Greater Boston Urology Blog

What We Talk About When We Talk About Erectile Dysfunction

Having frank, honest discussions about erectile dysfunction isn't something many people feel comfortable doing with one another—or even their doctors. Certainly, not in the same way we might discuss other medical conditions, such as heart disease or diabetes.

Sure, we've all encountered ED commercials on television, many of which use flowery euphemisms that make light of a serious topic. But those commercials don't typically get people talking in constructive ways.

If you do a Google search, you'll find articles that discuss why our society is like this. (And what makes ED such a taboo subject.) But we're not here today to talk about that, either. Instead, we want to discuss how to communicate better about erectile dysfunction, including what an actual conversation between two people might sound like.

But before we get to that, let's review some basic ED facts…

According to the National Institute of Diabetes and Digestive and Kidney Diseases, ED affects as many as 30 million men in the United States. While the likelihood of ED increases with age, the aging process does not cause ED. For example, ED occurs in…

  • About 12 percent of men younger than 60
  • 22 percent of men age 60 to 69
  • 30 percent of men age 70 or older

Erectile dysfunction can have many causes—both physical and psychological.

In the Q&A that follows, we talk to our COO Les Cavicchi about his experience with erectile dysfunction.

Les was diagnosed with prostate cancer in the fall of 2013 (this was before he joined GBU). After having a radical prostatectomy, Les suffered common side effects, including urinary incontinence and erectile dysfunction.

Three months after his surgery, Les still couldn't achieve an erection. His physician said it could take up to two years for the nerves to heal (nerves can be damaged when the prostate gland is removed).

Les's doctor recommended injections into the penis. While the injections worked, meaning Les could achieve an erection and have intercourse, he found it to be a cumbersome process, not to mention uncomfortable and even painful, since it could take several hours for his erection to subside.

He then opted for a penile implant, which has worked great. As Les says, "It definitely changes your life. You go back to normal, so to speak. It is quick, easy, functional, effective, and works like a charm."

While the penile implant ultimately "cured" Les's ED, it was his willingness to openly talk about erectile dysfunction with his doctor AND his wife that made all the difference—and that ultimately led to such a positive outcome.

Les believes communication is critical in the "fight" against ED. Too many men suffer in silence due to confusion, embarrassment, not knowing where to go for help, and so forth. Les—and all of our physicians at GBU—want to see this change. The goal is to create an open dialogue around ED—one that is comfortable, honest, and respectful for everyone involved.

Les sat down with us to share his thoughts on this, as well as his own personal journey.

As with all content on Greater Boston Urology's blog, the following information is educational in nature, not medical advice. Always talk to your physician about your specific health care questions and conditions.

[Editor's note: This article was reviewed and updated on 1/3/22.]

No one wants to talk about ED—men or women. Many men are even hesitant to discuss ED with their doctors. As a person who works in healthcare, but who is also someone who's struggled with ED, what's your take on this? What advice do you have for someone who is reading this article right now?

Les: My first observation is that each one of us—especially men, in this circumstance—is responsible for managing changes to our bodies as we age and as we encounter different circumstances like heart disease and so forth.

We're also responsible for managing our quality of life. I think the biggest barrier to quality of life, and it could be cultural to some extent, is an inability to communicate with the right people, like our partners and doctors, about what's wrong with us.

And it goes so much further than erectile dysfunction. So many people have trouble talking to their doctors about any issue they deem as embarrassing. What do you have to say to that?

Les. Here's what I'd say: doctors are trained to help you, especially with so-called embarrassing conditions. But they can't help you if they don't know you're suffering. You have to find a level of courage that allows you to speak freely to a physician who's trained in the relevant area. If you're not comfortable speaking with your regular physician, start looking for a doctor that you can speak to easily and comfortably. There are many who can help you.

In the case of ED, today's urologists have many options to help you overcome and/or manage this condition that's no doubt undermining your quality of life.

