Medical Daily had the chance to talk with Dr. Michael Eisenberg about erectile dysfunction. Dr. Eisenberg is the Director of Male Reproductive Medicine and Surgery at Stanford Hospital & Clinics whose research focus includes fatherhood's effect on a man's health and his clinical focus includes erectile dysfunction, infertility, urology and men's health. In the interview Dr. Eisenberg discussed men's health as well as what erectile dysfunction is all about.

Based on your recent research on fatherhood and cardiovascular risk, what does being a dad mean medically?

Dr. EisenbergThe study looks at the risk of childlessness. And in this country, certainly there is childlessness that is desired and not desired and the hypothesis was that undesired childlessness, or infertility, was a risk factor for cardiovascular disease and death. In fact, there seemed to be an increased risk for men that did not have children compared to fathers, anybody that had a biological child, had about a 17 percent increased risk of cardiovascular death.

Why that is, and the research is sort of hypothesis generating, my belief is that there is a biological cause. We know that men that are infertile have decreased testicular function and the testicles do two things, they make sperm but they also make testosterone and testosterone, if it is low, over the course of life can actually increase the risk for several of things. Testosterone can increase the risk for vascular disease, diabetes, obesity, things like that which can certainly increase the risk of cardiovascular events which we saw in the study.

What do you think are some factors as to why fathers fare better than childless males?

Dr. Eisenberg: Certainly, in my hypothesis, there is some sort of intrinsic biologic differences between men that can and cannot conceive but there certainly are going to be social factors as well. Being married actually lowers your risk of heart disease and death. Also having children I think would probably play a similar role, in general it would make men happier and there is somebody there to take care of you.

As you advance in life, you are probably more likely to seek healthcare, take care of yourself like diet, exercise and things like that. I think they all play a role but certainly a support structure I think is very important which your children can provide.

Was there any difference between fathers who had children but later developed erectile dysfunction?

Dr. Eisenberg: Unfortunately, that study did not look at erectile dysfunction. To my knowledge, that has never been clearly looked at. A lot of the studies that looked at erectile dysfunction are going to have a lot of fathers in the cohort and I think in general it would not be a leap to say that the same things that we would find in those groups as well, whether childless or fathers, that a lot of times we found that erectile dysfunction can precede other health problems.

Blood vessels in the penis are a lot smaller than other parts of the body. For example, in the heart, the main blood vessels are probably around 4mm and in the penis they are probably around 1mm. So, you can imagine what atherosclerosis (hardening of the arteries) or some of the other vascular problems that can develop from diabetes, high blood pressure or high cholesterol, it's much easier to accrue blood vessels in the penis than it is elsewhere so a lot of times erectile dysfunction does precede some of these other health problems.

For example for heart disease, we think erectile dysfunction can precede heart disease by maybe three to four years. So sometimes when I see men I tell them that it's a warning sign, that you should be evaluated and make sure you talk to your primary doctor because this may be a sort of window of curability where we can really catch things early so you don't have a heart attack.

What diseases increase the risk of erectile dysfunction and which diseases are you at an increased risk for if you have erectile dysfunction?

Dr. Eisenberg: If you look at a group of patients coming to a clinic with erectile dysfunction, these patients are at risk for high cholesterol, high blood pressure, diabetes and a lot of times you make that diagnosis. Depending on which of those ailments you are looking at, but with like high cholesterol that diagnosis may be made 30 or 40 percent of the time the man may not know he has high cholesterol, and with high blood pressure it's 10 to 20 percent of the time the man may not know that he has high blood pressure.

The man comes to an urologist or his primary doctor to take care of his erection but again, it's a warning sign of other health problems.

All of those kind of go together in terms of vascular problems for erectile dysfunction. Smoking is also associated with erectile dysfunction. Some of the medications we use to treat high blood pressure those could be associated with erectile dysfunction. Sometimes I'll work with the primary care doctor or the cardiologist to see if we could switch out some of the medications some have a higher incidence of erectile dysfunction than others, so we see if we could tailor treatment so that we can help both the high blood pressure as well as the erectile dysfunction.

Depression and psychological disorders, some of those ailments cause erectile dysfunction also some of the treatments do as well. Those are other things we can try to target and treat.

Some injuries to the penis, certainly prostate cancer treatment, radiation or surgery, can lead to erectile dysfunction. Prostate cancer itself is not necessarily a risk factor but certainly the treatment of it can be for erectile dysfunction.

