Erectile dysfunction is often a conversation that gets swept under the rug – in part due to potential feelings of shame and embarrassment. We are taking the subject on to help dispel the stigma!
Erectile dysfunction is often a conversation that gets swept under the rug – in part due to potential feelings of shame and embarrassment. We are taking the subject on to help dispel the stigma!
Our LISTEN WELL host Dr. Mo Alsuwaidan talks all things ED with Dr. Annamaria Girladi, the president elect of the International Society for Sexual Medicine. Together they look at how many people are affected, what it can mean physically, for relationships, mental health, and self-esteem, and how erectile issues can be an indicator of more serious health problems. Most importantly, they cover how to tackle the stress and frustration of ED and how to seek help. Tune in today!
The opinions expressed are the opinions of the individuals recorded and not the opinions of Viatris.
The International Society for Sexual Medicine:
https://www.issm.info/
Disclaimer: This podcast is provided for educational purposes and is not intended to replace discussions with your healthcare provider. All decisions regarding your care must be made with a healthcare professional, considering the unique characteristics of your personal situation. The opinions expressed are the opinions of the individuals recorded and not the opinions of Viatris. Individuals featured in this podcast may have participated in the past as or may be current members of an advisory group for Viatris.
Dr. Alsuwaidan:
Welcome back to Listen Well. We hope you're enjoying the episodes we've put together so far. One of the things I love about hosting this podcast is being able to bring you important topics that may be difficult to talk about in person. It's always better to shed a little discrete light on an issue than to have people remain in the dark because they're too ashamed to get help. Today's topic is a prime example. Erectile dysfunction, or ED, the inability to get and keep an erection for intercourse, is a common issue that can greatly impact a person's quality of life and be a challenging source of frustration and stress for couples. Beyond that, ED can also be an indicator of more serious health issues.
Dr. Alsuwaidan:
Dr. Annamaria Giraldi, the president elect of the International Society for Sexual Medicine, will help us understand the causes of ED, it's linkages to silent illnesses and mental health. We'll also learn how you can support yourself or your partner in seeking help. We hope that by the end of the episode, you'll avoid shying away from getting help and become a firm believer in tackling ED head-on. It's time to Listen Well.
Dr. Alsuwaidan:
So Dr. Giraldi, welcome.
Dr. Giraldi:
Thank you.
I. What we know about ED
Dr. Alsuwaidan:
I wanted to start off with a basic question. What is erectile dysfunction? How do we define it?
Dr. Giraldi:
We define erectile dysfunction as the inability to get an erection or to keep an erection that is good enough for having sex or having intercourse. And also, it has to be something that has been there for a while. It's not that you just lose your erection once and then you have erectile dysfunction. So it has to be there over some certain time. And also, we could discuss that it also has to cause distress for the man or maybe for the couple that you have these problems with your erection.
Dr. Alsuwaidan:
So you mentioned time. Is there a certain number of weeks that it has to happen or is it more related to function?
Dr. Giraldi:
It is related both to function, but also to time. So usually, we would say between three and six months. If you had the problem for such a long time, then we say then maybe that's when you want to try to get treatment or talk to someone about it.
Dr. Alsuwaidan:
I see.
Dr. Giraldi:
But then you have conditions where it happens immediately, if you have surgery or other conditions that might trigger your erectile dysfunction, then maybe it would happen immediately, and then we wouldn't talk about time because then we know why it happened.
Dr. Alsuwaidan:
And do we know how common it is?
Dr. Giraldi:
Yeah. There have been quite a lot of studies looking at how common is erectile dysfunction. It depends a little bit on the different studies, but like in popular, you would say that 10% of young men would have it. And we know that it's something that increases with age. I think that's the most important thing. So we know that maybe 50% of men within the ages of 50 might have a problem, and 60 to 70% of men in the age of 70 and above that.
Dr. Giraldi:
But it's also important to remember that there are different levels of erectile dysfunction. Some might experience what we call mild erectile dysfunction, meaning that sometimes they have a problem. Other men might experience complete erectile dysfunction, meaning they can never have an erection. And we know that the older you become, the more common it is that you will have what we would call complete erectile dysfunction or moderate to complete erectile dysfunction.
Dr. Giraldi (00:05:43):
And some of the studies have shown that younger men, we would say below 40 years, maybe it's 5 to 10% of the men having complete erectile dysfunction. But when you get older, like more than 70 years old, maybe 15 to 20% that have, realistically, problems with their erections. But most men will experience that. When you become older, it might become a little bit more difficult to have an erection.
