Shabsigh is one of a growing number of health professionals spreading the word that when a man starts to go soft it’s a red flag that other parts of his body need medical attention, too. A healthy penis starts with a healthy body, according to Shabsigh. But because most guys would rather swallow broken glass than admit they have a problem in any part of their bodies (let alone that part), it’s up to you, ladies. Read on to learn: 1. Why an Internet prescription for Viagra isn’t the best remedy for bedroom breakdowns. 2. How getting your guy to lay off the burgers and trade the couch for some cross-trainers might beat a prescription for a little blue pill. 3. A trick to get him to the doctor that doesn’t require hog-tying or chloroform. 4. Why pinpointing the cause of his ED could save your man’s life.
Dr. Ridwan Shabsigh: The first step is to overcome the barriers. We surveyed 32,000 men in waiting rooms of primary care physicians in America and five other countries. We asked those who had ED if they brought it up with their doctor. And we found that more than half of patients with ED did not bring it up with their doctors despite already being in the doctor’s office. When we asked them why, the reasons included denial, thinking that ED is a normal part of aging, not knowing that there’s help, and embarrassment. Embarrassment is a big issue. And we found that embarrassment was more common among younger men with ED. The younger the men, the more embarrassed they were.
In my book I talk about a number of techniques to overcome the barriers. Take someone with you to the doctor, such as your wife, who can help explain. Or write a letter to the doctor. Remember that there is nothing to be ashamed or embarrassed about. The penis is an organ like the spleen, the kidney or the liver. It can malfunction. It’s important to remember that ED is not a normal consequence of aging. It’s a progressive condition. And it should be treated.
You’ve called the penis the “thermometer” of a man’s health, and when that’s not working well it usually means there are more serious health problems brewing. What can the penis tell us about the state of a man’s health?
Shabsigh: A number of systems are required for the penis to function. These include the vascular system, which includes the blood vessels in the penis. Consequently, anything that damages the vascular system will result in erectile dysfunction. The nervous system is also required to send signals to the blood vessels in the penis telling them to open up and bring blood to the penis to make an erection. And both the nerves and blood vessels need testosterone to function.
Shabsigh: Erectile dysfunction can be an early warning symptom of heart disease, high blood pressure and high cholesterol. What are the symptoms of high cholesterol? It’s a number on paper for the patient. But erectile dysfunction is a real tangible symptom.ED is a warning symptom of future coronary artery disease with a lag time of about three years. If you have high blood pressure and erectile dysfunction, you’re more likely to have a heart attack or stroke than if you had high blood pressure and no erectile dysfunction – it’s an indicator of how dangerous your hypertension is. This is important because hypertension is one of those silent diseases.
Does obesity play a role, too?
Shabsigh: Obesity is related to vascular disease. The more obese a person is, the more hardening of the arteries – or atherosclerosis – there is, which affects blood flow in the penis and causes difficulty in obtaining and maintaining erections. There’s another and probably more profound effect of abdominal obesity: Fat in the abdomen is especially harmful because fat cells in the abdomen have an enzyme called aromatase, which converts testosterone into estrogen. Estrogen lowers testosterone. And if you have testosterone deficiency, then you have sexual dysfunction, erectile dysfunction, low sexual desire, poor orgasm, low-volume ejaculation, and lack of pleasure and satisfaction.
So how does losing weight help?
Shabsigh: If you lose weight, a number of things improve: The arteries become more flexible. Blood pressure improves. If you’re borderline diabetic, or even diabetic, that will improve. In addition, your testosterone goes up. It’s been shown that if you have abdominal obesity and you lose inches and pounds, your testosterone will go up, your sexual desire will go up, your erections will improve, and your orgasm and ejaculation will become more pleasurable. To see a difference in sexual function, you need to lose ten percent of your weight, which can improve things significantly.
Is smoking also an issue?
Shabsigh: Smoking damages blood vessels and reduces blood circulation in the penis. So the same way that it affects the heart and coronary arteries, it also affects the penile arteries, keeping in mind that the penile arteries are smaller than the coronary arteries. If you’re taking Viagra, Levitra or Cialis and you stop smoking, your response to the medications will improve.
According to the Health Professionals Follow-Up Study (an ongoing survey of men’s health administered by the Harvard School of Public Health), watching more than 20 hours of TV a week, along with excessive consumption of alcohol, smoking and being overweight, was associated with higher levels of ED.
Shabsigh: Watching football, drinking beer and smoking cigars are typical guy things. If you have a sedentary lifestyle and you start exercising, you improve your sexual function. But it has to be aerobic exercise. That improves the function of the arteries and the veins in the body. Remember, the penis is a complex vascular organ, and you need healthy blood vessels for it to function.
Any other lifestyle factors that affect sexual function?
Shabsigh: Acute stress releases adrenalin, which restricts blood vessels and makes erections less effective. In addition, when people are under chronic stress, they frequently cope poorly. They overeat. Some people also resort to alcohol, which has two effects: If you drink enough, you go to sleep, and some parts of you go to sleep before other parts. If you abuse alcohol for years, you will damage the nerves in the body. That’s why many men with a history of alcohol abuse report not only erectile dysfunction but also sensory numbness in the penis.
Shabsigh: The first step is to know where you are. Calculate your BMI [Body Mass Index] to know whether you’re normal, overweight, obese, or extremely obese. If you want to reduce your [weight], you have to … eat less and exercise more. How you do that? The general rule is that any diet that is healthy for the vascular system and the prostate is healthy for sex. As for exercise, I recommend thirty minutes a day, four to six days a week. Choose the activity most suitable to you, individually. Exercise also reduces anxiety and improves the ability to deal with stress. So do meditation and yoga.
Shabsigh: It could be a good day because it’s a day to review a man’s health. Many men haven’t been to a doctor in years. Women are used to going to the doctor. Once a year you get your Pap smear, your mammogram. Men aren’t like that. They go ten years without going to the doctor.Taking a pill is the easy part of this. That’s why I tell my patients that asking for samples of Viagra or Cialis or Levitra is not helpful because what they really need is a review of their health. I ask my patients, Do you know your blood pressure? Do you know your cholesterol? Do you smoke? Do you know your weight? Do you know your BMI? Do you know your waist circumference? Do you know your testosterone level? Do you have any prostate or urinary problems? Are you depressed? How is your relationship? Are you under stress? Do you have too much anxiety? Are you overcommitted in life? Do you exercise regularly? Do you overeat? Do you over-drink? This review makes coming to the doctor about erectile dysfunction more valuable than just taking a pill. Sure, there is value in pills for ED. There’s also value in using penile injection therapy for those who don’t respond to the pills. There’s great value in having a penile implant if medications don’t work. There’s value in taking testosterone if your testosterone is low. There is value in all these things. But alone they’re not enough. Just taking Viagra and maintaining bad lifestyle habits is not good.