And another big one we are just learning about is low testosterone, or hypogonadism. That is definitely associated with sexual dysfunction, not just erectile dysfunction but also problems with libido, orgasm, arousal, all those sorts of things. I think now that's becoming a standard part of evaluation for erectile dysfunction, we find out what the testosterone is and if it is low, we start treatment with that because we can completely cure the erectile dysfunction or we can make all the other treatment options available much more efficacious.

One of the more curious examples of two diseases being linked is gum disease and erectile dysfunction. How are these disease related?

Dr. Eisenberg: That's becoming more and more recognized. The etiology, study of its origins, is in some ways a little unclear. One of the popular theories is that it's a chronic inflammatory condition of the whole body so when there are these inflammatory markers possibly caused by gum disease you can get these other signs of inflammation. Atherosclerosis, a vascular disease, is another manifestation of this sort of inflammatory response so it may kind of predispose us to develop these inflammatory problems in our blood vessels just as they would occur in our mouth.

Does erectile dysfunction affect races differently?

Dr. Eisenberg: Certainly to some extent I think there are some race ethnicities that have higher degrees of high blood pressure, diabetes, obesity, things like that but the same risk factors span across all race ethnicities.

If you look at the world as a whole, erectile dysfunction is rising on every single continent, regardless of race ethnicity. As the obesity epidemic spreads across continents, diets with higher saturated fats, all that sort of stuff, reaches everywhere, reaches all countries, erectile dysfunction is rising. So I think there are differences in the obesity epidemic across different race ethnicities and certainly socioeconomic lines as well but erectile dysfunction can really touch all people.

I think the same risk factors are causes across those different races.

Do patients come to you unaware of these risk factors? Are they looking to treat the larger disease of erectile dysfunction or just the symptoms?

Dr. Eisenberg: I think a lot of times men don't know. The first kind of manifestation is just trouble getting an erection. Sometimes, in my practice, there are more educated patients that do understand that association but a lot of times, they don't know.  I think some men are happy to treat the problem, with just a pill or some of the other very effective therapies that we have.

Sometimes it's the first health problem that they've ever had, so they're not that excited about treatment that will mask the problem but like to treat the problem. We definitely go over all the risk factors, look over them carefully, vital signs, blood pressure, several laboratory tests to see if they have any risk factors.

I always tell them, "You know, anything that is good for your heart is going to be good for your penis."  Good diet, good exercise, maintaining a healthy bodyweight, all those things will certainly. Most of these men are going to have one or more risk factors that we can correct.

What are some of the ways to improve men's health and reduce the erectile dysfunction risk?

Dr. Eisenberg: Well I think it is education, awareness and just taking care of yourself. If you look across a whole population of men, 40 to 70 or 80 years old, the risk of erectile dysfunction is around 50 percent. I think a lot of that is due to some of these potential lifestyle factors, high blood pressure, diabetes, obesity, high cholesterol, these are things we can treat.

Through education, we can help men live healthier lives. In the news recently, the obesity epidemic continues to spread, for all the different reasons that it is going on I think erectile dysfunction is also increasing in this country.

So I think that's sort of a good avenue to gain a man's attention. In and of itself maybe a man isn't too concerned about diabetes but if you tell him the other health problems with it, trouble with erection, not being able to have sex. That's potentially a pretty powerful way to convince a man it's in his best interest to lose weight. Maybe if a heart attack or early doesn't scare him, maybe an erection will because a lot of men really associate that with manhood, enjoyment, pleasure, a life of satisfaction or relationship health. All those kind of things that surround sexual function and erectile function and that's a potential another avenue we can use to advance men's health.

What are some myths or causes of concern that you've heard about in regards to erectile dysfunction?

Dr. Eisenberg: I think a lot of men are concerned about a psychological component. Certainly that does play a role I think we used to think a lot of erectile dysfunction was due to psychological factors but now we know it's only about 10 percent of cases. So I think some men are more concerned about that than they need to be.

The other thing is a lot of men think it's a normal part of aging. Maybe to some extent that is true but I think there is a lot we can do, again all these modifiable risk factors. Certainly a man that's 60 or 70 won't have the same erection as a 20 year old but there is a lot we can do to get you a very good erection that can satisfy you and your partner. 

Men need to know we have a lot of treatments obviously there are some that are advertised very aggressively on television but even beyond that we have a lot of great treatments. I always tell men, "Basically we can be as aggressive as you want to be," it's a very rare case where we are not able to give a man his erection back.

I am very upfront with men about that and usually I'm very optimistic about our treatment success, basically we really are only limited to how much they want to do because we have really great treatments now.