Vasectomy: To Do or Not To Do?

By Hans Stricker, MD

Enjoying sex without fear of pregnancy; Limiting your family size; Protecting your partner from a dangerous pregnancy. These are all common reasons why men choose to have a vasectomy. And, with the minimally invasive techniques available today on an outpatient basis, the procedure is quick, easy and virtually painless. It’s also a fairly inexpensive procedure, especially compared to female sterilization. As with any procedure, you need to consider the long-term ramifications.

Despite the fact that vasectomy can be reversed in some cases, men should always consider it to be a permanent form of birth control. If there is any reason to believe that a man may wish to have children in the future, he definitely must consider other forms of birth control instead.

During a vasectomy, the surgeon makes one or two small openings in the scrotum, then cuts both the left and right vas deferens, which are the muscular tubes that carry sperm out of the testicles. Both ends of the tube are then tied off or sealed. Alternately, the surgeon can use the “no-scalpel” vasectomy method, which is performed through tiny puncture holes that don’t require stitches. There’s very little blood loss with this technique, as well as less pain and a lower risk of complications.

Overall, vasectomy is a highly effective, relatively simple procedure that takes as little as 10-20 minutes – which is why more than 500,000 American men choose this type of sterilization every year. But because it is permanent, the decision to have a vasectomy must not be made lightly. So here is a checklist of the do’s and don’ts you should consider both before committing to a vasectomy and after the surgery is complete:

Do make sure both you and your spouse or significant other is in absolute agreement that your family is complete and you won’t want more children in the future. If either of you is unsure, don’t go through with the procedure.

Do consider all other forms of birth control first. Female contraceptive methods are more than 97 percent effective, and many of them, like diaphragms and cervical caps, have no serious complications or side effects.

Do remember that personal circumstances can change over time. Death and divorce are a fact of life, and there’s always the possibility that one day you may want to have children with a new spouse or partner.

Do make sure you’re mentally ready. Although a vasectomy does not affect testosterone levels, sexual performance or the amount of ejaculate, some men or their spouses still have a hard time accepting the fact that they’ll be sterile permanently. If there may be doubts in your mind about going through with the procedure, postpone it for a while – or even indefinitely.

Don’t allow yourself to be pressured into having the procedure. Only you can make the final decision with the loving support of your partner.

Don’t bank sperm just in case you change your mind later. Sperm does not always survive the freezing process, and can begin to lose its ability to fertilize an egg in as little as six months. It’s also expensive to store sperm. So if you can’t make a firm decision about whether you’ll want children in the future, you probably should forego the vasectomy.

Don’t rush into having the surgery after the birth of your last child. Regrettably, some couples lose their child to Sudden Infant Death Syndrome (SIDS), and the heartbreak of knowing they can’t have another child can make the loss even harder to bear.

Don’t try to return to regular activities too soon after the procedure. Although the procedure is considered minor, you still need time to recuperate. You must avoid lifting anything heavier than 15 pounds – including babies and children – as well as doing any strenuous activities or sports, having sex, getting into and out of cars, and going up and down stairs for up to seven days so you have time to heal properly. You’ll also need to avoid doing heavy work of any kind for up to two weeks after the procedure.

Don’t forget to have your post-vasectomy sperm count tests. Vasectomy is extremely effective, but it can take several months after surgery for sperm to be flushed completely out of the vas deferens. Only a semen test can tell you whether it’s safe to have unprotected sex. You’ll usually need two consecutive tests to be sure, and until you’re given the all-clear, you’ll need to continue to use your previous birth control method.

Sidebar: Second Chance

An estimated 2-6 percent of the half million American men who undergo vasectomy later decide to have a vasectomy reversal. However, even though vasectomy is a fairly simple procedure, the microsurgical reversal procedure is not and a subsequent pregnancy is not guaranteed. The surgery also is usually not covered by insurance so the out-of-pocket costs can be high — $10,000 on average, but as much as $20,000.

