Talking with Mr.E.D.
What do Bob Dole and HIV'ers have in common? E.D. or erectile dysfunction. Somebody in our group chose this topic to talk about for one of the groups. As facilitators, we had to flip coins to decide who would get the job. Not really, it went to the psychiatrist of course. The topic was really sexual dysfunction, much broader then erectile dysfunction. Erectile dysfunction was a topic that was discussed at one time on Sex and the City, the TV series. How do you know if it fails to swell for psychological reasons or physical reasons? One of the women said you put some stamps around it before going to bed. If they are broken in the morning it is psychological. She was right because, normally we have several erections during sleep and the stamps break when that happens. If you go to a urologist, he will have you attach a device to your penis before going to bed at night that determines whether you have had erections during the night or not. If you can have erections your genitals are capable of normal functioning.
What happens if you do not have normal erections? We then talked about the different sexual dysfunctions. Premature ejaculation, of course is an ejaculation before you can start intercourse, or immediately thereafter. This is easily treated with antidepressant medications called serotonin re--uptake inhibitors such as Zoloft or Prozac, not because it is related to depression, but because it slows ejaculation. A common side effect of antidepressant medications is the reverse which is delayed ejaculation. Many people with HIV have depression and take these medications so if you are taking these medications and have erectile dysfunction or delayed ejaculation the medication may be the cause. Another less well known dysfunction is called retrograde ejaculation. This is a medical condition in which the semen rather than being ejaculated forward out the penis and instead goes back up into the bladder. It is not harmful but can be embarrassing.
Of course, by far, the majority of the group members had complaints about difficulty getting erections or having staying power. There are multiple physical causes for this related to HIV or HIV medications. If it is the antidepressant there is one antidepressant that does not cause it, and this is Wellbutrin. So you might ask your doctor to switch antidepressants if you continue to have problems. Another cause is low testosterone levels. Everyone with HIV should get their testosterone checked. There are two types of laboratory testosterone. One is regular testosterone and the other is free testosterone. It is the amount of free testosterone that is important. Make sure your doctor checks the free testosterone. HIV damages the luteal cells in the testes which make testosterone. As they die off testosterone levels fall. When this happens libido is less and erectile dysfunction may be present. Testosterone is also an important in increasing lean muscle mass and preventing wasting.
Unfortunately, another cause of erectile dysfunction is poor blood flow to the area. This may be caused by diseases of the arteries just like the kind we get with heart attacks or strokes or any other reason for obstructed blood vessels. The last cause I will mention is damage to the nerves to the genital area so that they do not turn on and off the blood flow to the penis. Both of these conditions may be caused by surgery or radiation such as occurs in prostate cancer or can be caused by the neuropathy so commonly seen in HIV patients.
We have some things that help now. In virtually every doctor's office you see the advertisements for Viagra, Cialis and Levitra as oral medications. There is also a medication called Muse and then is inserted in the urethra. There is an injectable medication. We had one group member who had a job adjusting the doses of Caverject. Caverject is first administered in the urologist’s office and the dose has to be adjusted just right. Our group member was the person who adjusted the medication by injecting the medication at the base of the penis and measuring the amount of pressure in the penis that resulted from the medication. If too much medication is administered the erection can be painful lasting hours and may require a visit to the emergency room to remove some of the blood causing the tumesence. For those for whom none of these works there are various kinds of prostheses that can be used to have an erection. They require surgery and frequently are not practical.
We have taken you through a journey on sexual dysfunction and its treatments. We hope that it helps some of you or raises some questions you can get some answers to for from your doctor. Mr. E.D. does not have to be your bed buddy.
