Dr. Cedric Strong, MD MBA
Dr. Strong was always inspired by his father, a doctor who also sought to help and serve his community.
After completing his residency at Tufts University in Massachusetts, Dr. Strong worked at hospitals in Florida and New Hampshire before moving to Hawai’i in 2007. (He still wonders how he made it through all those harsh New England winters.)
Dr. Strong experienced the unique pressures of Hawaiian healthcare right away. He traveled between the islands for several years treating patients before putting down roots in Honolulu. Dr. Strong loves his work in Hawaii, and is inspired everyday by the place and people to make a positive difference both in his own life and in the community.
Erectile Dysfunction or Impotence
Erectile dysfunction (ED) is also referred to as impotence. ED is a condition in which a man is unable to get an erection in his penis. It is also when a man has difficulty maintaining an erection as well. People who suffer from this condition may also only get a partial erection too.
The partial erection is not hard enough for proper sexual intercourse. They can also experience no swelling in the penis at all too. Thus, both scenarios may adversely affect one’s sex life and ability to bear children. There are two main causes of ED. The most common treatment is to take a pill that aids erection. Take this pill before having sexual intercourse. Your doctor may also suggest some changes in lifestyle as well. This is to decrease the side effects of the pill. It also reduces the risk of heart disease as well.
Causes of ED
Many times, tired and fatigued men are unable to achieve an erection. Also, it can happen if they drank too much alcohol as well. Distracted men or those experiencing stressors in life are other instances. But, this is usually temporary. They are able to get an erection most other times when aroused sexually.
ED is a condition when one regularly fails to achieve erection. Thus hampering one’s performance during sexual intercourse as a result. Although it may happen at any age, the onset is most common amongst older men. For instance, about 50% of men between 40 and 70 years of age suffer from ED. Furthermore, 70% of men over 70 years of age have reported the condition. The causes of ED are mainly due to issues with:
- physical health
- mental health
Causes of ED: Physical health
Nearly 80% of the time, erectile dysfunction is due to physical health issues. Issues such as:
- Blood flow to the penis may not be enough to cause an erection. This is usually the case in men over 40 years of age. That is to say, the arteries that carry blood to the penis may become narrow. As a result, lowering blood flow. The risk of narrowing arteries increases when men get older or smoke. Additionally, it increases with high levels of cholesterol. It also increases with high blood pressure as well.
- Other medical conditions may affect getting an erection. Conditions such as Parkinson’s disease, history of stroke or Multiple sclerosis (MS).
- In addition, people with diabetes may find it harder to get an erection. Diabetes can cause narrowing of blood vessels.
- Hormonal issues. Such as low levels of testosterone produced by the testicles. While this is rare, a severe head injury can affect pituitary gland function. As a result, this lowers stimulation to the testicle to produce the hormone. Reduced libido or sex drive or changes in mood may also affect levels of testosterone in the body as well.
- Any major injury to the spine or a fractured pelvis, radiotherapy to the saddle area may cause the nerves going to the penis to not function properly.
- Long-distance cycling often causes pressure on the nerves in the saddle area that goes to the penis and this may cause ED right after the ride.
- Alcohol and drug abuse of medications such as:
- beta-blockers (such as propranolol, atenolol)
- ‘water tablets’ (diuretics)
- This is not an exhaustive list of medications that may cause ED as a side effect.
Therefore, if ED is due to physical issues, except those that are relative to hormonal problems, the person is likely to have a normal sex drive.
Causes of ED: Mental health (psychological) issues
Sometimes, men can feel anxious during sexual intercourse. It can happen if they had previous episodes of occasional ED. As a result, this can make the ED worse. Thus increasing anxiety levels even more. Severe anxiety may prevent you from getting or maintaining an erection. Also, ED may trigger anxiety, low self-esteem, and depression in some cases. Psychological disorders could also lead to ED in some cases as well. Psychological disorders such as depression and anxiety or mental stress. Strained relationships is another example of a disorder leading to ED too.
