Talking About Erectile Dysfunction Treatment: A Doctor's Perspective

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It's not uncommon for men to experience at least some degree of erectile dysfunction (ED). Presumably, that means a lot of frank conversations about ED are taking place in doctor’s offices around the country: In a 2017 Harris Poll survey of more than 2,000 adults, 73 percent of men said they’re comfortable discussing sex problems with their physicians. While those men are primed to try ED treatments like oral medications, they tend to be less open to options like vacuum constriction devices, penile injections, and penile implants. Penile implants consist of a pair of cylinders surgically inserted into the penis; with inflatable models, doctors also place a manual pump in the scrotum.

Ryan P. Terlecki, M.D., associate professor of urology at Wake Forest Baptist Health in Winston-Salem, North Carolina, is a paid spokesperson for Boston Scientific, the penile-implant maker that commissioned the Harris Poll survey. HealthCentral spoke with Dr. Terlecki about why it is vital for patients to be honest with their doctors about ED and why he’s working to increase awareness of penile implants as a treatment option for many men with ED. Steve Cline, an ED patient, also joined the discussion to share his own treatment experiences.

HealthCentral (HC): Dr. Terlecki, what’s at stake for men with ED who don’t discuss their sexual health with their doctors?

Dr. Terlecki: The Harris Poll survey actually showed that men are significantly more comfortable discussing sexual health with their doctors than women are, even though women tend to be better about looking out for their overall health. It’s essential that men bring ED to the attention of their doctors because it may be a warning sign of underlying conditions such as high blood pressure, diabetes, or heart disease. And sexual health is very important for overall wellness.

HC: If a patient tells his doctor that he is having trouble getting or maintaining an erection, what kind of follow-up information will the doctor ask for, and why is that important?

Dr. Terlecki: I think the doctor would be likely to inquire about other medical conditions, about diet and lifestyle, to look at things that could be modified before initiating treatment. Among treatment options, of course, there are very effective regimens.

HC: Can you talk about the various treatments and why you’re working to educate patients about penile implants?

Dr. Terlecki: I think medications can be a reasonable option to start with. But there are potential side effects — headache, congestion — and there’s an ongoing cost. And medications may fail in up to 50 percent of men. Another option is penile injections, but sometimes they can be uncomfortable, and patients may feel some anxiety about them. And again, you have ongoing cost considerations. With the implant, the benefits are that it’s totally concealed, there’s no ongoing cost, and there’s no need to take medications. The appearance looks natural and feels natural for both the man and his partner. We have long-term evidence that it’s highly satisfying for men in restoring sexual activity. Over half a million men have gone this route successfully.

HC: What is the insertion procedure like?

Dr. Terlecki: It tends to be an outpatient procedure; 40 percent of my patients don’t even use any medication for discomfort afterwards.

HC: Steve, can you talk to us about your own ED experience?

Steve Cline: I was diagnosed with ED in my early 60s. And at first it was difficult to try to talk to someone — my wife, my doctor — because it’s an embarrassing situation for a man to have. I tried several different medications, and the side effects were atrocious — extreme flushing of my face that lasted for hours, severe headaches, blurred vision, stomach upset, things like this. And eventually, after a period of a few years, medications stopped working. Choosing the implant was one of the best decisions I’ve ever made. It restored my self-confidence. I was able to communicate with my wife better. It was a great decision that I had made for both of us.

HC: It’s terrific that you found a doctor you could be open with. Dr. Terlecki, is it possible for patients to share too much information with their doctors?

Dr. Terlecki: I want to emphasize that we as doctors are there to hear whatever a patient wishes to tell us as it relates to their health.

[Interview has been condensed and edited.]

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