iAPPE’s Guide to Men’s Health: Erectile Dysfunction (ED) and Benign Prostatic Hyperplasia (BPH)

An Introduction to Erectile Dysfunction  Erectile dysfunction (more commonly abbreviated as ED) was considered a crime and can be a legitimate cause for divorce in 16th and 17th century France.  Deterioration in sexual competency is not a crime in today’s society per se, but perceived stigma still lingers around the taboo subject.

Erectile dysfunction affects approximately 20% to 30% of American males, and its impact can be detrimental to one’s emotional well-being and quality of life.  Ordinarily, erectile dysfunction is manifested by males’ inability to keep an erection and/or involves premature or delayed ejaculations.  Aging is no doubt an inclusive criterion, but erectile dysfunction can occur at stage in a male’s lifespan.  While we may joke about it, erectile dysfunction is no laughing matter from a medical perspective.  Serious heath issues are commonly linked to ED; therefore, it is particularly imperative for men with erectile dysfunction to acknowledge and discuss the concern openly with a healthcare provider.  Common contributive factors regularly associated with erectile dysfunction includes—but not limited to—cardiovascular diseases, atherosclerosis, hypertension, peripheral neuropathy, depression, neurogenic disorders, multiple sclerosis, obesity, Parkinson’s disease, benign prostatic hyperplasia, and testosterone deficiency.

Select drugs, alcohol consumption, and tobacco use are additional risk factors for ED.

Pharmacological Treatments  Since the accidental discovery of Viagra (originally an antihypertensive study drug) by Pfizer’s scientists in the late 80’s, erectile dysfunction drugs have generated pharmaceutical companies’ generous volumes of revenues.  Drug class known as phosphodiesterase (PDE)-5 inhibitors—such as Viagra, Cialis, or Levitra—are the first line treatment for ED.  Male enhancing pills are no cheap thrills by any means. The vast majority of insurance companies will snub their responsibilities in picking up the tabs for these so called “lifestyle” drugs, leaving patients with huge monetary burdens.  What about generic Viagra from India–as seen advertised everywhere on the internet–promising similar ingredients and quality at a fraction of the price?  But wait! Before you decide to frugally self medicate, take into consideration that buying any kind of medications through the world wide web is dangerous, period.  According to data presented at the World Meeting on Sexual Medications, “77% of all generic Viagra purchased online from 22 different webpages were counterfeit 1.  After all, the FDA recommend against purchasing drugs through online entities (particularly from foreign countries).

In cases where patients are intolerable or have contraindications to PDE-5 inhibitors, Alprostadil is a viable alternative.  Alprostadil is a synthetic prostaglandin E1 analog, available as an intercavernous injection or urethral pellet.

Non-pharmacological Treatments   Life style modifications is your go-to solution.  Scientists have found that “men with a body mass index (BMI) higher than 28.7 have a 30% higher risk for erectile dysfunction than those with normal BMI 2.  Lifestyle modifications including regular physical activities, smoking cessation, and weight loss are recommended for maintaining optimum sexual functions.  Furthermore, a study published by the Journal of Sexual Medicine in 2012 found that “men with erectile dysfunction are three times more likely to have gum disease than men who do not have ED3.  Consequently, it is recommended to keep your gums and teeth healthy with regular, bi-annual dental check-ups.  Other non-pharmacological treatments are the use vacuum erection devices, extracorporeal shockwave therapy, and/or surgery.  Moreover, various alternative natural products available over the counter are L-arginine, ginseng, ginkgo biloba, and yohimbe.  Consensus regarding the effective of the aforementioned approaches have been reached.  The FDA continues to recommend against the use of natural and herbal products when weighing its unjustifiable risks and benefits.

For additional information,  refer to iAPPE’s Guide to Men’s Health (BPH, ED).


  1. http://www.medpagetoday.com/MeetingCoverage/SMSNA/34493
  2. http://jama.jamanetwork.com/article.aspx?articleid=198993
  3. http://healthland.time.com/2012/12/05/what-does-gum-disease-have-to-do-with-erectile-dysfunction/
  4. Shapiro, Karen, Sherry A. Brown, and John An. RxPrep Course Book. San Diego, CA: RxPrep, 2016. Print.
  5. lexicomp online
  6. https://www.nlm.nih.gov/medlineplus/menshealth.ht

Feature photo credit: http://www.nydailynews.com/life-style/health/male-birth-control-pill-ready-testing-year-article-1.1138014



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