Let’s Talk About Sex: Men’s Edition

If a man is having an issue with sex, their partner may be the only one who knows it. We tend to adore an image that is endlessly virile, yet persistently silent. Meanwhile, studies have shown that as many as 50 percent of men in the United States experience erectile dysfunction (ED). And this is the most common stumbling block to a healthy sex life.  

Angelo Baccala, MD, Deputy Physician in Chief, Innovation and Program Development, Lehigh Valley Institute for Surgical Excellence, says that men often treat ED as a side note. “Men are embarrassed to talk about it, and it comes out when we’re talking about something else,” he says. But he adds that secrecy can be risky. “Sometimes, men have stopped having sex because of ED and think it doesn’t matter. But it does. It could indicate an underlying medical problem.”

This is the biggest concern Dr. Baccala has for his patients, who engage him for everything from infertility to prostate cancer. “What’s needed for an erection are good blood flow and nerve function. If ED is happening, it could be caused by diabetes, neurological issues or cardiovascular issues, where blood flow is inhibited. Even medication can have an effect,” he says.   

Dr. Baccala urges men not to be afraid to tell their clinicians if they have ED. “It might simply require an adjustment, such as lowering the dose of blood pressure medication, for example,” he says.

If this isn’t the case and testing doesn’t show a medical condition, the first line of treatment for ED would be a vasodilating medication (also known as PDE5 inhibitors), such as Viagra®. Generic forms of PDE5 inhibitors are available and less expensive. The patient may only need to take the medication a few times before normal function returns.

In some instances, a next step might also be a referral for counseling. Conditions such as depression, anxiety and stress can play a part in sexual function.

For more serious cases of ED, the Institute for Surgical Excellence offers various surgical treatments. These include irreversible silicone penile implants and inflatable penile pumps, which comprise cylinders that the surgeon places inside the penis. Sometimes medication injections are used to dilate the blood vessels and increase blood flow to the penis. “There are lots of things we can do,” Dr. Baccala says.

In cases where ED results from a prostatectomy (surgery for prostate cancer), it can take up to a year for  a patient to get an erection even with rehabilitation and medication management. However, with leading-edge technology employed at Lehigh Valley Topper Cancer Institute, including the noninvasive robotic Focal One® HIFU (high-intensity focused ultrasound), patients have a better chance to recover function quicker.

“We precisely outline the areas of risk around the cancerous tumor, which lessens the impact to surrounding healthy tissue and spares the nerves,” Dr. Baccala says. “This minimizes the risk of side effects, including ED, commonly associated with radical prostatectomy and radiation. This technology has completely changed the landscape for our postop patients.”

Another common barrier to sex is when erection is possible, but the interest isn’t there. The issue could be hypogonadism, or low levels of testosterone.

In this case, hormonal treatments are available. These include testosterone gel injections that increase hormonal levels over time and testosterone pellets, which are injected under the skin. “There are different formulas, and we monitor hemoglobin levels in the blood and other levels in these patients closely,” says Dr. Baccala, noting that elevated hemoglobin can thicken blood, increasing the potential for blood clots. 

Regardless of the problem a man might be having, Dr. Baccala emphasizes the importance of sharing it with a physician so that they can rule out anything medical. For all such conditions affecting men’s sexual health, Dr. Baccala says – for the best care – men should see someone who specializes in this area, not just a general urologist.

“We want men to understand that they don’t have to change their lifestyle,” he says. “With our help, a healthy sex life is possible.”