Christopher Marinakis, MS, MD, is a urologic surgeon at Boone Urology Center. His clinical focus includes complex stones, incontinence, pelvic floor therapy and BPH surgery. Learn more about Dr. Marinakis.

Photo of an older coupleMost every man would agree that throughout our lives, sex and intimacy are important aspects of our lives. In a perfect world, all of our parts would continue to work “as advertised” throughout our life.  Unfortunately, that is not always the case. The maladies of aging, including high blood pressure, diabetes, obesity, and heart disease take their toll on our body. Many of these diseases can be “silent” and not cause any appreciable symptoms, but when detected are treatable with diet/exercise or medication.

When sexual function in men begins to falter, it is very apparent and can be quite troubling.  Fortunately, there are many treatment options available that can return sexual function in most every man. In an aging population, erectile dysfunction (ED) becomes much more prevalent. With the introduction of Viagra in the 1990’s, what was once a topic few men discussed became so prevalent that we were flooded with direct-to-consumer marketing on TV and media. In recent years, specialty clinics for men have opened up in metropolitan areas to treat ED, offering such eye-catching headlines as “98% success” and “guaranteed results.”  Often, these clinics are quite expensive and may not be covered by commercial insurance or Medicare/Medicaid.

All urologists receive extensive training in men’s health, including erectile dysfunction and low testosterone/hypogonadism and all the treatment options available at these expensive specialty clinics are available locally with the team of specialists at Boone Urology.


WHY is this happening?


An erection at its most basic level is a hydraulic event where blood flow into the erectile tissues is increased. In many instances, erectile function can be an indicator of overall health. Natural erectile function involves normal blood flow to the penis and normal nerve signals both to and from the brain.  For that reason, conditions that adversely impact on blood flow and nerve signaling such as hypertension, diabetes, atherosclerosis (hardening of the arteries) and heart disease can impact erectile function. In fact, ED may be a harbinger for these conditions if not detected previously. Diet, exercise, avoidance of smoking/tobacco, and maintaining a healthy weight are all important aspects of a healthy lifestyle. Annual wellness checks are essential in early detection of the conditions that can impact sexual function.


Is my ED caused by ‘Low T’?


Testosterone is the hormone that makes men, well …what they are. Having a normal testosterone level is essential for many health aspects for men, aside from libido and sexual function. Testosterone is primarily produced by the testicles. Production begins during a male embryo’s development in the mother’s womb and peaks during adolescence. Unlike women that have an abrupt decline in estrogen levels following menopause, many men will continue to have “normal” testosterone levels throughout their life.

Many factors can impact testosterone production, including obesity, lack of exercise, medications and prior surgery. Common symptoms of “low T” include fatigue, weight gain, loss of muscle mass, decline in libido, mood swings, and loss of erectile function.

Having ED doesn’t mean that testosterone levels are low, and correcting low testosterone may not improve erectile function.

For men that have low testosterone, replacement can give them an added “pep in their step”, improved mood, improved libido and erectile function, better sleep and improved exercise tolerance.  There are many options for testosterone replacement, including topical gels, injections, and implanting testosterone “pellets” just below the skin. Most treatments for low testosterone are covered by insurance.


What treatments can help ED?


Fixing the problem of erectile dysfunction begins with a discussion with your doctor. Correcting modifiable risk factors such as smoking/tobacco use, obesity, sedentary lifestyle, and alcohol use can restore potency for some.

When treatment is desired, the first step is determining if ED is “organic,” or psychogenic, meaning that the dysfunction is brought about by emotional issues or anxiety. Men have nocturnal erections as part of the normal sleep cycle. If men have normal nocturnal/morning erections, but are otherwise bothered by ED, medical management may be unnecessary.

When the underlying source is organic, often the first- line treatment is medication such as Viagra, Cialis and others. Previously, these medications were nearly cost prohibitive, but generic medications are now quite affordable. These medications can be taken prior to sex, or in the case of Cialis, can be taken daily.  These medications are often effective and side effects are minimal. Side effects can include headache, facial flushing and nasal congestion. Men that take nitrate-containing medication for angina (chest pain) must not take these medications as the combination of drugs can markedly lower blood pressure.

When medications like Viagra aren’t effective, other options include use of a Vacuum Erection Device (VED), or injection therapy. Injection therapy is safe, effective, and relatively painless. Most men that try injection therapy are very content to continue it once instructed on how to do this.

Another treatment option is an Implantable Penile Prosthesis (IPP). This is a minor surgical procedure where the existing erectile tissue within the penis is replaced with a prosthetic device. While there are several variations available, the most common is an inflatable IPP.  A small prosthetic pump is implanted into the scrotum and when an erection is desired, the man simply activates the pump resulting in a natural-appearing erection. When not activated, the implanted prosthesis is otherwise unnoticeable. While this is often considered to be a last option, it need not be, as men who have had this surgery express higher satisfaction rates than those using other treatment options.

The urologists at Boone Urology are specialists in diagnosing and treating men’s health issues, and can offer the same treatments that offered at “Men’s Specialty Clinics” at a substantially lower cost.

If you’re concerned about men’s health issues, we can help.  Call us today to schedule an appointment 828-264-5150.