Question: I am a 42-year-old man, and I'm concerned about my sexual performance. I have hypertension treated with enalapril (10 mg once daily for the past eight years), and I have been taking clonazepam (2 mg) on a daily basis and sometimes fluoxetine 20 mg and alprazolam (1 mg) for anxiety.
As a medical doctor I know these drugs can cause erectile dysfunction (ED), but I really would like advice from an expert on how can I solve my ED.
Dr. Hibberd's Answer:
When you consider erectile dysfunction, there is a meshwork of interacting processes that all need to work seamlessly for that "magic moment." Remember the largest causes of ED by far relate to psychological, stress, insomnia, medication, drug use, and associated emotional issues. But those with ED need to beware: ED is strongly associated with vascular disease and usually does not discriminate between arteries supplying the sexual organs from arteries supplying your heart muscle and brain.
All ED patients should have a history and physical examination, with an EKG (electocardiogram) to screen for coronary artery disease, as well as a fasting complete blood count (CBC), chemistry panel, lipid profile, urinalysis, and pelvic/rectal examination. Screening for common causes of ED that include diabetes, hyperlipidemia, hypertension, obesity, as well as tumor and nerve dysfunction will permit appropriate management of treatment options.
That magic "blue pill" (Viagra) is now available in many newer and longer acting forms (Cialis and Levitra, etc.), but they cannot be used by some cardiac patients that are deemed to be unfit for sexual activity or those on nitrate medications who may have precipitant drops in blood pressure. Other options are available from vacuum devices through injectable mixtures compounded by prescription from a urologist. It sounds like it is time to see the doctor, doctor. Self-management is not wise here.
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