The microsurgical reversal usually consists of sewing the vas deferens back together or reattaching it directly to the testicles, which allows sperm to reach the semen again. But while an experienced reversal specialist can reestablish sperm flow 99 percent of the time, a natural pregnancy will result only about two-thirds of the time, and it takes an average of 12 months for the woman to conceive. But for the man who wants to father a child again, the discomfort and cost of a reversal may be a small price to pay.

Hans Stricker, MD, is board certified by the American Board of Urology. He completed medical school at the University of Michigan Medical School followed by his general surgery and urology training, also at U of M. His clinical and special medical interests are in the areas of prostate, bladder and kidney cancer.

HRT for Men

With Robert Grafton, MD

When it comes to hormone replacement therapy, we often think about women, menopause, hot flashes, moodiness, bone loss and various other conditions that accompany the time in a woman’s life when HRT is necessary. However, when a man becomes more moody, loses muscle mass, puts on a few pounds, loses libido, we just chalk it up to old age and think there is nothing that can be done.

This just isn’t true.

In fact, hormone replacement – in this case, testosterone – is just as necessary for some men as estrogen replacement is for some women, according to Dr. Robert Grafton of Rochester Hills.

“Think about the crabby old man,” says Dr. Grafton. “You get the mental fogginess, the anxiety, you don’t sleep well, you have physical changes, each can be signs reflecting a loss of testosterone.”

According to Dr. Grafton, men are at the peak levels of testosterone at the age of 30, but testosterone levels decrease 10% each decade thereafter. The amount and severity is different with everyone but the only way to know how your hormonal levels are is to get a baseline value as part of a routine physical.

“You should check your levels in your 40s and if you notice certain levels are lower, and it is an issue get treatment, if not, then you are fine,” suggests Dr. Grafton. “Fifty year old men will get potbellys, skinny arms and have some breast growth, these are typical signs of decreased testosterone. If you haven’t gotten checked with these physical signs, you should.”

In some instances, Dr. Grafton points out that estrogen levels in men has increased due to diet. “Over the last 50 years we have had a decrease in testosterone, but an increase in Xeno-hormones; those that tend to be injected into beef, chicken, milk-producing cows, and our estrogen levels have gone up,” says Dr. Grafton. “Increased estrogen in our bodies is complicating the hormonal balance.”

There are an increasing amount of treatments now for men with low testosterone levels – from creams to pills and patches. These are generally synthetic hormones produced to be similar to your body’s hormones.

Dr. Grafton, and many other physicians, are now looking to treat their patients with biologically equivalent hormones that are engineered more like the hormones our body produces.

Testosterone has many benefits, points out Dr. Grafton. As a vasodilator, it opens your blood vessels, can help lower blood pressure, increase libido, raise your HDL (good cholesterol) and lower your LDL (bad cholesterol). With the many health benefits that go along with balanced hormonal levels, one can see the importance of knowing where you stand.

One treatment option is to have pellets of bioequivalent hormones injected under the skin, says Dr. Grafton. These pellets are similar to a small piece of rice and will last 4-6 months on average.

“These pellets are the same structure as what you’ve lost, put under the skin, and you don’t get the peaks and valleys that you can with other treatments,” says Dr. Grafton. “When you hit high peaks is when you get complications after injections.”

With the pellets, Dr. Grafton states they are released based on your body’s activity, you have a more balanced release. He adds that since the hormone replacement is necessary for the rest of one’s life, that the pellets simplify treatment compared to creams, patches and pills.

Normal hormone levels range between 200 and 1200, says Dr. Grafton, but he will generally start treatment on someone whose levels are under 650. “You want to be in the 80th percentile,” states Dr. Grafton. “You want normal levels, but you want optimal levels and you want to function to optimal capacity.”

As in every other health issue, good diet and exercise are the basic principles to adhere to, says Dr. Grafton. By using the bio-identical hormone pellets that are produced in compound pharmacies, you can simplify reatment and not have to worry about daily treatment regimens, he says.

So, if you are feeling some of the symptoms described, talk to you physician, have your hormone levels checked, and see what options fit the lifestyle that you want.