Dr. Alsuwaidan:
And is that a risk factor, becoming older?
Dr. Giraldi:
It is a risk factor becoming older because if we look at what are the mechanisms behind getting an erection, we can see some of the mechanisms might be a little bit impaired or very impaired when you become older or have different diseases that can have an impact on your erectile function.
Dr. Alsuwaidan:
I see. So age, and any other factors in a person's, for example, their lifestyle or other factors that might cause erectile dysfunction?
Dr. Giraldi:
Yeah. I mean, there are quite a lot of lifestyle factors and diseases. And I think I would like to maybe discuss it a little bit what is actually happening when you have an erection. Because I think if you have the picture of an erection being like fluid running to the penis and it has to run through the pipes to get there, then we can say that the vascular system, all the arteries are the pipes where the fluid has to run, the blood has to run to the penis. So that's the mechanism. You need to have the good pipe. You need to have a good vascular system to have the blood running to your penis to get a good erection.
Dr. Giraldi:
And also, you have to have some signals that tells the blood to run to the penis, that tells the fluid to run in the pipes. And you could say that the brain is like the headquarter signaling that you want something to run to your penis, that you want the fluid to run in the pipes. And also, from the spinal cord, the signal from the brain will go right out to the arteries saying now you're going to have an erection.
Dr. Giraldi:
So if we look at the system, you need to have the good arteries. You need to have the good vascular system. You have to have a good heart that can pump out the blood. You also need to have good nerves that will signal to the penis from the brain that now you want to have an erection or something sexual is happening.
Dr. Giraldi:
So if we look at that, it's very clear that the different aspects or different diseases and age can actually impair these signals. And we know that especially cardiovascular health is very important because you have atherosclerosis. If you have hypertension, if you have heart conditions that will impair the blood flow, then you will most probably experienced that. It's a little bit more difficult to have an erection. Also, if you have conditions like diabetes, that might impair the nerves to the penis, then the signal from the brain is impaired. And that means it's becoming more difficult to have an erection. Because even though you feel you would like to have it, then the signalto the brain is impaired. It's not as good as it should be because you have these damages in neuropathy of the penile nerves maybe.
Dr. Giraldi:
And also, we know that the brain is very important because if you have like depression or anxiety, if you're nervous about having an erection, or if you feel sad, if you're stressed, then the brain is actually sending out maybe more negative signals because it can feel that you're not doing very well, and then it might also impair the erection.
Dr. Alsuwaidan:
Yeah. I mean, the way you describe it, some people may understand it simply as erect or not erect, but there's a lot of complex mechanisms going on in the background.
Dr. Giraldi:
Yeah. I think there's a lot of kind of complex mechanisms going on in the background. And I think that when you think about how do you think your problem is if you have a problem or you as a physician want to discuss this with your patients, it might be very helpful to discuss a little bit, for example, can I have an erection when I'm alone with myself and not with a partner? That would indicate maybe it's because you become nervous, the brain becomes nervous, but actually, the mechanism is okay, the pipes are okay because you can have blood running into your penis when you're alone with yourself and you are relaxed.
Dr. Giraldi:
And another example is if you have atherosclerosis, you have very small blood vessels. It's very difficult for the blood to run to the penis, then most likely you'll have the problem all the time if you're with a partner, if you're alone, because the vessels aren't going to be the same no matter whether you're alone or with a partner.
Dr. Giraldi:
So I think that the history and the description of how you experience the problem is very important. Like do you have a morning erection? That might indicate that the nerves and the vessels are okay. If you don't have morning erections, maybe that's because the system is not working very well. You have maybe vascular problems or neuropathy.
So ED can be a sign of potentially serious problems beyond erection difficulties. We’ll explore this idea later in the episode.
Now, I was talking with a medical colleague once and he seemed to believe that the prevalence of this disorder is vastly overblown recently. So do we have any indication from the history of medicine of this problem?
Dr. Giraldi:
I think it’s very under-reported. I think that, I can tell from my clinical practice, a lot of the men that come to me, they will not have told anyone because having erectile dysfunction as a man is really a taboo that is so difficult to talk about, especially with other men. So often, they will come and say, "I've never told anyone. I had to tell my doctor because I had to get a referral to a specialized clinic, but it's so nice to actually talk about it and hear this is something that has been there for a while maybe. And I've been so sad about it.” And it's so nice to hear that other men will experience that, and maybe get an explanation. Because a lot of men will fear that something is really wrong with them. They fear it's only me and no one else is experiencing this thing.