The onset of the condition can worsen the anxiety. Some people do not realize that their mental health triggers their ED. In such cases, they end up stuck in vicious circles of anxiety leading to Erectile Dysfunction. Then in turn the ED increases anxiety. If one is able to get an erection sometimes, but not on most other occasions, one’s likely suffering from ED. This ED is triggered by a psychological problem. Usually, when mental health improves, Erectile Dysfunction is likely to reduce as well.
Treatment of Erectile Dysfunction
A good general physician is able to treat Erectile Dysfunction. However, in some cases they may need to refer to a specialist. This is in cases where it might be a hormonal problem. ED should not be a side effect of any medication. The doctors generally prescribe any of the 4 tablets to treat ED. The tablets increase the blood flow to the man’s penis. They affect cGMP, that causes the dilation of the penis when aroused sexually. The tablets are:
- Sildenafil (Viagra®), which was introduced in 1998
- Tadalafil (Cialis®)
- Vardenafil (Levitra®)
- Avanafil (Stendra®).
These tablets are phosphodiesterase type 5 (PDE5) inhibitors. It is not recommended to take a PDE5 inhibitor when you are already on nitrate medication. For example, Nitroglycerin, which is usually prescribed to treat angina.
You should take the dose of any of the 4 tablets, around an hour before having sexual intercourse. The tablet can increase blood flow to the penis once the man is sexually aroused. The tablets give an erection, in most cases. Discuss with your doctor in case of failure in getting an erection after medicines.
Consult your doctor if you are consuming alpha-blockers to treat high blood pressure. Alpha-blockers such as doxazosin, indoramin, terazosin or prazosin. Mixing tablets for ED and alpha-blockers cause sudden drop in blood pressure. The risk of narrowing arteries increases when men get older and smoke. Additionally, it increases with high levels of cholesterol. It also increases with high blood pressure as well.
A popular topical cream called Alprostadil. It is applied to the tip of the penis. It is also applied to the skin surrounding it for maintaining erections as well. The application should be about 15-30 minutes before sexual intercourse.
Persons suffering from ED can use penile injections. They inject themselves with a medicine into the base of the penis. The medicine is the same chemicals as in oral tablets. Unlike oral tablets, this method causes an erection within 15 minutes of the injection. This erection happens regardless of sexual arousal. It is a primitive method but still effective.
This involves placing a small pellet at the end of the penis or urethra. Like the injection treatment, the penis quickly absorbs the medication. It causes an erection in a matter of a few minutes.
The penis is inserted into a plastic container or tube and air is sucked from the container. As a result, creating a vacuum. Blood flow to the penis causes an erection. Once erect, one would place a rubber band at the base of the penis to maintain an erection. Removal of the rubber band must be within 30 minutes to bring the penis back to a flaccid state.
A surgeon can insert permanent implants in a mans’ penis. Most basic ones may have to be straightened out by hand. However, more sophisticated implants are inflated by an in-built pump.
Other Effective treatments
Treating an underlying cause
Counseling treats the underlying condition(s) that triggers ED. These underlying conditions may be, for example, anxiety or depression. Sex therapy or counseling for couples may also be useful in addition to other treatments as well.
- Changing medicines that may cause Erectile Dysfunction as a side effect
- Reducing the consumption of alcohol
- Treatment of the hormonal condition
Lifestyle and other advice
ED is a red flag that you may be at risk of developing heart disease. Thus, make lifestyle changes to minimize the risk after speaking to your doctor. A statin medication may also help to lower your cholesterol level in such cases as well.
Tests for Erectile Dysfunction
Tests can check what triggers the narrowing of arteries. A complete blood test will report:
- Testosterone levels (if you have a low sex drive or suffered a head injury)
- Cholesterol levels and lipid panel
- Sugar levels
- Liver/kidney disease
Other tests include, for example:
- Urine test
- Blood pressure
- Other heart tests, if heart disease is of concern
Tests to check how blood circulation happens in the penis may also be checked as well. This is through using drug injections or scans in a hospital, in some rare cases.
Here are some of the conditions we treat:
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North Shore, Oahu
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Waimea, Big Island
The best part was definitely seeing the doctor on the video call. It is comforting as a patient that there is a real doctor on the other end laying eyes on me and the symptoms I could be having.
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