to that, narcotic pain medications, whether you are being prescribed that for something, those also can limit your ability, and obesity.
So the healthier lifestyle that you lead, the more physically active that you are, those are going to be things that are going to help preserve your body's natural erectile function. So I think overall, generally avoiding all of the habits that we all know are "taboo" or things that are, you know, maybe pleasurable, but not necessarily good for our bodies. Those are all things that can impact our ability to get an erection.
Scott Webb: Yeah, and it sounds like when you're in the room with a patient and you're doing, you know, patient medical history and trying to diagnose and get at the root cause, sounds like there's a lot to sort through, a lot to unpack there, to figure out exactly what is causing the erectile dysfunction in this patient. And once you do and assuming that you do, what are the treatment options?
Dr. Elizabeth Boes: Treatment options vary widely. Sometimes it's coming down to the root cause, is it a physiologic problem or is it a psychologic problem? And a lot of guys will come in and they'll ask me doctor, "Is this in my head?" And I say, "Well, in a sense, it is in your head because that's how the erection starts. You have to be stimulated. So we need your brain, we need that part of your consciousness to be part of the erections."
So treatment sometimes is talking through, "Okay, well, what are the concerns that you have? Is it situational?" Sometimes it's sex therapy. For other patients, we oftentimes will start with medications. So there's a varying level of different treatments for patients.
First-line therapy tends to be oral medications, and those are prescription medications. Those have been around, you may have heard of them Viagra and Cialis. Those are the most commonly used ones. They are generic now and we prescribe them very frequently to men and we use them in different doses and we use them for men of all different ages.
After oral medications, there are additional options. There's something called an injection or intracavernosal injection. And that's a therapy where the patient actually injects a medication directly into the penis that allows the blood to flow there and allows the patient to get a natural erection. There is a device that's called a vacuum erection device, which can be used to help pull blood into the penis to allow the man to get an erection and be sexually active and be intimate with their partner. And then there's actually treatments such as surgery or a penile implant, which we can do for patients who either aren't satisfied with oral medications, have a contraindication to taking oral medications or don't respond to the medications or the injections. So that's an implant where we can actually put an implant in the patient, allows them to get an erection whenever they want for however long they want.
Scott Webb: So, obviously, lots of causes, lots of treatment options. Thankfully, we have experts like yourself to help sort through all of this. Let's switch gears just a little bit and talk about male urinary incontinence. It seems like it kind of goes with this conversation. What are the most causes?
Dr. Elizabeth Boes: Most commonly, we're going to see male urinary incontinence or stress male urinary incontinence in a patient who has had something called a prostatectomy. So these patients will typically have been diagnosed with prostate cancer and undergone surgery to remove their prostate. Another reason that we might see that is a patient who has had some sort of surgery on their prostate or their urethra. That's the most common reason for stress incontinence. After that, you can understand that they've gone through a pretty significant surgery to treat or hopefully cure their cancer. And now, they're left with debilitating, at times, urinary incontinence leaking all the time. That can be a very big lifestyle upheaval for patients and actually treating urinary incontinence is one of my favorite things to do. Whether it be a man who's leaking enough to wear one pad a day, two pads a day to a man who has complete urinary incontinence, there are different options for them.
We always start post-operatively with treating the man, doing physical therapy. So there's pelvic floor physical therapy, and we can teach exercises to help strengthen the muscles. But that's not enough for everybody. For the man who desires additional treatment, there are non-invasive options, which are non-surgical that involves different drainage systems to collect urine or clamps to help lock the urine flow. But there's actually something called a male sling, which can help if patients have mild urinary incontinence after surgery. Or there's something called an artificial urinary sphincter, and this can restore the man's ability to have nearly full control of their urinary stream and allow them to return to daily activities. Like I said, it's my favorite surgery to do because of the huge impact it has on their life.
Scott Webb: Yeah, I think as we wrap up here, I want to ask you, men sometimes aren't the best at speaking up, at telling their doctors what's going on. And we get into areas of erectile dysfunction and male urinary incontinence, those are the types of things that maybe men aren't always great at speaking about. And so from your perspective, as a doctor who sees men who treats men and maybe even has couples in the room, what would you like to tell them? You know, how would we encourage them to speak up when they're having what they might feel are sort of embarrassing things going on so that they can be treated?
Dr. Elizabeth Boes: Well, one thing I always try to reassure my patients about is that you may think that you were the only person with this problem, but I guarantee you, you are not. And it's just that, like we talked about, you're not talking about this at the bar with your friend on a Friday evening. You don't say, "Hey, Bob, how's it going? How's your urinary stream?" It's just not something that's talked about. But when you come into the urology office or when you come into your primary care office, you know, that's a safe place, that's a safe space for you. And I encourage you to speak up. I ask all my patients, if they come in there, it doesn't matter what they're coming in for. If they're coming in for, say, a kidney stone, we talk about sexual health and I bring it up because who else is going to? This is what I treat. This is what I do. And I try to reassure my patients and tell them, "Hey, you're not the only one out there. This is something that I treat and I see on a daily basis. And I see multiple patients with this on a daily basis." And you're right, getting men to ask for help and getting them to bring this up is a challenge. And I think hopefully by spreading the word that there are many people who are treated for conditions such as this, and it shouldn't be a condition that is considered taboo, it should be something that is talked about more openly so that they know there are options, there are treatments. They don't have to suffer in silence. And there are things we can do to hopefully improve their quality of life and, you know, potentially improve their sexual function as well.
Scott Webb: Yeah, that's perfect. And we certainly hope, you know, podcasts like this, we hope that we accomplish that goal of engaging people in conversation, letting them know, as you say, they don't have to suffer in silence. They just need to speak up. And we hope that they do in those safe spaces. So doctor, thanks so much for your time. You stay well.
Dr. Elizabeth Boes: All right. Thank you so much.
Scott Webb: And for additional information, visit summahealth.org/urology or call 330-374-1255 to schedule an appointment. And if you found this podcast to be helpful and informative, please share it on your social channels and be sure to check out the full podcast library for additional topics of interest. This is Healthy Vitals, a podcast from Summa Health. I'm Scott Webb. Stay well, and we'll talk again next time.