New York--When a teenager complains of erectile dysfunction, do not assume that the problem is psychogenic, advises John P. Mulhall, MD.
Analysis of data on 40 young men, ages 14 to 19 years, found that "74% of these men coming to major medical centers had a physical problem, and 60% of those had an underlying vascular problem," Dr. Mulhall told the Sexual Medicine Society of North America annual meeting here.
Databases at three large centers-Weill Medical College of Cornell University, New York (where Dr. Mulhall is an associate professor of urology); Loyola University Medical Center in Maywood, IL; and Boston University Medical Center-were accessed in a retrospective analysis of ED data between 1998 and 2003 for males under 19 years of age. The review considered demographic characteristics, such as age at time of treatment, associated comorbidities, and erectile function history, as well as erectile function and hemodynamic parameters from questionnaires.
"We pooled information on all patients 19 years of age and younger," Dr. Mulhall said. "The youngest was 14. These people come in with their dad or even their mother. They hear their friends talking about erections, but they're not getting erections."
Vascular testing was performed on 24 patients, consisting of either duplex Doppler penile ultrasound (DUS; 8 patients) or dynamic infusion cavernosometry and cavernosography (DICC: 16 patients). Six of the eight DUS studies (75%) were abnormal, and 13 of the 16 DICC studies (81%) showed abnormalities.
On DUS, four of the six abnormal readings showed arteriogenic ED, while the other two showed mixed vascular insufficiency. The abnormalities shown by DICC were arteriogenic in five patients, venogenic in another five, and mixed vascular in three cases. Four of five patients with venogenic ED had crural venous leak.
Physical exam is essential
"The entire bottom-line message here is that you cannot assume that when a 16-year-old boy comes to see you, he has a psychological problem," Dr. Mulhall said. "When you see young men in your practice, you should give serious consideration to testing them to see if there is a vascular problem."
Admittedly, some of these patients may have psychological problems, Dr. Mulhall said.
"Sixty-year-old men who have ED are depressed," he noted. "There can be a secondary psychological reaction that causes worsening of the physical problem. A boy who has problems with erections will have an anxious personality, with problems at school and depression."
Vascular testing of adolescent ED patients is essential because "you cannot tell what the cause is just by talking to them," Dr. Mulhall said. "Even in the hands of an expert, defining physical [cause] from psychological cause is a coin toss."
Early determination of the cause of ED is essential because the problem can cause "ongoing erosion of confidence, so that the boy can become a sexual cripple," Dr. Mulhall pointed out.
But Stanley E. Althof, PhD, of the Center for Marital and Sexual Health of South Florida, West Palm Beach, commented that the psychological health of this adolescent study population was an important element to be considered in such cases.