Hernias: The Working Man’s Condition

By Christine Wideman, RN, with Scott Laker, MD

Moving furniture, shoveling snow, playing sports – everyday activities done without a second thought in our busy lives, until a sudden pull, an awkward twist or a heavy-lift goes wrong , and a hernia is born.

Inguinal hernias are among the most common medical conditions faced by men. According to the National Center for Health Statistics, about 600,000 inguinal hernias are repaired in the United States every year. Nearly 25 % of men and approximately 2% of women will develop inguinal hernias.

“A hernia is essentially a defect in the wall of the abdomen,” said Dr. Scott Laker, M.D., a surgeon at Harper University Hospital in Detroit. “When the abdominal muscle is weakened, the inner lining of the abdomen can slip through, creating a bulge. Depending on the location of the hernia, different structures of the inner abdomen may also protrude.”

There are many types of abdominal hernias, according to Dr. Laker. Hernias may be located around the belly button (umbilical hernia), or near the site of a previous surgical incision (incisional hernia) and in other areas. The most common type of hernia and the one most closely associated with men’s health is the inguinal or groin hernia.

Inguinal or groin hernias make up the majority of all abdominal hernias. They can occur in women, but they are much more common in men. This type of hernia is often associated with heavy lifting, but there can be many other causes.

“People can get a hernia for various reasons,” said Dr. Laker. “Some hernias are congenital and are present at birth. Others develop as a part of the wear and tear process over time.” Basically anything that increases abdominal pressures can help create or worsen a hernia. These would include heavy lifting, coughing or straining during a bowel movement or urination.

Obesity can also be a factor as well as family history. However, Dr, Laker cautions, “hernias can occur to anyone at any time (in their) life.”

Signs of hernia can also vary. “Some people may have a painless lump or protrusion that they can actually push back into place themselves. Others may have pain or aching at the site. Any symptoms suspicious for a hernia should always be evaluated by a physician,” Dr. Laker says.

Treatment of a hernia is very individualized and there are many factors to be considered such as the size, type and location of the hernia as well as the person’s overall health status. Trusses or hernia belts may help support the weakened area for a time, but are not used unless a patient has a medical condition that prevents him from having surgery. Ultimately, according to Dr. Laker, a hernia must be surgically repaired.

“A hernia will not get better by itself and it may get worse. There is always the serious risk of strangulation. If a segment of the intestine slips through the hernia opening and becomes trapped with loss of blood supply to the tissues, there is a danger of developing dead bowel within a few hours time. Strangulation or incarceration of the bowel is considered a surgical emergency and must be treated immediately,” says Dr. Laker.

There are two main surgical options: traditional open repair and laparoscopic repair of inguinal hernias “The traditional open repair has been the gold standard for 100 years,” said Dr. Laker. In the open repair, the surgeon makes an incision long enough to access the hernia site. A synthetic surgical mesh is placed into the defect to help support the repair and then the incision is closed.

In the last ten years, minimally invasive laparoscopic surgery techniques have been developed as an alternative to traditional open repair. In these techniques, smaller incisions are used to insert laparascopes into the site. This enables the surgeon to view and repair the hernia with telescopic cameras. Synthetic surgical mesh is also used in this technique to support the repaired area according to Dr. Laker.

Both procedures are performed on an outpatient basis and recovery time varies from person to person. Generally, because laparascopic procedures have smaller incisions, patients tend to require less pain medication and return to normal activities sooner, according to Dr. Laker.

Which procedure is right for you? Dr. Laker says your surgeon is the best person to make that decision. “Depending on the surgeon’s evaluation of the patient and his overall medical condition, as well as the size and location of the hernia, the surgeon will opt for whichever procedure is most beneficial to the patient. Since laparoscopic repair is fairly new, a lot also depends on the surgeon’s comfort and skill level with the procedure.”

