Mr. Softie could be heading to Stroke City

Although the pill campaigns have been unarguably successful (Viagra alone raked in US$438 million in the first quarter of 2005, according to Associated Press), giving millions of middle-aged men a new lease on their sex lives, they don't appear to have made erectile dysfunction any less taboo a conversation topic than genital warts or herpes. It remains firmly on the list of things best kept to oneself.

That such ad campaigns have raised ED's profile, but only as a lifestyle issue for older men, combined with the fact that men are still reluctant to talk about it, has some people worried. They want ED out in the open.

Kevin Billups, a urologist at the EpiCenter for Sexual Health and Medicine in Minneapolis, is one such person. In a January 2005 study in The Journal of Sexual Medicine, he provides a more complete, and disturbing, picture of the disorder. ED has long been considered a complication of cardiovascular disease, diabetes, and hypertension. The study, however, suggests that the disorder can also be a precursor to potentially serious or fatal cardiovascular problems.

The reason ED can be an early warning for cardiovascular trouble has to do with blood flow, Billups explains in his paper. Although the ability to have an erection is complex, involving psychological, emotional, and physical factors, the simple fact is that without blood flow to the penis, a full erection is impossible. The network of arteries travelling to the penis are smaller than those leading to the heart or brain. If someone's arteries are going to get blocked-the root of cardiovascular disease-the smaller ones will block up first, stemming the flow of blood. This makes erection difficult, at best.

This cardiovascular link doesn't mean every failed erection is reason to rush to a heart specialist. According to Peter Pommerville, a clinical instructor at UBC, and a Victoria-based urologist, it's rare for any man to perform 100 percent of the time. "Most men, if they are physically healthy, should be able to perform sexually about 75 percent of the time," he told the Georgia Straight from his office in Victoria. In other words, even healthy men can expect the occasional malfunction.

But Pommerville cites a U.S. study that showed that half of men over the age of 40 suffer from significant ED-enough to interfere with their relationships-an indicator that there's likely an underlying health problem.

Indeed, the majority of men Pommerville sees with ED have a related condition, such as diabetes, high blood pressure, or high cholesterol levels. ED can also be a side effect of Statins, the drugs prescribed for high cholesterol.

These men are sent to Pommerville by their GPs, who are reluctant simply to prescribe Viagra, Cialis, or Levitra-the drugs that treat ED-and rightly so, for several reasons, Pommerville says. First, these medications have limitations, a point that has been lost behind a growing mythology that has the pills producing marathon erections in an instant. The expectations are unrealistic, Pommerville warns. "These drugs don't always work right away; you have to be comfortable for them to be effective. They should be taken on an empty stomach because fatty foods inhibit their effectiveness. And your mind has to be in the game too." He cites another reason for caution when prescribing these quick fixes. "If you have a patient with ED who is overweight, has high blood pressure, and who may or may not smoke," he said, "and you prescribe Viagra and they continue to ignore the signs, the buildup of plaque in the arteries will continue. Eventually the Viagra will stop working and the damage done is irreversible.

"Awareness of ED is certainly higher today," Pommerville continues, "but the majority of sufferers are still not coming forward. Often, the wives will be the ones sitting across from me." He says a lot of the men in their 50s he treats have just seen a GP for the first time in their lives. Unfortunately, even if men do see their doctors regularly, the issue of sexual function tends not be addressed. In his study, Billups recommends that questions about ED become part of routine doctor visits for men aged 25 and older. Pommerville supports this recommendation but recognizes a major obstacle. He cites six minutes as the typical duration of a routine doctor's visit, hardly long enough to discuss with any degree of sensitivity a person's sexual history.

Questions about ED or sexual performance are certainly not what a young man expects to encounter during a routine visit to the doctor-if he's in the habit of seeing a doctor at all. And they'll likely be as welcome as a digital exam. But young, apparently healthy men are among the group with the most at stake. "Men who have ED with none of the other indicators-high blood pressure, diabetes, or high cholesterol-likely have coronary disease," said Pommerville. "The men who get early help, they'll be okay. The others are heading for serious ED, heart attack, and stroke."

When weighed against such severe consequences, what's a little embarrassment? So start talking, men-if not at the water cooler, at least in your doctor's office.