More than 80% of men with erectile dysfunction know that the condition can be an indicator of other serious diseases, but 38% of men with the condition still haven't spoken to their physician about it, according to a survey sponsored by Eli Lilly & Co.
Many men cited their own discomfort as the main barrier to discussing their sexual health, but they also said that they didn't know what to ask, or thought that other health topics were more important to discuss during the visit.
The online survey of 300 men aged 45 and older who reported experiencing erectile dysfunction at least occasionally was presented during a Webcast sponsored by the Men's Health Network and Eli Lilly, which markets tadalafil (Cialis) for the treatment of erectile dysfunction.
But for those men who are willing to broach the subject with their physicians, the visit offers an opportunity to assess other aspects of their health, experts said.
“The new interest in erectile dysfunction is bringing men to see their physicians who might not otherwise have gone, giving us an opportunity to assess a man's overall health far beyond the presenting complaint,” said Dr. Jean Bonhomme, a member of the board of directors of the Men's Health Network.
Disturbances in the circulatory or nervous systems or hormonal systems can all result in or contribute to erectile dysfunction, Dr. Bonhomme said.
In fact, new research indicates that erectile dysfunction may offer physicians an early warning about coronary artery disease, diabetes, and metabolic syndrome, said Dr. Ridwan Shabsigh, director of the division of urology at Maimonides Medical Center in Brooklyn, N.Y. Dr. Shabsigh received honorarium from Eli Lilly for participating in the Webcast and has served as a consultant to Eli Lilly and other companies that market erectile dysfunction medications, including Pfizer Inc., Bayer Healthcare Pharmaceuticals, and Schering-Plough Corp.
In a study recently published in the Journal of the American College of Cardiology, researchers found that among men with type 2 diabetes, those who also had erectile dysfunction were more likely than men without the condition to have symptoms of coronary heart disease and that erectile dysfunction was an independent predictor for coronary heart disease events (J. Am. Coll. Cardiol. 2008;51:2045-50).
The process of atherosclerosis and coronary heart disease is frequently silent until the first heart attack, Dr. Shabsigh said. As a result, it is important that middle-aged men with erectile dysfunction who are otherwise asymptomatic see their physician. And physicians who see these otherwise asymptomatic patients should try to intervene early with disease and behavioral modification, Dr. Shabsigh said. Conversely, physicians should ask about erectile dysfunction in patients with hypertension, he said.
“This presents an opportunity for erectile dysfunction to be an early warning marker of otherwise dangerous silent diseases,” he said.
Conversations about erectile dysfunction vary in his practice, Dr. Shabsigh said, depending on the comfort level of the patient. Some men will initially avoid a long conversation about erectile dysfunction even when they have questions. However, they usually open up once they feel more comfortable. Other patients are more comfortable from the start and will ask a lot of questions about what causes the condition.
The first step in helping a patient become more comfortable communicating about sexual issues is for the physician to be comfortable themselves, Dr. Shabsigh said, and there are continuing medical education courses and other resources available to help.
Once the physician is comfortable, he or she should raise the topic in the context of overall health, Dr. Shabsigh advised. For example, physicians can include erectile dysfunction in the review of systems. Signaling to the patient that sexual function is just part of overall health removes some of the stigma associated with the conversation, he said.
Physicians can also consider dedicating an entire visit to discussing sexual health issues. If a patient brings up the issue and there's limited time for a discussion, the physician can schedule another visit to work out those issues, he said.