Any surgical procedure carries the risks of bleeding and wound infection. And unfortunately, even if the initial surgery is successful, there is always the possibility that the hernia may come back. According to Dr. Laker, avoiding activities that increase abdominal pressure such as coughing, heavy lifting and straining can help. Obesity is also modifiable a risk factor and Dr. Laker advises anyone who smokes to quit, since the development of chronic lung disease and persistent cough increases hernia risks.

Overall, when it comes to hernias, the best advice is to seek the advice of your health care professional EARLY. If you suspect a hernia, your physician can evaluate your specific needs and recommend a plan of care. A hernia can only grow larger with time, so the time to take care of it is now.

Further information and illustrations of hernias can be found online at WebMD: http://men.webmd.com/guide/understanding-hernia-basics

Christine Wideman, RN, has a degree in nursing and journalism. She continues to work as a nurse and has written on a variety of topics for both local and national publications as a freelance journalist.

Dr. Scott Laker is a native of Southeast Michigan.  He received his medical degree from Boston University and completed his residency in general surgery at New York University.  Dr. Laker’s clinical interests are minimally invasive approaches to obesity, colon and hernia surgery.

Emery King: A Man Dedicated to Healthy Living

For nineteen years on Channel 4 WDIV, we all watched him as he gave us the evening news with a sense of honesty, integrity and humor. Now, Emery King, 59, is the Communications Director for the Detroit Medical Centers, a post that he assumed two and a half years ago. The electric energy of working for a medical facility as comprehensive as the DMC is on par to working in the lightening bolt pace of a newsroom. For Emery, he has found his element once again.

As part of this month’s celebration of men’s health, we thought we would sit down with this famed former newscaster and learn about what makes Emery, who turns sixty later this month, move and think like he was thirty years younger.

Being mindful of his health has always been in the forefront of Emery’s mind and actions. Getting in shape has never been a problem for him. It is maintaining the weight that he worked so hard to achieve that challenges him.

“I’m not one of those people who is blessed with a fast metabolism. I’m a naturally big guy and as I’ve become older, it becomes much harder to take off those extra pounds that are so easy to put on,” says Emery.

When he was younger, he was an avid runner but a few sprained ankles and the wear and tear of pounding the pavement day after day took its toll on him.

“I loved the solitude of running but I never liked the process of it,” says Emery who now takes full advantage of The Brasza Center, the state-of-the-art fitness center the Rehabilitation Institute of Michigan maintains for its patients and DMC employees.

In order to combat the tendency for the pounds to creep on, Emery works out a minimum of three times a week and sometimes with the extra guidance and motivation of his personal trainer, Pam Haretski. Variety is key for this media man who mixes it up by doing a variety of cardiovascular exercises with strength training.

“On the weekends, I get in a lot of walking even in the colder temperatures. During the summer, I’ll add swimming and even yard work to my weekend routine in order to keep things interesting,” says Emery.

His health challenges and goals are just the same for men his age. In order to make sense of all the wellness information we receive, The U.S. Preventive Services Task Force in conjunction with the U.S. Department of Health and Human Services has put together a list of the six most important things men of all age can do to be healthy. Here’s a look at what they are:

• Get the recommended screening tests. Consult your doctor to find out what tests apply to you and how often you should be screened.

• Be tobacco free. If you do smoke, talk to your doctor about quitting.

• Be physically active. Try to get in 30 minutes or more of moderate physical activity most days of the week.

• Eat a healthy diet. Think color and fresh by emphasizing vegetables, fruit, whole grains and lean protein.

• Stay at a healthy weight. Make sure that your intake balances out with your energy expenditure.

• Take preventive medicines if you need them.

Emery can put a check mark next to virtually every one of these recommendations. But he does admit to one Achilles heal when it comes to his diet:

“My one bad habit is ice cream. Even in the cold weather in the winter doesn’t stop me from eating it,” he says.

When he is in his zone, he prefers to not have any of the creamy stuff around. Even though Emery’s personal trainer has been lecturing him on the value of moderation and how a healthy diet should not eliminate any one kind of food, he still prefers having ice cream chilling in the grocery store frozen section rather than in his icebox.

