Erectile dysfunction is a common topic today - at least for TV advertisers. The three main drugs - Viagra, Cialis, Levitra - each has a "signature" image.
Even Dr. William Pearce, a Santa Ana, Calif.-based urologist, observes that "taking Cialis requires owning two bathtubs," a reference to the commercial that always ends with a view of a couple in separate tubs.
But there's nothing funny about erectile dysfunction, Pearce says. Indeed, the condition might signal overall health difficulties.
Viagra, Cialis and Levitra are prescription drugs.
Q: The data say 94 million men may suffer from ED yet may be embarrassed to discuss this issue with their significant other. Is this possible?
A: There are cultural barriers and fear of failure, used by many men to avoid the topic. Or simply denial. Erectile dysfunction usually signals problems with blood flow. This is not just a problem with getting an erection. The penis could be affected by diabetes or other medication that diminishes the flow of blood to the body.
I have always told male patients that living a heart-healthy lifestyle improves their chance of avoiding erectile dysfunction.
Diabetes and weight are definite concerns. One of the most powerful ways to get a man to quit smoking is to point to the link between smoking and ED. These men are three to four more times at risk than nonsmokers.
The things we do to live heart-healthy usually helps avoid ED. All of them work by increasing the blood flow to the penis. But you must make sure you have a healthy enough heart for the sex act - and that means not taking nitroglycerin medication or similar medication designed to depress blood pressure.
Also, there can be an emotional link to depressing the blood flow - such as stress or relationship problems. It is important to consider them all.
Q: What is the blood flow situation to the penis and why is it different from female sex organs?
A: Women have heart disease just as men do. But the penis is fed by very small blood vessels. Any minor decrease in blood flow will, therefore, impact it.
Q: Which is another reason that men need to be concerned about the onset of ED?
A: Erectile dysfunction can be a sensitive marker for decreased blood flow problems throughout the body.
While blood pressure medications can contribute to ED, other situations, from kidney and bladder problems to atherosclerosis, can be flagged by ED.
Q: You told me of a not-pleasant scenario. What's this about a man who decides to leave his wife - and when he's with her he has ED - and gets a girlfriend. This man, and other unfaithful men, often use common ED medications such as Viagra, you said?
A: Sometimes there is no crosstalk about the problem between husbands and wives. The wives will say they don't want to embarrass or hurt their husband's feelings. So they don't mention it.
But once they lose a spouse - through death or divorce - many men want to date again and so they are suddenly concerned about ED.
Q: Does this solidify a stereotype that men don't believe there is more to intimacy than just the sex act? This says that men will do anything to avoid ED when they "strut their stuff."
A: It is a social stigma for men. That is why there is microinjection therapy, penile prosthesis, other ways to restore function if the medications are not effective.
You must remember this is like urination and breathing to a man. It is part of his function and to lose it is tied to a social stigma.
Q: Are there similar medications for women?
A: Postmenopausal women often suffer from issues of dryness and discomfort. This can be a problem. I refer these patients to a gynecologist. There are creams available also.
Explore further: Obama offers new accommodations on birth control