Dr. Emmanuel L. Sta. Cruz

It doesn't have to be, age should not be a factor

    Sometime in the early Nineties when ED used to be known as Impotence, this problem was very rare among men below 50 years old. I recall between 1989 to 1994, there were very few patients I saw whose primary complaint was ED. Very few men then were interested in listening to lectures about ED which was such a tightly-guarded secret. 

    ED was presumed by many elderly men to be part of a normal aging process because it was common among their peers. This assumption is even more evident in men who are diabetics and those taking anti-hypertensive drugs. Because of this preconceived notion, there were fewer men then, in the aforementioned group, who sought treatment for Erectile Dysfunction unlike the younger ones. 

    But starting 1997 onwards, I was seeing more men interested in ED, and they had become more open in seeking help. Now, I see ED as a more accepted and common phenomenon. Definitely there are more men today who are suffering from ED in varying degrees of severity.

I. What is Erectile Dysfunction?

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    Erectile Dysfunction (ED) is a condition where a man has a persistent inability to obtain and sustain a firm penile erection, adequate enough to provide his female partner satisfactory sexual gratification, or an orgasm.

What is Premature Ejaculation?

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    Premature ejaculation is a sexual problem where a man has an uncontrolled ejaculation shortly after the vagina is entered, or way before the female partner reaches an orgasm. This is more often associated with an inadequate erection.

II. Types of Erectile Dysfunction

    1. Psychogenic:

        Early on, ED was first thought to be primarily due to psychological factors such as anxiety, stress, anger, frustration, depression and others. So patients were initially referred to a psychologist or a psychiatrist. But later studies have shown that there could be many organic causes of ED.

    2. Organic or Functional Causes of  Erectile Dysfunction:

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                                   Table 1:  Possible causes of Erectile Dysfunction. Modified from Smith AD: Urol Clin North Am vol 8:83 1981

    I find this mnemonic by Smith AD as quoted by Drago K. Montague, MD, and Milton M. Lakin, MD, in their Chapter in Secrets of Urology by Resnick &  Novick (1995) to be the most comprehensive for clinical use and a brilliant concept (Table 1). 

    I am glad that Prostatitis has been recognized as one of the potential causes of ED. If one looks closely at Table 1, among the possible causes of ED, Prostatitis is a far more common disease that affects most adult men, young or old.

    Having an Erection is not a mechanical act that is, like a hydraulic jack that one can use to lift  anytime he wants to. It is a physiological process that starts with a stimulus perceived by the brain, which comes from sight, smell, feel or touch.

    A man's sensitivity to this stimulus is greatly dependent not only on his testosterone level but mainly on its conversion into Dihydrotestosterone (DHT) by an enzyme called alpha reductase inside a Healthy Prostate. DHT is the potent or active form of testosterone and has 5 times its strength (Robert Veltri & Ronald Rodriguez, Campbell-Walsh, 2007).

    My years of experience in handling various ED problems have shown me that DHT is indeed the primary male hormone necessary for a man's Erectile Function rather than raw testosterone. I have seen patients who were previously taking testosterone orally while others parenterally (by injection), with no improvement in their Erectile Function. But after Prostatitis treatment, most noted an improvement or resurgence in their function.

III. Diagnosis of Erectile Dysfunction

    A diagnosis of ED is based on the subjective complaint of a man and this is mainly dependent on his appreciation of his sexual capacity. But evaluating one's Erectile capability could be difficult for men to accurately assess as some are in a state of denial. 

    In other cases, some men are able to attain an erection but are not able to sustain it, or some have a weak erection but are able to get by, so many men with ED may not recognize the problem at the onset. These may be two of the early signs of an impending complete ED. Other early signs are loss of a morning Erection, Premature Ejaculation and lack of interest in sexual activity. This should all serve as an omen of an impending doom. It is better to recognize this potential problem early on and address it while there is still much that can be done to remedy a diminishing Erection.

    The key is to diagnose Prostatitis. This entails doing various test on the Expressed Prostate Secretion (EPS) collected after Prostate Massage through Wet Mount, Gram Stain and Cultures including Ureaplasma and Mycoplasma bacteria as well as Direct Fluorescence Antibody (DFA) test for Chlamydia by Immunofluorescence Microscopy. These are necessary tests to evaluate a man's Prostate Health, yet these are not routinely done. Then, how would you know if you are harboring these organisms if these test were never done on you.

IV. Treatment of Erectile Dysfunction    

    Most of the patients I have seen who came to me primarily because of Erectile Dysfunction were in their 20s, 30s and 40s. Although the cause of ED may be multifactorial at times, the most common cause of ED I have observed in my practice was Prostatitis, which is present in both young and old. It is essential to diagnose and treat Prostatitis to maintain a healthy Erectile Function (Chapter 3 Genitourinary & Prostate Health).

    It made me realize, that if Prostatitis can cause ED in the very young, how much more in older men, who have more years to acquire Prostatitis or accumulate organisms in their Prostate Glands, plus other contributing factors of ED that come with age.

    Therefore, ED is not necessarily a normal part of an aging process but may rather be a part of a Disease Process or secondary to a disruption  of its normal physiology. In most cases, this may be completely reversible or at least up to a certain extent that is acceptable, provided that the causative factor or factors of ED are identified and treated accordingly. 

    ED may start with Prostatitis and could affect men in varying degrees and may be compounded by other factors in advancing age.  

    I have seen how Prostatitis has caused ED in both the young and the old and how the treatment of Prostatitis by thrice weekly Prostate Massage coupled with culture-based antibiotic has restored much of the Erectile function provided,  enough organisms have been eradicated to restore the balance in favor of the immune system.

    Definitely, we cannot take the problem of ED sitting down. We also have to find out the other causes of ED and look for a solution directed towards the root of the problem. Heart diseases, Hypertension and Chronic Alcoholism are some of the common contributing factors of ED. A man's heart should be able to sustain his body weight and the rigor of sexual activity to be able to maintain and sustain a firm erection. 

Having a good Erection is part of a healthy man's mind and body. It can be a reflection of one's total wellbeing. With the proper diet, regular exercise and a Healthy Prostate, one need not experience Erectile Dysfunction.

    A man may never realize the value of Prostate Massage in restoring or augmenting one's Erectile Function until he has experienced Prostate Massage.

    I noted some of my patients have  responded with very good Erectile Function with as little as a single Prostate Massage, although most would need more massages depending on one's Prostate condition.

    My years of experience has taught me that it is important to keep a Healthier Prostate by periodic Prostate Massage to preserve one's Erectile Function.