He also tries to keep red meat and refined carbohydrates down to a minimum and instead up’s his intake of fish and vegetables. Being on the go during the day, he avoids the temptation to get the quick fast-food meal on the run and instead opts for Caesar or Greek salads and takes advantage of the DMC cafeteria for healthy selections when he is in the office. With breakfast as his favorite meal, he skips the pastry section of Starbucks and instead skillets up his own egg white omelets.

For all the men out there who aspire to have the energy and discipline that Emery does, he has his own thoughts of advice for all Detroit men who are looking to stay on top of their health goals.

He recommends finding work that is meaningful, getting enough sleep and taking some time away to free your mind. Turning off the computer, cell phone and blackberry and having time to yourself to meditate or simply sit quietly is a vital component of any healthy lifestyle, he says.

Additionally, he suggests casting fear aside and schedule a physical examination. “Arming yourself with knowledge and action can put truth to Franklin Delano Roosevelt’s adage of ‘the only thing to fear is fear itself,’” says Emery.

Working for one of Michigan’s largest medical facilities has also rubbed off on him in some very important ways.

“With the technology and medical advancements that I see all around me, I become more and more fascinated by the human body, its capacity to heal itself and what we can do to prevent illness,” says Emery.

He takes this intrigue and applies to his own life by keeping up with his regular physical examinations including seeing a urologist twice a year since prostate cancer has such a high incidence among Black men. As he has gotten older, he has become more concerned about his health and takes the necessary preventive steps to ensure that he is doing all he can to live a long and healthy life. And, if his personal trainer has any say in his lifestyle choices, a dish of ice cream every now and then is an okay part of this healthy living plan.

Have You Changed Your Oil Lately?

By Bruce Eisenberg, MD

I have been practicing primary care medicine for over twenty-two years, and I have recently begun to notice a trend that concerns me. Numerous patients with a wide variety of backgrounds – both on and off regular prescription medications – have been missing follow-up visits. Some of these are as far back as two to three years and most of these are male patients. I often ask these patients if they change the oil in their car on a regular basis. The answer is always yes. I then suggest that perhaps their own body deserves the same basic maintenance as their automobile.

Most patients are surprised by the length of time that has passed since their last appointment. Many patients state they have not come in because their diet and exercise have not been consistent, or they were in the process of quitting smoking, and they were waiting to come in when their cholesterol, blood sugar and blood pressure were improved. These are, in fact, the patients which need the most attention because they are at the highest risk. If behaviors are less than perfect, I tailor therapy and screening based on these historical patterns for early disease prevention.

Heart disease is the number one cause of death in America. Cancer is the second leading cause of death and illness. Even with the most meticulous balance of diet and exercise, many individuals are susceptible to these potentially life-threatening illnesses because of family history and what I refer to as a “21st century lifestyle.”

With this lifestyle, one may workout vigorously for one hour every single day and watch his diet. But, the other 23 hours of the day are spent sitting at a desk, using remote controls, operating computers, driving around in cars, riding elevators, and eating processed foods too high in sodium and fat. It is nearly unavoidable.

Historically, women have been better at regular follow-up visits because most of them are getting screenings from a gynecologist. Men, on the other hand, often never get into a routine of regular health maintenance.

Here are some general suggestions on how to improve your own health screening.

By age 20, all individuals should have a complete cholesterol profile and know their “good” HDL and “bad” LDL cholesterol as well as blood pressure. This should be repeated approximately every five years along with a diet, exercise, family history and general health assessment.

If there is a family history of illness such as diabetes, high blood pressure, high cholesterol or cancer the intervals should be adjusted. If there are any abnormalities or lifestyle changes such as smoking, abnormal body weight gain or loss, these intervals should be customized as well.

After the age of 40, prostate screening should be done on a yearly basis. A blood test called a PSA and a digital rectal exam are the usual ways this is done. Body mass index (the ratio of height to weight), blood pressure, heart and lung health, along with general blood and urine checks should also be performed regularly.

