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Melanie Cole (Host): Erectile dysfunction affects approximately 1 in 5 men over the age of 20, including more than half of men who are at least 40 years old, and it’s not just the individual who suffers. ED oftentimes causes intimacy issues between a man and his partner, but the good news is there’s help available. Here to discuss erectile dysfunction and the impact it can have on a man’s life, his partner’s life, and his overall health is Dr. Jaspreet Singh. He’s a board certified urologist with St. Luke's Cornwall Hospital and Howard Montanye. He’s a patient who’s found a long-term solution to his ED. Welcome to the show, gentlemen. So, Howard, let’s just start with you and please tell us your story and how you came to meet Dr. Singh.

Howard Montanye (Guest): Okay. I am 65 years old, and probably a good 15 years ago, I started with having a little problem with erectile dysfunction, and I went to my primary doctor. It’s something that, you know, you don’t talk about, and it’s pretty embarrassing as a man. So, I went to my primary, and I tried some pills, and they didn’t seem to work. The doctor told me that, you know, it was more psychological than anything. So, I lived with that all the time. So, two and a half years ago and I got a groin pull, and I wasn’t sure what I was. I thought it was a hernia. So, I ended up going to Dr. Singh in Newburgh. I was recommended to him, and he found out it wasn’t a groin pull. He said, no. He took care of that problem, but he also noticed that I was a diabetic, and he said to me, I see you're diabetic. How are your erections? And I said, I don’t even get them anymore, and he took me down this road to where I am today. We started with some pills. Nothing worked, and finally, he brought to my attention that there's a penile implant that you can have. So, after some discussion with my wife, we decided to go ahead and do it. So, in February, two and a half years ago, I went to Dr. Singh, and he implanted it in me, and since that day, it has been so good that I said, you know what? Guys don’t talk about this; I’d really like to get out and discuss it because it’s just the perfect thing for me and a lot of guys out there because there’s plenty of men who are dealing with this issue and just doesn’t talk about it. So, today, I'm a happy man because of Dr. Singh.

Melanie: Wow. What an interesting story. So, you were hesitant to discuss this as any man might be, and your first doctor mentioned that it might be psychological, and what did you think when he said that? Were you thinking, okay, now I'm just going to let it be or maybe I’m—

Howard: Yeah.

Melanie: —going to go see a counselor—I mean, what did you think when he said that?

Howard: You know what? I was ready to give up. I thought it was my problem. I thought it was my head. I didn’t know what to think, really. I felt alone. I was very depressed over it because, you know, for a man, that’s a big deal, and I just let it go. I just, you know, and it did cause some problems in my wife and my relationship. There was no intimacy there. So, you didn’t want to hug, kiss, or even touch because you knew what it was going to lead to, an argument or discussion. So, I just went about life with my head down, not talking to people about it.

Melanie: Well, and as far as your relationship with your wife, because women we tend to be very sensitive about things like that—

Howard: Definitely.

Melanie: —and we also tend to be the person who pushes you guys to get to the doctor. Was your wife involved in this decision to start talking about it and to get to see somebody about it?

Howard: No. No, actually, no. My wife was saying to me, don’t worry about it, everything’s okay. It’s fine. You know, we’ve been married for 40 something years. That used to make me upset because it wasn’t fine with me. There was something missing in my life. That intimacy, that part of being a man was gone, and she quite didn’t understand it. Even when I was talking about the implant, she was against it. She said, no, it’s a surgery. We don’t need it, but for myself I needed it. I had to have it. I had to do that. You know, I thank God every day that I did it, and so does she now. She’s very happy. We’re both very happy with our quality of life right now, and I owe this, I really, I do owe this to Dr. Singh. There’s no doubt about that because he was the one who took me through this journey and brought me to the end.

Melanie: So, Dr. Singh, what's the first thing you tell a man like Howard? You met Howard and then you said, oh, you're a diabetic, and we know that there is a link there. So, how do you discuss it with men like this and how did you put this together?

Dr. Jaspreet Singh, DO (Guest): You know, Melanie, there are many different physicians that are out there. Most primary care physicians will tackle erectile dysfunction. They are the gateway doctors to this disease. What the difference between a primary care doctor, or I would say, a general urologist is that the journey that Howard is describing ends pretty early, and it usually ends with an advice to lose weight, to try oral medications, and that’s really it, and then exactly what Howard has stated that it’s turned around, said, oh, it’s in your head. What the difference between my practice and the rest of the care providers is the fact that you're seeing a doctor who’s skilled and trained specifically in managing erectile dysfunction and offer the whole algorithm in treatment of erectile dysfunction. So, yes there are medications. There are other options such as vacuum devices, but they’re only a few subset of urologists, even, that will perform surgical intervention for erectile dysfunction.

Melanie: So, when you determine treatment, and obviously people say, you know, you're going to start with the medicational intervention, Viagra or whatever, and those don’t work. Do you then search for a deeper cause of the situation or then do you just move on to whatever the next intervention might be? How do you know what causes it?