And that’s why I love doing these podcasts – because information is so empowering. But I digress.
II. ED as being a Symptom of other disorders
Dr. Alsuwaidan:
So how does that conversation usually go for you once you tell them more information about erectile dysfunction?
Dr. Giraldi:
I think that what usually happens is that they become a little bit relieved because they see they are not alone. They see that we can actually do something.
Dr. Giraldi:
And I like to introduce what I call “penis wisdom” when I talk to my patients saying that something is happening in your penis, but it might be an indicator of what is happening else in your life, your body, in you. And that might be that we could talk about, if you have a bad relationship, then you might understand better why you don't get an erection, because maybe you're not attracted a lot to your partner, maybe you have a lot of fights with your partner. So, this is maybe what the erectile dysfunction is telling us. Maybe it's telling that you work too much, that you're stressed all the time, and then you come home and feel you need to be sexually active and actually you just want to be in the couch, maybe relaxing a little bit, or maybe it tell us just that you have a problem we need to look at. Maybe it tells us you're depressed, you don't really have the desire to have sex. Maybe you have low sexual desire, and that will be experienced as erectile dysfunction, because if you don't have desire, it might be difficult to have an erection.
Dr. Giraldi:
Or maybe it tells us that we need to check up on your cardiovascular health. We need to check up on your... Do you have hypertension, do you have diabetes. Maybe you have a sedentary lifestyle where maybe you're obese. Maybe you don't exercise. Maybe you don't live a healthy life. So, I think that actually, at least where I come from, we sometimes have a problem that men will not go to the doctor. They don't go as often as women will go to the doctor; they don't seek help. And I think that erectile dysfunction might be a window where we can discuss overall health, overall quality of life.
Dr. Alsuwaidan:
Mm-hmm (affirmative). So, once you've done that and maybe rolled out some of the other causes of erectile dysfunction and get to the point where we're talking about treatment, how does that conversation go? I mean, do people have different perceptions of what the treatment is like?
Dr. Giraldi:
I think people have different perceptions because some men are very reluctant to take medication. Some say, "Just give me whatever you have. The problem is so big that I need to get some treatment." Some have a very clear understanding of this is psychological. This is more organic or more physical. Some men have a partner that has a very strong opinion on that. And we have different types of treatment. Usually you would offer what I would call just basic counseling, that you would tell like I just described here, what is an erection, what might impair it, what will help you have an erection. So you get a basic level of understanding of the mechanism. And then, depending a little bit on what the problem is, you very often will start talking about healthy lifestyle, saying that it's very important that you have a healthy lifestyle. And the problem is not all doctors will say that to their patients. And we know that it's very difficult sometimes to actually get people changing their lifestyle.
Dr. Giraldi:
But, I think you need to talk about lifestyle modifications, maybe eating healthier, exercise, quit smoking, quit drinking too much.
Dr. Giraldi:
Losing your weight.
Dr. Giraldi:
Also, maybe if you're very stressed, maybe, if you can, you need to change your life. And then, when you have done that, I think that's the basic counseling. Then I think I would always try to treat you because I don't only say, "Okay, now you need to change your life, and then you could come back in several months." I think we can already start treating them. So, that can go hand-in-hand that maybe they change their lifestyle, but also they can have some treatment. And what usually you would start with giving a tablet that you need to take when you want to have sex. Most of the time, that's how you use it. When you want to have sex, there's a pill. We know the different brands that you can actually take and you explain how it works. And that's usually what you would offer as the first treatment.
Dr. Giraldi:
And then, we have other treatments like injecting medication into the penis. We have, some men will use a pump that can get more blood into the penis. And in the end you might also have surgery with a prosthesis, but that’s a more specialized treatment. So usually, I would like to make the picture for the man saying, “These are the different ways we can treat.” And then, you can also choose to treat with maybe couple therapy or psychotherapy. If we think this is something that’s very psychological, this is a man that has never a problem when he’s alone. But when he’s with a partner, he has a lot of performance anxiety. Then maybe we can help him with a pill, but also you could give him some kind of therapy. There are different kinds of cognitive therapy. There are some exercises you can ask them to do.