At the age of 50, (sooner if there are symptoms or a family history) colon cancer screening with a colonoscopy is recommended, with follow up every five years.

Consumers these days are bombarded with a tremendous amount of health information from the media. It is nearly impossible to make sense of this maze of information. One common mistake often made is when a patient alters a prescription medication, or adds a supplement, because of a study they heard about on the news. Please consult your health care professional before making changes and see if it is actually appropriate for you. Your health care provider should be the first one you consult with, not the last to know.

When your doctor asks you about the medications you are taking, be sure to include all medicines and their doses. Do not forget to also include all supplements and herbs you are taking because they may have important health implications, too.

One example is vitamin C. It has been shown not to prevent colds, but has been linked to lowering good cholesterol (HDL) and can raise the risk of heart disease in some patients.

Another topic in the media these days is erectile dysfunction or ED. Many men are reluctant to discuss this with their physician. Remember that the majority of men will have some degree of ED during their lifetime. What is not commonly known is that it is often related to the early blockage of arteries due to elevated cholesterol, blood pressure and smoking. If you are suffering from this condition be sure to seek treatment and be screened for underlying causes of heart disease as they are one in the same.

The next time you notice that little sticker in the corner of your windshield reminding you of your next oil change, think about when the last time you did a body check-up.

With careful attention to the calendar, you can make a positive step toward early detection and prevention of mechanical breakdown in your most precious vehicle – your own body.

Dr. Bruce Eisenberg is board certified in internal medicine. He is a graduate of Wayne State School of Medicine and has been voted one of the “Best Doctors in America” the last 10 years and has been recognized by Top Docs Detroit Monthly.

Men’s Health: February 2007

In our society, men are generally taught to withstand pain. There is also the feeling of invincibility that comes along with the male species. These two factors can prove fatal when men ignore heart attack or stroke symptoms and do not seek treatment quickly.

To avoid a heart attack, you should know the risk factors. The foremost risk factor is gender. According to the American Heart Association, men have a great risk of heart attack or stroke than women. Men are also more likely to have attacks at a younger age than women. And as part of the male lifestyle, things such as stress, inactivity, alcohol and other factors are contributors to these diseases.

Since early treatment is critical when someone suffers from a stroke or heart attack, it is important to understand the signs and symptoms. No man should ever ignore these symptoms and feel that they will “just go away.” In fact, oftentimes, symptoms of a heart attack are so mild, that you may just pass them off as muscle pain, joint pain, or strains. Knowing and understanding these symptoms, and your risk factors, can help with early diagnosis and treatment.

According to the AHA’s website, symptoms include:

1. Chest discomfort – Heart attacks generally occur with discomfort in the chest that lasts a few minutes, or comes and goes. It can be described as a fullness, pressure, squeezing or pain.

2. Discomfort in other areas of the upper body – Symptoms can include pain or discomfort in one or both arms, the back, neck, jaw or stomach.

3. Shortness of breath – May occur with or without chest discomfort.

4. Other signs – These may include breaking out in a cold sweat, nausea or lightheadedness.

If any of these symptoms lasts a few minutes, it is important to call 9-1-1 and get help. Clinical data supports that as more time passes without treatment, survival rates decrease.

When it comes to stroke victims, it is equally important to understand the symptoms and to receive treatment immediately. Recent data has shown a significant decrease in stroke death when treatment is received within a few hours of symptoms presenting.

The American Stroke Association identifies the following symptoms as signs of stroke:

1. Sudden numbness or weakness of the face, arm or leg, especially on one side of the body

2. Sudden confusion, trouble speaking or understanding

3. Sudden trouble seeing in one or both eyes

4. Sudden trouble walking, dizziness, loss of balance or coordination

5. Sudden, severe headache with no known cause

As with all illness, it is important to seek medical attention as soon as possible.

Although as men, you are taught to withstand a little pain and discomfort, do not ignore the symptoms of stroke or heart attack. Your life may depend on it.

