Erectile dysfunction: Pills aren't the only answer

Never heard of erectile dysfunction?

Fifteen years ago, that might have been possible. Then came Viagra, Levitra and Cialis � and everyone with a TV started hearing about erectile dysfunction, or ED, the inability to get or keep an erection. Or, more precisely, everyone started hearing about drugs to treat ED and seeing images of frisky older couples who seem to find those drugs effective.

Get ready for more of the same: The Food and Drug Administration just approved the first new pill for ED in a decade. But Stendra, also known as avanafil, works the same way and is likely to work for the same men as the other pills, urologists say.

It does have one new selling point: "It acts a little quicker," often in about 15 minutes, says Wayne Hellstrom, a professor of urology at Tulane University in New Orleans. He worked on clinical studies for drugmaker Vivus Inc. The other drugs typically take effect in 30 to 60 minutes, he says. The drugs all increase blood flow to the penis, and men who take any of them can get side effects such as facial flushing, headaches, upset stomachs and stuffy noses.

In real-world use, men sometimes find they like one pill better than another for various reasons, says urology professor Ajay Nehra of Rush University Medical Center in Chicago.

"You have a spectrum of products," he says, and that's a good thing.

Still, these heavily marketed pills are not the whole answer to a problem estimated to affect 30 million U.S. men and their partners, experts say.

For one thing, they don't work for everyone: The 40% to 60% of men who get results are likely to have milder ED (they can still get some spontaneous erections), are in stable relationships and do not have a long list of other health problems, Nehra says. Those health problems � including heart disease, diabetes and obesity � point to what he says is an underappreciated fact: Many cases of ED could be prevented or improved with the same lifestyle choices that improve overall health, especially heart health.

Nehra is among experts who are developing ED prevention guidelines based on studies showing links with risk factors for cardiovascular disease, including smoking, obesity, lack of exercise and poor diets.

Those links are so strong that doctors now know that a man in his 40s who arrives in a doctor's office with ED is at high risk for an eventual heart attack and/or stroke, says Stephen Kopecky, a cardiologist at the Mayo Clinic in Rochester, Minn., and president of the American Society for Preventive Cardiology.

"These are different manifestations of the same disease process," he says. "What causes heart attacks? A decrease in blood flow to the heart. What causes erectile dysfunction? It's a decrease of blood flow to the penis." But the effects on the penis show up sooner, he says.

Sometimes, there are other factors. ED can be caused by certain medications, including drugs for high blood pressure and depression. Many patients have had surgery for prostate, colon or bladder cancer, Nehra says, and for those men, pills often are less effective than other options, including penile injections and pumping devices. Blood vessel surgery is an option for some young men with ED caused by pelvic injuries.

Whatever the cause, ED can be made worse by "conflict in the marriage, hurt and anger, depression and performance anxiety," says Ruth Hutcheson, clinical director of North Shore Center for Marital Therapy in Oakbrook, Ill., and a certified sex therapist with the American Association of Sexuality Educators, Counselors and Therapists.

Sessions with a therapist may help, she says. "It's very important to improve communication," she says. When couples do that, they often find that "the Viagra works better."