People often overlook the quality of life angle. Sometimes it's easier to dismiss things by thinking, "Well, it's not life-threatening, so…"

Les: Yet I'd argue a poor quality of life is threatening. And ignoring the problem or dismissing it or simply resigning yourself to living with it won't help, either. Right after I was diagnosed with prostate cancer, I read a series of books. They each contained different stories about men and women—how their relationship completely eroded because of the prostate cancer, the surgery, and the resulting erectile dysfunction. To me, that was sad—beyond sad. It suggested that people weren't working together as a couple to communicate with each other about what each person needed.

You have said that you and your wife have a very good relationship in terms of communication. What are some of the things that she said that helped you? For women (and men) reading this, what are some things they should do or say to support their partners? So many partners want to help, but they're also afraid of saying the wrong thing.

Les: A week after I was diagnosed with prostate cancer, I remember saying to her, "With my prostate out, there's no more ejaculate. I can still have an orgasm. I don't know about erections." She says, "Who cares? You're still here. That's what counts." She added, "We'll have sex, it'll just be different. We'll have fun. We'll deal with it however makes us both comfortable and happy."

My wife is truly unbelievable in general, but when you break down what she said, it's basic stuff: Acknowledge the other person's concerns. Because you don't want to diminish what a man is going through. But let the person know that there's so much more about him that you love and that you'll get through this together.

My wife is phenomenal. She is also pragmatic. She said, "I don't want you gone. I don't want you dying from prostate cancer or anything else for that matter." She said, "I'm glad we know. I'm glad we're getting the surgery. I'm glad this is being addressed. I want to go back to normal, riding bikes, doing our 5K runs, and having fun in bed. It all counts."

When I had ED, we had to make some adaptations, of course. And don't get me wrong: it did take a lot of patience—on both our parts. It was also important for her to understand what was going on. I think there's as much responsibility on the part of the partner to learn as well.

It seems like patience would be a big part of what couples need—on both sides.

Les: Yes, I think patience is important, but I also think communication is very important. You can't just go to separate rooms. In those books, I read how husbands and wives would start using separate bedrooms because they weren't having sex and they weren't communicating and they didn't know how to deal with it and they just stopped talking to each other, stayed in different parts of the house, and ultimately separated and divorced. I'm thinking—are you kidding me?

People get together in the first place because they love each other and want to be together. Now you're going to ignore it? How about working through it? How about talking about it? How about meeting together with the doctor? Even counseling, if necessary. It goes back to what I was saying before: grabbing the bull by the horns and figuring out what you're going to do about this, creating a plan, or at least creating an environment to talk about creating a plan. If you want to ignore it, do it at your own peril.

My wife and I are patient with each other. Nobody gets angry. Nobody's yelling. None of that. It's just a question of what's wrong and how do we fix it. She's looked at this entire prostate-cancer process that way, up to and including our sexual relationship together, up to and including the long-term solutions for my ED.

For the men reading this article, what would you like to tell them?

Les: The biggest thing you need to remember is you're not alone and there ARE options. We see people all day, every day at Greater Boston Urology with these issues, but you need to find the courage to step forward, make the appointment, and talk to the doctor.

Again, it may be difficult, but it will change your life. The right doctor can give you tools, techniques, and whatever you need to be happy again. 

The other thing to keep in mind is this: I think that ED is something that's going to hit almost every man as we grow older. It's isn't simply a byproduct of prostate cancer treatments. As you mentioned earlier, there are multiple causes, but I do think people need to look at it as part of the aging process and I think they need to do something about it if/when it happens. I don't think they should simply say, "Well, I'm getting old and I have ED. Those are the breaks." Why stop there? Why not do something about it? People's knees give out; people need a pacemaker. Guess what? Guys get ED. Put it on the list and talk to your doctor and your partner. If you're both willing to talk, learn, and be patient, you'll get through it.

Are you suffering from ED?

Are you in the greater Boston area? Our urologists can help. Schedule an appointment today.

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