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Erectile Dysfunction

If this topic doesn't convince you of the importance of functional medicine then nothing will, because if there is any place conventional medicine really falls short of addressing the root cause of an issue (to the point of near negligence) then this is it.

Maybe it's lack of understanding of the root cause? Maybe it's not having enough time to offer options beyond the highly marketed pharmaceutical? Or maybe it's because clinician's just don't appreciate sexual function as an important part of a thriving life so it goes undiscussed? But whatever the cause, healthcare is failing men miserably in this regard.

What we do know is that practitioners are not asking about sexual health and individuals are not initiating these conversations because they feel this may be inappropriate. If asked though, most are willing to share their concerns and are grateful for the opportunity to discuss options for improving their performance (Bladwin, Ginsberg, & Harkaway, 2003; Fisher, Dervaitis, Bryan, Silcox, & Kohn, 2000; Fisher, Meryn, & Sand, 2005; Pascoal, Slater, & Guiang, 2017).

Interestingly, studies have demonstrated that primary care providers fear they may offend clients or that these conversations may jeopardize their professional relationship. There are, of course, some practitioners who share these conversations are prohibited because of their own personal, cultural, or religious beliefs. Maybe they shouldn't have become primary care providers? Others make the assumption that their clients are not sexually active so they avoid the topic entirely (Gott, Galena, Hinchliff & Elford, 2004; Gott, Hinchliff, & Galena, 2004; & Wei & Mayouf, 2009).

The reality is though, that the primary care provider is exactly who should be asking these questions. It is our role to evaluate and manage #sexualdysfunction because these diseases and their medications are within our specialty. Embarrassment or any discomfort with regards to sexual health really has no place in primary care. Here's the thing though, even if the clinician does bring up this sensitive discussion and even when the client shares their concern, at best, he will receive a pharmaceutical without regard to the underlying cause (Lim, Moorthy, & Benton, 2002; Blonde, 2006; Laties, 2009; Santaella, & Fraunfelder, 2007; Mukherjee, & Shivakumar, 2007; Choi, Ahn, & Kim, 2003; & Kruuse, Thomsen, & Birk, 2003).

Sexuality is an Important throughout Our Lifespan

A huge misconception about sexual dysfunction, even among clinicians, is that it is an inevitable part of the aging process (Pascoal, Slater, & Guiang, 2017; & Vik & Brekke, 2017). Ignorance to this fact means that clinicians are missing early warning signs of declining vascular health and impending diabetes. The data is clear that both men and women remain sexually active their entire lives and that their sexual satisfaction is an important aspect of both their physical and mental wellbeing. Sexuality is a key element of vitality in the later years of life, so identifying dysfunction early is an important component of our wellness evaluation as primary care providers (Pascoal, Slater, & Guiang, 2017).

Complaints Among Men

Erectile dysfunction can present in a number of ways. It isn't exclusive to inability to attain and maintain an erection. Rather, it may include premature ejaculation or even an inability to perform and satisfy as they were previously capable. Elderly men in particular who are struggling with erectile or sexual dysfunction are also reporting more injury and chronic illness which leads to more frequent sexual problems and decreased sexual satisfaction (Pascoal, Slater, & Guiang, 2017).

Low sexual interest and performance anxiety are also frequently reported, but again, the clinician must ask these questions to initiate dialogue. Our clients are not likely to feel this topic is appropriate to bring up on their own, so they wait for invitation. Additionally, most are unaware that sexual dysfunction is an indicator of declining health, not related to the aging process. The literature is clear though that the penis is a barometer of the body's endothelial function; meaning, if you're suffering erectile dysfunction, you are headed into #diabetes or heart disease so a very important part of the wellness exam (Cayan et al., 2007, p 123).

Erectile Dysfunction is an Early Warning Sign of Dis-ease

Clinicians should consider erectile dysfunction an early warning sign of other co-morbidities, as the vascular endothelium plays a pivotal role in the health of the corpora cavernosa (spongy innards of the penis). Prostatic diseases, kidney failure, chronic obstructive pulmonary disease, and vascular ris factors including atherosclerosis, high blood pressure, high cholesterol, coronary artery disease, heart diseases, and diabetes are all risk factors associated with erectile dysfunction. Interestingly, neurological disorders such as spinal cord injuries, epilepsy, prior pelvic surgery, and trauma were not associated in the Cayan et al (2017, p 126) study. In my own practice, this is also indication of alcoholism. Five or more drinks a week, for men, is considered excessive alcohol intake.

