Spam

I love my new Blackberry but I am not savvy enough to stop all the spam e-mails that come my way. All are annoying, but particularly vexing are those for “Male Enhancement” products. I presume they are for erectile dysfunction products, but since I never open them I can’t be sure. What I can be sure of is that many unsuspecting folks are opening them and a few have turned up in my practice wondering if these are more effective than those FDA-approved products that are widely advertised on TV.

Rather than get into a discussion about the poor decision-making involved in trying out any of the many come-on remedies bombarding our senses, it is best to focus on the clinical problem and seek out possible underlying and treatable causes.

There are many causes of erectile dysfunction that need to be considered, and chief among them are vascular disease, male hypogonadism, diabetes and, often forgotten, medications. This is by no means an exhaustive list. Many men with erectile dysfunction may have symptoms of depression or emotional disturbance, but this is likely to be the result of the erectile dysfunction rather than the cause and it is too simple and too often wrong to start down that path before completing a comprehensive history and physical. One item to clear up quickly is whether there is associated loss of libido because that is a more clear indication of hypogonadism than is erectile dysfunction. Make sure that you include the testes in your physical examination. In patients with diabetes, erectile dysfunction may be the first clinical clue to vascular complications and that too should direct your examination.

Investigations and management should be driven by the history and physical, but if that did not provide specific diagnostic clues, send the patient for fasting lab work, including glucose, glomerular filtration rate, lipids and testosterone.

P.S. – If you know how to stop the Spam on my Blackberry, please let me know.