Dr. Singh: Right. So, as I approach a patient who’s seeing me perhaps for prostate issues, one thing that you know you're going to be comfortable with in talking in my office hours is the fact that I treat a lot of men with erectile dysfunction. It is not an uncomfortable topic. It is something that I always screen patients. I’ll see patients who have a history of high blood pressure, diabetes, smoking, and perhaps may have had heart issues, and there is no such thing as an embarrassing question. I literally will just ask them, hey, by the way, how are your erections? And sometimes men are caught off guard. A lot of times men are relieved that I asked the question because it is the, kind of the elephant in the room that they are hoping the urologist or doctor will ask, but may not get around to. And, so, typically in the workup and the treatment, the algorithm in my hands is pretty simple. I think that any advice as far as what's good for your health, changing your diet, eating healthy, exercising, committing to 20 to 30 minutes of some sort of exercise daily, weight loss, tobacco/smoking cessation, controlling or managing your diabetes, all these things are the basic framework in approaching erectile dysfunction. Now, despite all this, many men will not have an improvement of their erections, and medications are often needed, and typically, I will see men who have already failed medication or perhaps two medications, and unfortunately will go through the gamut of medications that are out on the market. So, by the time they see me, they’ve kind of given up on this. What we do different in our practice is that, you know, a lot of what I see, a lot of men that are coming to see me will say, doc, you know, my medical doctors tried, and I see he's trying, and perhaps it’s in my head. Well, let's see, and what I do is an ultrasound study, very simple, in the office. We see what the issue is. We see how the blood flow is into the penis, whether it’s a problem with the circulation or is it a problem that the penis can’t trap the blood, you know, within the shaft of the penis, and you’re losing erections early. And so what this provides is the feedback, and it really shows in plain black and white, hey, listen, you know, this is not in your head. I see a problem here, and these are our options, and not everybody does that, and I think only a specialist who manages erectile dysfunction can really sit down and give you that feedback that often the guy’s looking for because it’s truly not in your head.

Melanie: What a great way to put it, and I certainly agree with you. I don’t find it an uncomfortable topic at all, and even as a woman, because this is a physiological issue, and it has so much to do with intimacy and the quality of a man’s life. So, Howard, how did this feel when you said you were going to have this surgical intervention, and your wife was like, you don’t need to do it? It’s surgery because surgery can be scary sometimes. Now, how does it feel now to you, and was it an easy recovery?

Howard: You know, it was an easy recovery for me. The pain was minimal, but I had gotten good instructions from Dr. Singh to keep the area iced really well. He told me to expect a lot of bruising. He gave me the timeframe that I would come back and see him, and when I could be intimate again. So, no, it wasn’t tough. It wasn’t tough. I mean, if anything went wrong, and I had to do it, I’d do it again tomorrow. I would not hesitate, but I would say that you need to find a doctor that specializes in it, that’s for sure, and Dr. Singh happens to be that guy. He’s a good guy. He really is. He really is.

Melanie: Now, wrap it up, Howard, and tell other men what you’d like them to know about your situation and what they can take away from this for their concerns and any do’s and don’ts that you might have.

Howard: If I was to talk to guys, I would tell them, they're not alone. There’s a lot of guys dealing with this, number one. So, and it’s not an embarrassing thing because guys are embarrassed by it, and the thing that I’d want them to take away is that there is, there’s definitely an answer to it, and it’s a great answer. It’s like I’m normal again. I mean, intimacy is back in my life anytime. It’s just a great thing. I would say guys get to see Dr. Singh or somebody who specializes in this because the answer is there.

Melanie: Dr. Singh, last word to you. What you want men to know as a urologist about speaking about this. I mean Howard—we certainly applaud the fact that he's willing to come out and talk about this delicate situation, but to really say it so that men hear it. What would you like them to know?

Dr. Singh: Yeah. I'm just going to briefly highlight a couple of points that Howard had made and try to bring it to the attention to the audience here. One, women often don’t talk about erectile changes with their men, or their husbands or partners. That is because it is already embarrassing to the guy, and their partners are not in a situation to make them feel more embarrassed or put the more pressure on them. So, you had asked Howard whether his wife had asked him to see the doctor, and often this is what doesn’t happen because women support their guys and say, you know, it’s okay, honey, and you know, we’ve been married for 35, 40 years, and it’s not important, which is quite the contrary. What most women will come back and tell me or their partners will tell me and say, Dr. Singh, thank you for helping out my husband. I feel as though we’re back how we were 20 years ago or 30 years ago. This is fun. This is what we enjoy. You know, you’re at an age where there's nobody else in the house. Kids have left. You’re empty nesters, and this is really the time to reconnect, and it’s not happening. Sexual intimacy for men and women is completely different. Men are about performance, about satisfying their partner, and when they can’t, they feel embarrassed, and we’ve pointed that out. Yes, it is embarrassing, but not embarrassing that you shouldn’t talk about it. Women like the hugging, kissing, caressing intimacy. When guys face erectile dysfunction, even that cannot happen, and I see couples separate and all that fun, that flirting goes away. So, you know, to wrap it up, I think erectile dysfunction is like a dipstick to the car. It’s an indicator of how healthy you are. Yes, erectile changes can be one of the first signs of diabetes or high blood pressure, so don’t ignore it. Come to your doctor, you know. Talk about it, and it’s something that we should all be comfortable in talking about and clearly treating.

Melanie: Thank you, gentlemen, so much for speaking about this important topic today. This is Doc Talk, presented by St. Luke’s Cornwall Hospital. For more information, please visit stlukescornwallhospital.org. That’s stlukescornwallhospital.org. I’m Melanie Cole. Thanks so much for listening.