Dr. Giraldi:
Or you might include the partner in the... If there’s a couple problem, if they have problems in communicating about sex, if she’s very sad or very angry, and then you need to include the couple or include both the man and the woman or the man and the man, whoever you have as a partner.
Already we can see there are lots of ways to approach treatment, depending on the suspected cause, including involving a partner. As they say, it takes two to tango, and with an issue like ED, the other person impacted by the condition can make a big difference – either helpful or not.
Dr. Alsuwaidan:
So in your practice, do you prefer the partner to be there when you’re providing this counseling or do you advise the patient to bring their partner?
Dr. Giraldi:
I usually advise them to bring their partner because I think the partner's always there, no matter whether the partner's in the room. And I do that and I become more and more sure that this is what we need to do if we have the possibility, because if the man goes home to the partner and says, "Oh, the doctor told me to do this and this and this," maybe the partner will say, "Well, I don't agree with that. I don't see it that way." So, then it's going to be very difficult. And I think that some partners might say, "I don't want to have sex." So sometimes you will see a man and when a man comes back to the partner, the partner says, "Yeah, but I'm actually not very interested in having sex." And then you, as a physician, you prescribe maybe a drug and the man comes back and never filled in the prescription because the partner didn't really want to have sex or were very satisfied that they didn't have sex anymore.
Dr. Giraldi:
Or maybe the partner has a sexual problem. We also see that maybe the partner has some expectations that cannot be fulfilled. Maybe the partner has a sexual problem, him or herself. And then, you need to take care of that too. I have some experiences, but there are also some studies that have shown that in some couples, these were in female partners, it was shown that some partners felt that if he takes medication, it means he's not turned on by me. So, it's a fake desire. It's a fake erection. And I think we need to somehow explain that's not what's happening, because most of the medication you need to actually want to have sex. You need to be turned on by your partner before it works.
But as helpful as medications can be in treatment, some medications can actually lead to erectile dysfunction.
Dr. Alsuwaidan:
So Dr. Giraldi, are there some medications that can contribute to erectile dysfunction?
Dr. Giraldi:
Yeah. We know there are some large groups of medications that might increase the risk of having erectile dysfunction. We know that some antihypertensive medications will have an impact on erectile dysfunction. We know that a lot of antidepressants having a negative impact. We know that antiandrogens also, if you have prostate cancer and are treated with antiandrogens or have other compounds where you decrease the level of testosterone, it might have a negative impact. And also, we know that this goes for especially younger men, that if you take illegal drugs, if you're bodybuilding and you take supplements to enhance your muscle growth, that will have a very negative impact on your erectile performance.
But, to be clear, Dr. Giraldi is NOT advising anyone to stop taking a treatment on their own if they think it’s affecting their sexual health.
Dr. Giraldi:
I think it's very important to not try to be the doctor yourself and stop medication. I see many cases of people stopping, for example, antidepressant treatment because they have sexual side effects, and then they become much more ill of the condition that are treated with medications. So the important thing is that if you have side effects, sexual side effects, to the drug, go to the physician that prescribed it and discuss it, because it might be possible to treat with another drug or change the dose or do something else. But you always get a medication for some reason, and that might be a very good reason, so don't just discontinue the drug because you have side effects.
That’s seriously good advice for anyone being treated with a medication. Now, as much as people think they already know about erectile dysfunction, it’s a condition that is still wrapped up in myth and misinformation.
III. Myths and facts regarding treatment for ED
Dr. Giraldi:
So I think that there are so many myths about medication and treatment for sexual problems, for erectile dysfunction. Some partners might be afraid that the man is going to drop dead when they have sex, because he had a problem with his heart and now we're having sex. So, they might be very reluctant to go into sexual activity because they're so afraid what's going to happen.
Dr. Alsuwaidan:
And they might've seen something in the media, right? Some story in the newspaper.
Dr. Giraldi:
Yeah, we know there are so many stories in the newspapers about, this is so dangerous to take maybe the pills for erectile dysfunction. There are so many strange stories running around. So I think that we need to educate and we need to tell and just say, "Actually, it's not very dangerous.If it does something, it's good, what it does. And I think we need to get people to relax a little bit. And I think we also need to educate the man about how do I use the medication, no matter what kind of treatment you give, that very often you might make a prescription and then you say, "Okay, now you can go home." And he'll say, "I read on the internet how to use it." But, it's very important that you actually tell people how to use the treatment, what is the idea behind this treatment, what is the mechanism, how does it work. And that goes for all different kinds of treatments, no matter what kind of treatment we suggest to people.
