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The opinions expressed herein are the guest's alone. If you have questions about your health, you should consult your personal physician. This event is meant for informational purposes only.
Moderator: Hello, members, and welcome to WebMD Live. Joining us now is Milton Lakin, MD, head of the Section of Medical Urology in the Urological Institute at The Cleveland Clinic. He joins us today to answer questions about erectile problems you or your partner may be experiencing. Welcome to WebMD Live, Dr. Lakin.
Lakin: Hello. I am pleased to be here.
Member: what are major reasons for ED with PD?
Lakin: PD referring in this case to Parkinson's disease. There is definitely an association between erectile dysfunction and Parkinson's, which is a neurodegenerative disease, and the mechanism of erectile dysfunction. It is not well understood, but is most likely neurological in origin.
Member: Is MUSE an acceptable treatment for PD patients, when Viagra has not been helpful?
Lakin: MUSE is a trademark preparation standing for medicated urethral system for erection. It is a suppository that is inserted into the urethra; it contains prostaglandins in various concentrations. The suppository is inserted by means of a delivery system that allows the suppository to be inserted just below the level of the tip of the penis. Once it is inserted, the delivery system is removed, the penis is massaged to help absorb the suppository and the patient needs to stand up and walk around for about 10 minutes to see if an adequate erection develops. MUSE could be safely used in patients with Parkinson's disease. In my experience, it is not a very effective treatment and fewer than about 30% of patients are truly satisfied with the firmness of the erection they can achieve with this method of administration. In general, however, it does appear to be safe, but each patient needs to check with his physician.
Member: When will Cialis and vardenafil become available, and what is your opinion of their efficacy in long-term (six years) impotence?
Lakin: It is likely that both Cialis and vardenafil will be approved sometime this year, but FDA approval is never a certainty for any drug, so we will just have to wait and see with both of these medications. Both drugs, based on current published material, appear to be effective in erectile dysfunction that can be severe, so it is possible that either one of these drugs will work in a case of severe erectile dysfunction.
Member: Are there herbal supplements that can be used as an alternative to Viagra?
Lakin: Herbal supplements have not been tested with the same degree of scientific rigor that Viagra has been tested, and my experience with patients who have tried these is that many of them are not terribly effective. Many times we do not know all of the ingredients in some of these preparations.
Member: Can any of the creams on the market actually cure ED or are they just temporary relief?
Lakin: There are no creams or topical preparations that I am aware that have been approved by the FDA for use in erectile dysfunction. There are also no preparations that I am aware of that can cure erectile dysfunction. There are currently some topical preparations that are being tested and may eventually be approved for treatment. It is not entirely clear how effective these would be for most patients with erectile dysfunction.
Member: Can depression cause ED?
Lakin: Depression may certainly be associated with ED and as a psychological cause probably can result in ED.
Member: Does Viagra have any side effects, or could it hurt him if he is only depressed and does not have ED?
Lakin: If one is taking Viagra, the side effects to watch for are headache, a flushing sensation, some gastrointestinal side effects such as heartburn or acid indigestion, nasal congestion, and visual symptoms. The visual symptoms may consist of the lights looking brighter or some difficulty with color discrimination or a blue haze or halo around objects. The visual disturbances usually do not last longer than about 2 to 4 hours and are generally more likely to occur with the higher dose of Viagra, which is the 100 mg dose. These are the major side effects that I have seen with this medication.
Member: Which is easier, in your opinion, to treat/overcome -- ED caused by physical issues or ED caused by mental anxiety, etc.?
Lakin: Erectile dysfunction is a complicated symptom and probably is a combination of physical difficulties associated with psychological issues. Trying to separate those problems can sometimes be very difficult. One of the advantages of oral therapy such as Viagra or the newer medications which may be approved is that they may be reasonably effective no matter whether the problem is physical or psychological or both. This is also true for other treatments such as injections of medication into the penis or the previously mentioned therapy with MUSE.
Member: What types of therapies are available to treat long-term male anorgasmia? Any drugs on the horizon?
Lakin: Anorgasmia is a difficult problem and may be seen with some
neurologic diseases such as multiple sclerosis. When it occurs with multiple sclerosis, it is very difficult to treat unless the disease improves at times. Anorgasmia may also occur with use of some antidepressant medication, particularly the SSRI antidepressants. Some of these drugs are Prozac, Paxil, Zoloft, and Celexa. This list is by no means complete. Sometimes switching anti-depressants or discontinuing them for a brief period of time, sometimes referred to as a drug holiday, may be effective in helping deal with this difficult problem. It is very important, however, that each patient discuss this with his physician before any change or discontinuing medication. I am not aware of a specific medication that will treat anorgasmia.
Member: Are all forms of ED treatable?
Lakin: In a certain sense, I do believe that we can treat almost all ED with some available form of therapy. This would include oral medication such as Viagra, use of penile injections, use of MUSE (MUSE is a suppository treatment, for those just joining us), use of a vacuum constriction device or perhaps the need for surgery with a penile prosthesis. Sometimes these therapies need to be combined with psychological intervention. With these treatment choices, I think we can offer most patients a suitable form of treatment.
Member: Is there a way to correct premature ejaculation?
