Man's best-kept secret: sexual dysfunction: Once a taboo subject, sex-related difficulties are now discussed openly. Yet many men are reluctant to reveal such intimate problems, even though 30 million suffer from impotence. Keep in mind that pills alone can't treat dysfunction when your sex drive flags or disappears

VFW Magazine, March, 2003 by Norman Brown

When a man tells his doctor that he has lost either the will or ability to have sex, he's likely to get a complete physical and a promise that solutions--from Viagra to testosterone patches--can be found to fix the problem.

A detailed personal and medical history, along with a thorough physical exam and blood tests, usually will identify the problem, whether psychological, vascular, neurological or caused by medication. An ultrasound scan of the penis also is done to provide information about its structure and blood supply.

Psychological problems are responsible for about 20% of cases, and the rest are physical. As far as age is concerned, more men have a sexual problem after age 65. But impotence can occur at any age, depending upon the causes (most of which can be treated successfully).

Erectile Dysfunction

Failure to "perform" once in a while--when you're tired, depressed, worried or have not been sufficiently stimulated--is not erectile dysfunction. And don't confuse impotence with lack of desire. Viagra and similar drugs won't work if there's no sexual desire.

For you to respond when stimulated, your body must make enough of the hormone testosterone. And while testosterone production gradually decreases with age, the amount available usually remains high enough to permit sexual function. "Too many men resort to testosterone supplements when a hormone deficiency may not be the cause," says Dr. Francis Hayes, a specialist at Massachusetts General 'Hospital in Boston.

Vascular disease--most commonly arteriosclerosis, to which diabetics are especially vulnerable--can affect nerves and blood vessels that reach to the penis, resulting in erectile dysfunction.

Many other chronic diseases can leave you impotent, as can over-the-counter and prescription drugs such as beta-blockers, antidepressants, tranquilizers and ulcer medications (cimetidine). If erectile dysfunction appears to follow any new medication, that drug' is suspect until proven otherwise.

The big change in treatment is the availability of several therapies that can help regardless of the cause. Viagra is a case in point. It takes effect in about an hour and continues to work for several hours with a success rate of about 82%.

But it is not without side effects: blurred vision, headaches and impaired color perception. More important, it can lead to a deadly drop in blood pressure when combined with heart medications like nitroglycerine. Anyone who has had a recent heart attack, who has angina or an irregular heartbeat should not take Viagra.

Nor is Viagra an aphrodisiac. It's great for impotence, but won't cure erectile dysfunction if there's no sexual desire. Fedings harbored by either partner-can derail intimacy and cause stress, anxiety or guilt feelings--any of which can trigger erectile dysfunction. Injury to the pelvis or prostate surgery can also cause changes in the way blood flows to the penis and result in erectile dysfunction.

Currently, a veteran can receive four Viagra tablets through the non-formulary (master drug list) request process. Traditionally, veterans suffering from post traumatic stress disorder have been prime candidates for Viagra. The drug, however, is dispensed to VA patients under strict guidelines.

"In the case of Viagra, service-connection does not matter," says Karen Fedele, VA public affairs specialist. "Criteria are clinically based in this case. Such patients have a variety of illnesses, ranging from diabetes to hypertension to spinal cord injury."

Mike Valentino, VA consultant on pharmacy benefits management, says, "Viagra (sildenafil) is available from the VA as one form of treatment for erectile dysfunction, but only after a physical examination and medical history is taken."

VA studies have involved nearly 7,000 men, revealing that Viagra worked two-thirds of the time.

Indeed it does. "Viagra is still the most patient-friendly method of treating erectile dysfunction," according to Dr. Ira Sharlip, assistant clinical professor of urology at the University of California at San Francisco.

Lack of Desire

Doctors say that patients are often reluctant to discuss sexual problems--even though they're a common side effect of widely prescribed drugs like antidepressant and blood pressure medications. "There are many medical conditions that can show themselves as decreased libido," says Dr. Steven Weinreb, an internist at Hartford Hospital in Connecticut.

"Lack of libido in men or women and difficulty in erection in men can be an early sign of diabetes, thyroid problems, tumors or depression," says Weinreb. In fact, recent studies show that one of the best predictors of heart disease may be erectile dysfunction. Libido does decline with age, but not nearly as much as one would think. Almost 80% of couples in their 60s and 70s continue to enjoy sex, according to one survey.

About 17% of men experience performance anxiety, and the same number complain about lack of sexual desire, according to a symposium on human sexuality sponsored by Columbia University College of Physicians & Surgeons. But few men seek help (even in the age of Viagra), report psychologists and sex therapists.