While taking treatment properly is important, so is taking the proper treatment. A condition like ED, which can feel very private, can lead people to find their own, often suboptimal, solutions.
Dr. Alsuwaidan:
So when men come to your office, is it common that they've tried something before, a herbal medication, a supplement or a medication in the past?
Dr. Giraldi:
It's very often they have tried that. And I think that really emphasizes how important this is for men when they experience not being able to have an erection, that they really want to try almost everything to solve the problem. And there are a lot of different things sold on the internet that claim to be able to help men with erectile dysfunction. It's a big market because it's a big problem for men. And there are some herbal products that might help a little bit, but I think a lot of them, there's no documented effect, and some of them, you don't know what's in. And also, there might be a problem that sometimes people have bought medication for erectile dysfunction over the internet and we don't know what's in these products, even though they claim to be the right product.
Dr. Giraldi:
So I take a discussion with the man, of the problem in buying medication on the internet, unless you know it comes from a regulated pharmacy. Also, the problem in using a lot of money on maybe herbal products that have absolutely no effect. But the reason why they are with you is because it didn't help enough. And I think then you need to discuss, how can we use one thing or another thing? And how was your experience with what you actually tried? But very often, they have tried something or their partner has found something on the internet and asked them to try that.
Dr. Alsuwaidan:
And you mentioned earlier that erectile dysfunction could signify a medical illness. Are there other sexual disorders that are linked to erectile dysfunction?
Dr. Giraldi:
Yeah. I think it's very important to ask about other sexual problems, because maybe the man sees that the problem isn't erectile dysfunction, but maybe it's because he doesn't have desire. So you also need to screen, for example, for no testosterone. Doesn't he have desire? Is there a conflict that makes him not having desire for the partner? But also, problems like premature ejaculation might make him so nervous about ejaculating too early that he also becomes so nervous he won't have an erection. So I think it's very important that we also ask about other sexual problems.
Dr. Alsuwaidan:
I've had the experience, there's certain classes of medications that patients tend to fear. For example, if you write an antidepressant for someone, there's often a lot of myths and fear around it. Do you find that the same for some of these erectile dysfunction medications?
Dr. Giraldi:
Yeah. I think that's a very good comparison. It's just like we have medications that everyone would take them any time and have absolutely no questions about that. And then, there are other medications that have a better reputation. I think, I'm a psychiatrist and I agree completely with what you say about antidepressants. And I think the reason is that, as we discussed a little bit in the beginning, people also think, "Oh, this is something you need to treat." Is this really important? And some people wrongly think that depression, "Oh, you just need to pull yourself together, and you know exercise, and get a little energy." But depression is a disease, is a very severe disease; a lot of people die from it. But, some people feel, "Oh, you shouldn't give medication to that," and maybe erectile dysfunction have had the same reputation. I think it's changing. And I think that's very nice, but I think that it's because, as you said, is it really necessary? This is what happens. Do we need to treat everything in life that's not nice?
Dr. Giraldi:
So, there's this impression that, "Oh, erectile dysfunction is something that's always psychological, something that comes with age, something that you just need to not complain and just live with because now you're getting older." So, maybe that's why it has a little bit another reputation than if you have diabetes or something, hypertension that then we all know that you need to treat, and we know that there might be adverse events on that medication too.
Thinking about ED as a health condition worthy of treatment is a great place to start, but there are other ways to support men with this unique challenge.
IV. How to support men in their ED burden
Dr. Alsuwaidan:
As doctors and other healthcare providers, do we have a role, not just in the clinic, but educating society about some of these ideas, these myths around treatment, medication, speaking up? And what role can we play?
Dr. Giraldi:
I think that we can have the conversation like we have it now about... It's very difficult to say this is the right thing to treat and this is not the right thing to treat. And we need to educate, because people's lives are so different. So, I think we need to recognize that what is important for me might not be important for you. But some people don't care if they are obese, but we can say, "It's not very healthy, but it's your life." And some people wouldn't care if they had erectile dysfunction, and we could say, "I'm not going to force you to have treatment, but it's there if you want to have it." And I think we also need to recognize, for a lot of people, what does it mean to be healthy? It's not only not having a disease, it's also to have a healthy life, having a good quality of life. And I know for many people that's not possible, but if it's possible, I think we need to help and sex is a part of a healthy life.