Lakin: Premature ejaculation is when an individual would come or ejaculate either before vaginal penetration or shortly afterward. There is some helpful treatment available with the SSRI antidepressants, which I have previously mentioned. The reason that these can be useful is that one of the side effects of these drugs is to prolong the time to reach ejaculation, and if used properly, these drugs may be helpful to some men who experience premature ejaculation. One wants to avoid a dose, however, that will result in being unable to achieve ejaculation or climax. These drugs are not approved for this purpose but have been widely used for this and have been, in published series, shown to be effective.
Member: Is a nerve transplant possible to correct impotence? Even after several years?
Lakin: The only instance where I am aware that nerve transplant has been used to help deal with erectile dysfunction is in patients who are undergoing removal of their prostate for prostate cancer. In some cases, the prostate is removed and the nerves that control erection cannot be spared because of the extent of the prostate cancer. In some younger patients, sural nerve grafts have been used at the time of the original surgery for the cancer. They would not be used once the surgery has been done and the patient several years later has a problem.
Member: Can weight gain or obesity (or loss) affect the occurrence of ED? I know diabetes and other weight-related issues have an effect, but can just weight gain alone cause ED?
Lakin: The relationship between obesity and erectile dysfunction is complicated and the current data do not, in my opinion, allow for a definitive statement. Some patients, I believe, gain weight and do not have any difficulties with their erectile function, but this needs to be studied in greater detail. Diabetes is a common cause of ED and in my opinion may in fact be the most common complication to occur in diabetic men. I am not, however, aware of studies that show that weight loss in diabetic patients will improve their erection problem if it is already present.
Member: What are suggestions for venous leakage?
Lakin: Venous leakage is a term that implies that blood flowing into the penis is escaping so rapidly that the penis cannot remain firm enough for adequate sexual activity. This can occur in a number of different circumstances. For instance, an individual who may have high levels of anxiety may have venous leakage and be unable to maintain his erection. A person with diabetes may have a similar problem. A person with significant vascular disease that affects the penile circulation may also have venous leakage. It is therefore not a particularly helpful term in terms of trying to decide what would be the best treatment. All of the treatments that I have previously mentioned for erectile dysfunction may be helpful to someone who has venous leakage for whatever reason. At one time, it was popular to do surgery on patients who had venous leakage, but this has not proven to be a successful therapy and is only very rarely ever done now.
Member: If I am taking Viagra and it works, how will I know if I can ever stop taking it?
Lakin: I would suggest that an individual consider stopping the medication and trying to see if they can have satisfactory sexual activity without it. This should be easy to do, although it may produce some disappointment if the drug is still needed.
Member: Member question: I am aged around 28 years. I was having good and frequent erections three years back. I was smoking a pack of cigarettes per day. I smoked for around seven years. I quit smoking and drinking alcohol three years back. Now my erections are not good. I cannot bring erections when I desire and they don't stay for longer duration. My erections are not hard. If I just try to relax or just divert my mind a little I lose my erections very quickly -- within a minute. I had tuberculosis three years back. Has this affected me? Now its completely cured and I am quite healthy. This is really worrying me for the past six months since I intend to get married in another six months. Can you please tell me what I need to do? I do have some anxiety problems but not always. Is this a permanent problem?
Lakin: It is thought by most physicians who evaluate and treat patients with ED that cigarette smoking is a risk factor and may definitely result in and aggravate ED. Recently, the Sexual Medicine Society of North America voted on a statement indicating how significant cigarette smoking is as a risk factor and recommending that patients quit smoking.
Member: Do penile implants work? Are there any side effects?
Lakin: I am not a surgeon and do not perform penile implants. However, penile implants can be an effective form of treatment for some patients in whom other forms of therapy are ineffective or unacceptable. I do feel that any patient thinking about having an implant should be fully evaluated for his ED and see a surgeon who performs such implants to discuss the possible side effects and the details of the surgical procedure.
Member: Is diabetes a cause of erectile dysfunction? I have type 2 diabetes and it seems that I am suffering from ED. I am taking Glynase and Glucophage two times a day for over seven years now.
Lakin: As I have previously mentioned, diabetes is a very common cause of ED and can occur in both type 1 and type 2 diabetics. The evaluation and treatment recommendations for a patient with this problem can include the treatments I have previously mentioned, including drugs like Viagra. Although Viagra can certainly be effective in diabetic patients, in general diabetics do not respond to Viagra as well as other patient groups.
Member: I am taking Wellbutrin. Will this cause a decrease in sexual arousal? I have noticed a difficulty in maintaining any erection since I have been taking it. Thanks.
Lakin: In general, looking at the currently available antidepressants, Wellbutrin has been associated with the least sexual side effects and is usually mentioned along with Serzone or Trazodone as antidepressants that seem to have the least sexual side effects.
Moderator: Unfortunately, we are out of time. Thanks for joining us, members, and thanks to Dr. Lakin for being our guest. Sorry we couldn't get to all of your great questions. For more men's health information and advice, be sure to visit our Men's Health message board here at WebMD. Be well and goodbye!
WebMD does not provide medical advice, diagnosis or treatment. See additional information.
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