Diabetes mellitus is the strongest independent predictor for moderate-severe erectile dysfunction in men older than forty with a five-fold increased risk for erectile dysfunction. The risk is four-fold with hypertension, three-fold with atherosclerosis, two-fold for coronary artery disease, and two-fold for elevated lipids (Cayan et al., 2017, p 126).

Erectile dysfunction is an early symptom of artery disease and studies show it presents as an early warning sign two or three years before a heart attack or stroke (Jackson, 2008). Prostate disorders are also an independent risk factor for occurrence for moderate to severe erectile dysfunction (Cayan et al, 2017, p 126).

Propaganda Has Led Physicians to Not Think Any Further

Consumers have been educated by pharmaceutical companies that sexual symptoms are corrected with drugs. This same propaganda has led physicians to not think any further than the primary complaint, simply offering Viagra, Cialis, or Levitra. These pharmaceuticals only work in half of all men for which they are prescribed and cause significant side effects in many of those who do utilize them (Lim, Moorthy, & Benton, 2002; Blonde, 2006; Laties, 2009; Santaella, & Fraunfelder, 2007; Mukherjee, & Shivakumar, 2007; Choi, Ahn, & Kim, 2003; & Kruuse, Thomsen, & Birk, 2003).

A study published in Andrology found a significant number of men with erectile dysfunction also have low levels of L-arginine, an amino acid and precursor for nitric oxide (Barassi, Corsi, & Pezzilli, 2017). Nitric oxide relaxes blood vessels and enables efficient blood flow, which is vital for vascular health and male sexual function (Schoones, Visser, & Musekiwa, 2012; Wu & Meininger, 2009; Stanislavov, Nikolova, Rohdewald, & 2008).

Another study, from 2015, found that supplementing with L-arginine and pine-bark extract significantly boosted erectile dysfunction (Kobori, Suzuki, & Iwahata, 2015). These nutraceuticals not only improve erectile dysfunction, but also the root cause within the cardiovascular system (Stanislavov, Nikolova, & Rohdewald, 2008; Kobori, Suzuki, & Iwahata, 2015; Stanislavov & Nikolova, 2003).

Adding pine bark (80mg) to L-arginine aspartate increased the number of men who could achieve erections by 75 percent over L-arginine alone, and increasing the dose of pine-bark to 120mg increased the response another 12.5 percent so that 92.5 percent of men could achieve and maintain erection (Stanislavov & Nikolova, 2003). A double-blind, placebo-controlled, crossover study found pine bark extract and L-arginine restored erectile function to normal and doubled intercourse frequency within one month. Nitric oxide synthase and blood testosterone levels were also significantly increased, and blood cholesterol, as well as blood pressure readings were improved (Stanislovov, Nicolova, & Rohdewald, 2008). Mic drop.

But I am offering even more. A 2012 double-blind study, by Aoki, Hago, & Ueda found patients with mild-to-moderate erectile dysfunction were treated with either placebo or a daily dose of pine bark extract (60 mg), L-arginine (690 mg), and aspartic acid (552 mg) and after eight weeks, there was remarkable improvement in erectile dysfunction, including improved hardness and satisfaction with sexual intercourse. There was also significant decrease in blood pressure and a slight boost in salivary #testosterone, with no adverse reactions.

Men with erectile dysfunction and a low sperm count receiving pine bark extract (60 mg), and aspartic acid (552 mg) had significantly improved sexual function four months later and their sperm concentration was notably increased and no adverse reactions were reported (Kobori, Suzuki, & Iwahata, 2015). I kinda feel like Michael Scott right now.

Nine of ten men have improved sexual dysfunction with complementary medicine, without adverse effects and they have improved health that is quantifiable.

The good news is that while studies demonstrate that physicians are poorly prepared to discuss human sexuality with their clients, we have also identified that they are interested in learning more (ogan, Demir, Eker, & Karim, 2008; Gott, Hinchliff, & Galena, 2004; Bouman & Arcelus, 2001, Hughes & Wittmann, 2015). Sadly though, research has also found they aren't discussing condom use, sexual coercion or intimate partner violence either (Garcia & Fisher, 2008).

Not Being Able to Achieve an Erection is Pathologic

Our goal as clinicians is to address the complaint and correct the root cause in effort to optimize health. When the nutraceutical approach not only offers far greater success without any reported symptoms, and the heavily marketed pharmaceutical is only effective for about half its users and risks potential blindness in users, then we are either practicing as clinicians who do what is best for our clients and offer an integrative approach or we stick with conventional medicine and acknowledge we are puppets in a broken system.

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