Dr. Giraldi:
And as we discussed in the beginning, it's also, for many people, a part of a healthy life. But also maybe you have a more healthy life if you have sex. So, I think that we need to have the discussion that maybe being sexually active is a part of having a healthy life.
It’s nice to know that being healthy is not just its own reward – it seems that it can also contribute to you leading a healthy sex life as well.
Dr. Alsuwaidan:
When you have couples in your office, do you give them specific tips about strategies around sexual practices that may help with the condition?
Dr. Giraldi:
Yeah. You know, sex therapy in that way is a lot about taking away performance anxiety. So actually, some of the tips and tricks we give in the beginning is to increase intimacy, and we actually tell the couple not to have intercourse. Because a typical patient in my practice will be, that the man has experienced erectile dysfunction, and as soon as he starts to think about sex, or as soon as the partner starts to initiate something, he will think, "Oh my God, what's going to happen? I'm not going to be able to perform." So that means that his alert system from the brain and in the body is so high, that it's actually going to be impossible for him to have an erection.
Dr. Alsuwaidan:
He goes into a panic mode?
Dr. Giraldi:
Yeah, it's like the body will go into panic mode. And what happens when you go into panic is that it shuts down erection, because it's very inconvenient to have an erection if you need to fight, or whatever you think you have to do when you go into panic mode.
Dr. Giraldi:
So that of course is because, maybe a lot of it is psychological, but I think most men will experience that. And I have had couples where he would say, you know "We go for a date, we go out for a dinner ... " And even when he wakes up in the morning, and he thinks, "Oh, I have to go out for this date tonight," even if it's a partner that he knows, he starts thinking about, "Where are we going to end? We are going to end up in bed, and we're going to end up with me not being able to perform."
Dr. Giraldi:
So what we actually recommend is that you make an agreement that, "We don't have intercourse," because then you take away the pressure that, "Now I need to perform something ... An erection." And then he can relax a little bit, and maybe he can take the medication, or they can caress each other. They can kiss, they can touch each other. So we try to broaden sexuality a little bit more to be not only having an erection, and that might take away the performance anxiety, and also open for other ways to have sex.
Dr. Giraldi:
Sometimes sex is very much about having an erection, having an intercourse, so you forget that you can also have a lot of types of intimacy. You can touch the rest of the body. And we really make very detailed instructions in, you need to touch the whole body, you need to see the other pleasurable things. So that's one thing that we very often start with recommending.
Dr. Giraldi:
And then we also talk a lot about, that sexuality is not always the same. I think a lot of men will feel they have a lot of responsibility, that it's on their shoulders that the sexual interaction is good, that you have a good result. So, she needs to have an orgasm, he needs to have an orgasm, so you always have a specific goal.
Dr. Giraldi:
So, we talk a lot about, that sometimes sexual interaction is extremely nice and good, and sometimes it's just medium, and maybe that was nice, too. So it cannot be like a high-score every time. Sometimes it's better, sometimes it's a little bit less good, and that's normal. So, you don't feel like a failure if you don't have an "A plus", or whatever your grading system is, every time. You might have something a little bit less, and it's also good.
Dr. Giraldi:
So you don't put all these expectations on yourself, and we talk to both the man and the partner about this, because the expectation might also come from the partner about what is going to happen. And if we have the partner involved, we also discuss a lot that a lot of partners will think that it's because something is wrong with them. So they will say, "Oh, the penis is telling that you don't like me. I've become too fat. I'm too old. You're not attracted to me anymore."
Dr. Giraldi:
So we try to, by increasing intimacy, and increasing touching each other, doing new things, maybe, really say, "This is not because I'm not attracted to you. It's because I have a problem with my erection, maybe because I have diabetes." But also discuss this so you don't have these conflicts and misconceptions within the couple.
Dr. Alsuwaidan:
And I think, as you said, false expectations can come from within, but maybe also from society and the media and wanting always to be perfect, ideal. As you said, "A plus". It's a common theme.
Dr. Giraldi:
Yeah, and I think it's very, very common. I think that most of us think that the neighbors and all the others have this very exciting sex life. They have sex every second day. And one of the first questions people might ask me when they come to my clinic is, "How often is normal?" Because they have the idea that you need to fulfill a certain quota that's so many times a week, or a month, and they want to find out if they're normal or not normal. And I think a lot of men think that they should be able to have an erection every time ...
