On Erectile Dysfunction, or An Outrageous Lecture

Dr. Brindley’s exposure of a very private part of his body, during a lecture he gave, was daring — some would say outrageous. Years later, physicians still talked about what had happened during that presentation. (It happened in Vegas, but it definitely did not stay in Vegas). One doctor who was present in the audience reminisced about the event in an article called “How (not) to Communicate Scientific Information.”

Dr. Brindley was introducing a new treatment for erectile dysfunc- tion. Erectile dysfunction is defined as the inability to obtain or maintain satisfactory erections. I will tell you more about Dr. Brindley’s presenta- tion and what made it infamous, but first, let me tell you about the anato- my of the male genital system, how erections develop and about the causes for erectile dysfunction.

The anatomy of the penis is com- plex. Its design would not put to shame even the most ingenious of Apple engineers. Like the iPhone, it is a compact “device” that contains several applications. The penis is innervated by multiple nerve end- ings. (Shall we call this app “iSense?”) It has a rich blood sup- ply. Three cylindrical, sponge-like structures run along the penis: two of the cylinders run side-by-side, while the third one, a cylinder that contains the urethra — the “pipe” through which men void – runs underneath the two other cylinders.

In a healthy man, an erotic stimu- lation results in a tiny electrical impulse traveling through the nerv- ous system from the brain into the penis. Through a series of biochem- ical reactions, this impulse leads to widening of the arteries that supply blood into the penis. The spongy tis- sues within the penile cylinders fill with blood, and erection develops.

Any injury or disease affecting one or more of the structures men- tioned above — nerves, blood ves- sels, or the erectile tissue within the penile cylinders — will result in erectile dysfunction. Interestingly, some of the risk factors for erectile dysfunction are similar to the risk factors for the development of coro- nary heart disease, where the arter- ies supplying the heart become blocked, possibly leading to a heart attack. These risk factors include: advanced age, diabetes, high blood pressure, hyperlipidemia (elevated blood lipids and cholesterol), being overweight, lack of exercise and smoking.

Why do erectile dysfunction and coronary artery disease share the same risk factors? It is because the arteries supplying the heart and the penis are of similar diameter. So factors leading to blockage of the arteries supplying the heart can also lead to blockage of the arteries supplying the penis.

In some men, erectile dysfunction is the first sign of heart disease. Therefore, erectile dysfunction should not be ignored, especially in

young men. Other causes for erectile

dysfunction include: use of medications for the treat- ment of hypertension or depression, low testos- terone levels resulting in decreased libido (lack of desire for sexual inter- course) and injury to the nerves innervating the penis. Injury to the nerves

innervating the penis can occur during long bicycle rides, or as a result of surgery or radiation treat- ment for the treatment of prostate cancer.

Depression, emotional stress and anxiety can also affect men’s libido and sexual performance.

In the past, doctors divided the causes of erectile dysfunction into two groups: psychological causes and physical causes. To distinguish between the two groups, doctors tested the quality of the natural, spontaneous erections during sleep (nocturnal erections).

If the patient had erections during the night, it meant that there was no physiological cause to his erec- tile dysfunction, and that his prob- lem is psychological in origin. If no erections occurred during the night, it meant that the cause for patient’s erectile dysfunction was physiological.

The presence of nocturnal erec- tions was tested by sticking a stamp (like on a letter) on the patient’s penis (a torn stamp in the morning would confirm that the patient had an erection during the night), or by applying an elastic ring around the penis which was connected to a small computer that recorded the changes in penile girth and rigidity.

Patients with psychological erec- tile dysfunction were sent for sexu- al therapy, while patients with phys- ical erectile dysfunction were told that there was no effective treat- ment for their condition.

Today, most doctors do not dwell on differentiating between psycho- logical and physical erectile dys- function. This is for two reasons: first, we now know that most men with erectile dysfunction have at least some degree of physical abnormality. Second, no matter whether the cause is psychological or physical, we have effective treat- ment options for men with erectile dysfunction.

Dr. Brindley’s famous presenta- tion, in Vegas, made history. It brought to the forefront a new treat- ment option for men with erectile dysfunction.

It proved that no matter what the cause for erectile dysfunction is, it can be successfully treated. Please join me next week, when I will tell you more about Dr. Brindley, his lecture and the treatments avail- able for erectile dysfunction.

Dr. Shahar Madjar is a urologist working at Aspirus Keweenaw Hospital. He sees patients in Laurium, Houghton and L’Anse.

On Erectile Dysfunction, or An Outrageous Lecture

Contact him smadjar@yahoo.com.