A 58-Year-Old Construction Worker Can’t Maintain an Erection

Edward D. Kim, MD

Disclosures

May 21, 2020

Discussion

The patient was diagnosed with organic erectile dysfunction (ED). Although organic and psychogenic ED may be commonly seen together, the patient's smoking habit, obesity, dyslipidemia, and hypertension are highly suggestive of an organic etiology.

After counseling from his physician, the patient decided to pursue aggressive lifestyle modification with smoking cessation, diet, and exercise. At the same time, he decided to use an oral phosphodiesterase type 5 inhibitor on a daily basis to treat both the ED and benign prostatic hypertrophy (BPH). He was given an alternative treatment of an oral phosphodiesterase type 5 inhibitor on an as-needed basis in combination with oral BPH therapies, such as a selective alpha blocker or a 5 alpha-reductase inhibitor.

ED is defined as the inability to achieve or maintain an erection that is sufficient for sexual intercourse. ED is only one type of male sexual dysfunction, however; on the basis of a comprehensive history, ED should be distinguished from problems with orgasm, ejaculation, genital pain, or libido

A low serum testosterone level may be seen men with ED. Many men become focused on concern about low testosterone levels. However, most men who are administered testosterone therapies do not have significant improvements in erectile function because comorbid conditions are responsible for the ED. Morning total testosterone level, as well as serum chemistries, complete blood count, lipid profile, and fasting blood glucose level, are typically obtained at the initial evaluation. If the total testosterone level is low or borderline, a free or bioavailable testosterone level and luteinizing hormone level should be measured.

BPH, also referred to as "LUTS," and ED are increasingly common with aging. A strong association between these conditions was observed in the large-scale Multinational Survey of the Aging Male (MSAM-7).[1] In this questionnaire-based survey, the prevalence of moderate to severe LUTS was age-related, increasing from 22% in men aged 50-59 years to 45.3% in men aged 70-80 years. The prevalence of ED also increased with age. The association between LUTS and sexual dysfunction persisted after controlling for age and other comorbidities known to affect sexual function.

Similarly, Seftel and colleagues analyzed studies that reported on the prevalence of coexistent LUTS/BPH and ED using alternative scales for LUTS (ie, International Prostate Symptom Score).[2] The average rates of coexisting conditions were 43% among men in their 40s, 72% among men in their 50s, and 79% among men in their 60s.

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