Men’s Health: January 2007

by Mitchell Hollander, MD

So, you have been hearing about Erectile Dysfunction (ED) for quite a while now. First, was Bob Dole and Viagra, and now with other various personalities in advertisements for Cialis and Levitra. So what do you really know about ED? Unless you have actually talked to a physician about the condition, you may not know everything that a man needs to know about Erectile Dysfunction.

What is ED? It is a condition in which a man has trouble achieving or maintaining an erection (or both). In addition to affecting intimacy between couples, ED can also serve as an early warning sign for a whole host of other medical conditions, some life threatening. The three most common conditions associated with ED are:

1. Diabetes – Which affects more the 8.7 million men in the U.S.

2. High Blood Pressure – 29.4 million

3. High Cholesterol – 50.4 million

All of these conditions affect the circulatory system and therefore affect a man’s ability to achieve and maintain an erection. Since all three of the above mentioned conditions have signs and symptoms that can progress slowly, ED may be the first symptom that you actually notice. Another possible cause of ED is a hormone imbalance and your doctor may want to run a blood test to check your testosterone levels.

There are other risk factors associated with Erectile Dysfunction, such as:

1. Smoking

2. Lack of Exercise

3. Obesity

4. Heavy Drinking

5. Stress

6. Lack of Sleep

7. Medication Side Effects (such as anti-depressants and beta-blockers)

8. Depression

9. Spinal Cord Injury

10. Prostate Surgery

So what can you do if you think you have ED? The first thing is to see your doctor. He can look over your past medical history and run some tests to help determine the cause of your problem. Since ED may be a sign of underlying disease, your doctor will first need to find out if you are healthy enough to sustain the cardiovascular stress to have intercourse. For this reason, your doctor will perform several cardiovascular tests to assess your heart’s fitness level and make sure you are still a candidate for sexual intercourse.

If those tests show that you are healthy enough to engage in sex, your doctor will make some recommendations to help correct the problem. Some men may only need to make some lifestyle changes such as losing weight, quitting smoking, or getting more exercise (which are always a good idea anyway). Other men may have a more serious underlying condition that will need to be treated medically in addition to some lifestyle changes.

Both the lifestyle changes and treatment of the underlying disease may take some time before they have a positive affect on erectile quality, and therefore your doctor may prescribe a medication to help you achieve and hold an erection.

You see the ads for them all the time, Viagra, Levitra, and Cialis. They all work in a similar way and allow more blood to flow to the penis by relaxing the blood vessels. There are some people who should not take these drugs, especially those on a type of drug know as a nitrate, often prescribed to treat chest pain or angina. Using both of these medications together may cause an unsafe drop in blood pressure.

There are other possible side effects and your doctor can go over those if they decide to prescribe one of these drugs. If drug therapy is unsuccessful or eliminated due to nitrate use, you may have to use alternate therapies. Some of these other therapies are: suppositories that are inserted into the penis to increase blood flow; injections into the penis to also increase blood flow, and vacuum pump systems. When more conservative measures fail, surgical implants are also a safe and effective means for achieving an erection.

So, now you know a little more about Erectile Dysfunction. You may be surprised to know that even with all those ads talking about ED and the treatments available, that the vast majority of men do not seek the care of a doctor. Many are embarrassed, and some just don’t want to admit they are having a problem.

There is nothing to be embarrassed about ED. It is a common occurrence in men. In fact, all men in their 50’s, 60’s, and 70’s have some level of erectile dysfunction, and your doctor is well trained to evaluate and treat this condition. Secondly, ED may flag a more serious medical condition and help get you treated earlier in the disease progression, which may allow for much better outcomes. Finally, if you think you have a problem, then your partner probably does too. This can lead to stress and depression in a relationship.

The bottom line – if you think you have Erectile Dysfunction go see your doctor, get a physical and get treated. The earlier you take care of it, the better it can be treated, and earlier you can get back to being that guy you always remember.

Dr. Mitchell B. Hollander is a board certified Urological Surgeon, and is the Director of Male Reproductive Medicine at William Beaumont Hospital in Royal Oak, Michigan.