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men speak out on life with erectile dysfunction

almost half of canadian men over 40 have difficulty maintaining an erection.

by vanessa hrvatin

apr 12 2021
read time 5 minute read
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erectile dysfunction causes and treatment
many many are reporting erectile dysfunction amid the pandemic. getty
it was a few days before christmas when nick batistic got the news — he was about to undergo his second battle with cancer. diagnosed with thyroid cancer nearly 20 years prior, he was now facing prostate cancer. he received a diagnosis in december 2010 and shortly after started hormone therapy followed by radiation treatment.
more than a decade later, 74-year-old batistic enjoys relatively good health and is cancer free. but the radiation did leave him with one noticeable side effect — he has erectile dysfunction.
it’s estimated that nearly 50 per cent of canadian men over the age of 40 have some level of erectile dysfunction, which is the inability to achieve and/or maintain an erection that allows for satisfactory sexual activity. this of course means there’s a spectrum — what one man considers satisfactory another might not, so a diagnosis hinges on what a person identifies as a change in their own normal function.

what causes erectile dysfunction?
in some instances, erectile dysfunction is a natural by-product of aging. other times, like in batistic’s case, it’s the result of treatment or medication, and sometimes the root cause is psychological such as stress or mental health conditions.

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in many cases, erectile dysfunction is the first symptom that presents when someone has an underlying medical condition such as diabetes, a sleep disorder, high blood pressure or heart disease.
“if we can identify the underlying root cause [of dysfunction] and it’s reversible, whether it’s getting diabetes under control or making sure all cardiovascular risk factors such as blood pressure and cholesterol are properly managed, doing this will result in better erectile function,” says dr. anthony bella, urological surgeon and former greta and john hansen chair in men’s health research at the university of ottawa.
according to bella, the pandemic is causing a spike in erectile dysfunction, probably as a result of less exercise, stress, poor sleep hygiene and anxiety. toronto urologist dr. yonah krakowsky says he’s seen an increase in the number of young people coming in with erectile dysfunction since the pandemic — he estimates about half his patients are under the age of 40.

the underlying cause of ed matters
  the starting point for treatment involves collecting a full medical history and running tests that might identify or rule out other medical conditions.

“the underlying cause matters because you wouldn’t want to jump into giving someone a pill if by improving their sleep and stress levels [their erectile function] gets better,” says krakowsky. “but you don’t need to point to the exact medical cause for someone that has erectile dysfunction in order to offer them treatment. if someone is bothered by their inability to have erection, then they should be offered treatment.”
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if lifestyle modifications have been made and other medical issues addressed but a person is still struggling with erections, therapies directly targeted at the dysfunction are an option. krakowsky says it’s important to figure out the least invasive treatment plan that’s most appropriate for each person. typically, oral medications such as viagra will be offered first, but medical history plays an important role — a person who has undergone radiation on their prostate is unlikely to respond to these medications. other treatment options include injecting medicine into the penis with a needle, a vacuum device and surgery to place an implant in the penis.
these are the treatments typically offered in canada, but a quick internet search will present other options like shockwave therapy and platelet-rich plasma (prp) injection therapy. these therapies usually carry a hefty price tag and aren’t covered by provincial health care plans.
bella says there is some scientific evidence that shockwave therapy is effective, but it’s important to look at a person’s medical history to decide if they’re a good candidate for this type of treatment. he says on average, out of every ten patients he sees who ask for shockwave, one or two might benefit from it. there isn’t much scientific evidence to support prp therapy — where blood is drawn from a patient, plasma is removed and then injected into the penis — and only a few small trials have shown modest benefit when it comes to herbal supplements such as korean red ginseng and horny goat weed.

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bella and krakowsky agree that a patient should have autonomy in choosing treatment but being cautious and doing research is a good approach. some factors to consider are whether the person offering treatment is a specialist in this area and what claims they make about the end result (claiming a treatment is guaranteed to work is a red flag).
“i don’t think it’s controversial to say if you have a hammer, then everything looks like a nail,” says krakowsky. “if you’re not a physician and the only treatment you have is a shockwave machine for example, then everyone who comes in will be a candidate, as opposed to if you see a family doctor or a urologist or an endocrinologist and they look at your testosterone, lifestyle, blood pressure control and consider different pills, injections and surgeries and put all this information together.”
treatment should always be optional — if there are no underlying medical conditions, erectile dysfunction doesn’t need to be treated. this was the case with batistic — he didn’t seek out treatment and says his inability to have sex has not impacted his relationship with his wife.
“to me, it was just a passing of a physical ability,” he says. “i liked it, it was fun, but it’s not important to my wife and if it’s not important to her then it’s not important to me.”

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finding support
if a person notices a change in their normal erectile function, the first step is making an appointment with their family doctor, who will then refer to a urologist or other specialist if necessary.

rick johann is 60 years old and lives in fort lauderdale, fla. five years ago, he was in europe with his partner on vacation when he stopped being able to have erections. over the next several years the situation got progressively worse, and his family doctor referred him to a urologist last year. johann says the urologist suspects his dysfunction is the result of antidepressants he’s been on for many years. johann has tried different therapies and says the latest has resulted in much improvement over the last several months — he can now maintain an erection for 15 minutes.


 

johann describes his experience with erectile dysfunction as “disturbing” in many ways and says he often worried his husband was losing patience. he joined a facebook group for support which has been a positive experience.
“i think for most men, including myself, there is disappointment and shame,” says johann. “you can’t believe it and you’re embarrassed to even admit that you have an issue with your penis. i think men are programmed —whether you’re straight or gay — to believe that half of your life lives below your belt and that is not true. i’m not embarrassed about any of it anymore and i think it’s helpful for people to have conversations about this.”

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