Urologist with UBMD Urology discusses erectile dysfunction. ‘It’s often a harbinger of bad things to come,’ he says of the condition
By: Chris Motola
Q: I’ve heard from some urologists that there’s some concern that the COVID-19 pandemic is leading to a rise in erectile dysfunction. Any truth to this?
A: Erectile dysfunction can be a problem for patients as they get older and unhealthy. But specifically related to the pandemic, as in “is there a relation between getting the virus and having erectile dysfunction?” That would be very challenging to prove. I don’t know of any literature on that. You’d need a real investigative trial to come up with that answer. But have I, specifically, seen patients who appeared to develop erectile dysfunction with no explanation beyond COVID? No. I haven’t seen any evidence regarding that.
Q: I imagine it would be confounded by a lot of the lifestyle alterations brought about by the last two years.
A: Yeah, it’s very difficult to prove. And erectile dysfunction is a very common reason people come to our offices, so we see a lot of it. But so far, I’ve seen no evidence of a direct connection.
Q: Generally speaking, what are the factors that tend to lead to erectile dysfunction? What’s the difference, let’s say, between an older man with no issues and one who has erectile dysfunction?
A: That’s a good question. There are different types, but we generally think of it as a vascular problem. It’s a problem of small blood vessels. Anything that affects small blood vessels can potentially cause erectile dysfunction. As you might imagine, the common ones are diabetes, high blood pressure, obesity, high cholesterol and smoking. Smoking is clearly a killer of erections; especially if you’re combining obesity, diabetes and smoking. That’s almost a guarantee you’re going to run into erectile issues. Age is also important. If you’re seeing it in a patient in their 40s and they’re smoking, obese and have diabetes and they start having erectile problems, that’s a sign of bad things to come. Usually their larger vessels will be affected next.
Q: That was going to be my next question. To what degree is erectile dysfunction a harbinger of more serious health problems?
A: Especially with the smokers—it’s amazing how many patients still don’t know that smoking contributes to erectile dysfunction. But, yes, it’s often a harbinger of bad things to come. There have been some great papers written on that. Patients already having some problems in their 40s and 50s really need to start thinking about what’s going to happen down the line with their heart. I always bring that up to patients. Smoking cessation really is critical.
Q: What kinds of treatments are available for erectile dysfunction? Can it be cured, or just managed?
A: There are all sorts of different treatments. We don’t like to just throw medications at patients. The most important part is lifestyle modifications: controlling blood pressure, losing weight, controlling diabetes, smoking cessation. Sometimes medications can contribute to erectile dysfunction. There are some blood pressure medicines in particular that are known to cause it. Exercises that increase blood flow to the pelvis can help. So that’s number one. We also try to rule out hormonal issues, like some patients will have low testosterone. We can screen for that and address it if needed. That’s the primary focus. There are medications a lot of people are already familiar with that have been on the market for a while. They’re now generic, which is nice, because they’re a lot more affordable and they work fairly well. Then we have three other options.
Q: What are those?
A: We have the vacuum erection device, which increases blood flow to the penis. We have injection medications. And there are surgical options that work well, but are typically the last resort.
Q: Have baby boomers brought more attention to the subject?
A: I think so. I’ve been practicing for about 12 years and it no longer seems taboo to talk about. Most patients are freely able to talk about it without the shame we might have seen in previous generations. Patients are also bombarded by advertisements on TV, radio and the internet, which has good and bad impacts. But we talk about it as urologists every day. It’s no longer something to fear.
Q: With regard to lifestyle changes for erectile dysfunction, are there any targets to hit, at which you can expect symptoms to improve?
A: I think it’s different for everybody. It’s certainly a process. The important thing is things are pointing in the right direction. During the pandemic, we’ve seen a lot of patients go in the wrong direction; staying home, overeating and unfortunately gaining a lot of weight. Losing weight and eating better tends to have a positive effect on their overall health. I usually tell patients that a heart-healthy lifestyle is a prostate- and bladder-healthy lifestyle. Stay away from a lot animal proteins and eat a more plant-based diet. Those things are important. The other thing, too, is the importance of screening. Even before the pandemic there were a lot of confusing messages about prostate cancer screening being conveyed to patients. And then during the pandemic, patients stayed away from the office. Now some are presenting with more advanced cancers than we’d like. Screening is very critical when it comes to cancers, not just urological ones.
Q: Has there been an increase in STD rates as of late?
A: Yeah, I think there has, particularly chlamydia; some other STDs as well. But yes, there has been. Again, we are seeing that in the office and screening the appropriate patients. You have to remind patients to have safe sex.
Q: Is that across all age groups?
A: Good question. I’m not exactly sure how the demographics break down. Typically it’s in the more sexually active age groups, but even in older patients. Just because you’re in your 60s or 70s, it doesn’t mean you can just forget about STDs. They’re really quite common. And those patients can certainly still be active. So if the patient presents with those symptoms, we usually screen with urine and blood testing.
Name: John Rutkowski, MD
Affiliations: Western New York Urology Associates, UBMD Urology
Education: Medical degree from the State University of New York at Buffalo; general surgery internship and urology residency also at University at Buffalo; clinical fellowship in urologic oncology at the Cleveland Clinic in Florida. Currently a clinical associate professor at University at Buffalo having received the Faculty Teaching Award in 2021
Organizations: American Urologic Association; Erie County Medical Society; Society of Urologic Oncology
Family: Wife; one child
Hobbies: Running, biking, skiing, hanging out at the park