Dr. Alsuwaidan:
On demand.
Dr. Giraldi:
... on demand, and when the situation is there. So, sometimes I see men saying, "You don't understand, I don't get an erection." I think I understand it, because you were very tired, you wanted to do something else, your mother-in-law was in the room next door, so you were a little hesitant to do it. But it's like, both men and women, and maybe culture, have the expectation that men are always willing and always able to have an erection, and that's not the case.
Dr. Alsuwaidan:
It reminds me of a patient I saw once, who was a doctor, and the complaint came from his partner. And they had come to the office, and it turned out that he was just burnt out, that he was working too long hours, he was on-call all the time. Because when they went on vacation, he was performing fine.
Dr. Giraldi:
Yeah, I think that's a very good point. And I think that's when we go back to what we call "penis wisdom", that the penis is that actually telling you that you have a very stressful life. I very often ask people how it works when they're on vacation, because that tells us if it's related to the life they live.
Dr. Giraldi:
And when you talk about tips and tricks, I think that one of the things I talk to couples about is, how do we get more vacation in the everyday life? Because most of our life is actually everyday life. So it's not that we can have vacation every day, but how do we keep some of this atmosphere, some of these habits that are good for us? How do we keep them a little bit in our everyday life?
Dr. Alsuwaidan:
Having a balance.
Dr. Giraldi:
Yeah, yeah. Having kind of a work-life balance, and balance also in having time to each other. And I think that a lot of the couples I see, maybe you become a little bit older, it becomes a little bit more difficult to have an erection. And then, you have had the same partner for quite a long time, so maybe you need to do a little bit extra. We know you need more stimulation when you become older to have an erection. We know that maybe it's, there's a little bit longer time between having had intercourse and being able to have an erection again.
Dr. Giraldi:
So maybe we need to work a little bit more on it, but we also need to work maybe a little bit more on the relationship. And, how do we stimulate each other? How do we still think this is something exciting, even though we have known each other for 30 years? So even though it's something that might be rooted in more organic things like getting older, also the psychological aspects are important because they might also help when you treat it.
It seems that ED is potentially a many-headed beast – and that taming it can require looking at it from multiple different angles. The good news in all that? ED can be successfully managed when the right approach is found through both honest communication and careful consideration.
Dr. Alsuwaidan:
Well, thank you so much for a fascinating conversation. Do you have some key take-home messages you want our listeners to leave with?
Dr. Giraldi:
I think I would like to say that it's so important that if you experience sexual problems ... And here we have discussed erectile dysfunction, but I think it goes for all sexual problems. I think you should talk to someone about it, if it's something that's important for you, and not just think, "This is not going to happen to me anymore," or, "I just don't want to talk about it," or maybe that you cannot do anything about it.
Dr. Giraldi:
And I think also it's important that if you think that it's nice to be able to have an active sex life for most of your life, maybe, then it's important to live a healthy lifestyle. I know all doctors say that, but it really has an impact, especially on erectile function, how you live. And I think it's also very important that if you have a partner, to involve the partner.
Dr. Giraldi:
Because very often it's a help to talk to the partner, because hiding it from the partner might make the problem even worse. And also if you have a condition that we know might be a risk factor, like diabetes, like cardiovascular disease, like hypercholesterolemia, hypertension, it's very, very important that you are treated for this and stick to the treatment and follow the treatment. Because if you don't, it might impair the erectile function.
Dr. Alsuwaidan:
Well, thank you so much, Dr. Giraldi, for joining us today.
Dr. Giraldi:
Thank you for having me.
Mo Alsuwaidan:
There you have it – the full story on erectile dysfunction. We covered some important ground, including how ED can be a sign that something else is up with your health, not to mention the fact that there is a lot that can be done when men choose to look for support. As always, I encourage you to keep the health conversation open with your healthcare provider, and to stay on top of any changes that are affecting your life – because it’s up to you to be your own best health advocate, no matter the issue. I’d like to sincerely thank Dr. Annamaria Giraldi for providing her expertise and personal experience on this topic.
Mo Alsuwaidan: If you're looking for more information or resources about the topics covered in this or other episodes, you can visit www.listenwellpodcast.com.
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