Link between men’s sexual health and their overall health

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AUGUSTA, Ga. (WJBF) The Means Report turns its focus to men’s health. It is a topic that can sometimes be difficult and uncomfortable to talk about with friends and loved ones, so an expert will help navigate everything from prostate cancer and screenings, reproductive health, and incontinence. To do that, the show is joined by Dr. Sherita King, a urologist out of Augusta University Health specializing in Sexual Medicine.

Brad Means: Dr. King, thank you for your time and for what you do, I appreciate it.

Dr. Sherita King: Thank you for having me today.

Brad Means: My first question is just a general one, it’s just to get you to confirm something I was thinking before the broadcast and that’s sure your specialty is Sexual Medicine and the health of men out there but I bet that goes a long way toward having healthy families and relationships because if you can get those issues resolved with the man everything else falls into place, right?

Dr. Sherita King: Yes, absolutely. I look at erectile dysfunction as a couple’s disease is not just the man or the male partner that’s going through it, it’s the couple as a whole that’s dealing with this. It’s also very important as the health of the individual as a whole. So I think of urologist as the first line for a lot of… Just overall cardiovascular health for men because erectile dysfunction is the canary in the coal mine for coronary artery disease.

Brad Means: How young a patient have you ever seen walk through your door?

Dr. Sherita King: The youngest I would say is about 16 actually. He had a different reason it was more of a trauma issue as far as being like medically related linked to diabetes, hypertension, heart disease, the youngest I’ve seen has been like 30. Especially with insulin-dependent diabetic patients, they can start at exhibit issues with erectile dysfunction pretty early in life.

Brad Means: Is it mostly erectile dysfunction if I’m basing that assumption on the commercials I see then that’s all you all get in the urology field, is that the bulk of it?

Dr. Sherita King: No, we also deal with Peyronie’s disease, there’s been a recent commercial with Zanaflex where they talked about curvature of the penis. That’s not as much related to like the overall health but usually like a trauma or if they have deuterons contractures in their hands, then they can have that but that is another thing we deal with. We also deal with infertility, there’s been recent studies that have been shown that infertility is actually linked to cardiovascular disease also with issues with pre-diabetes, insulin resistance, hypertension too, so I feel like we’re like the gateway because these are the things that will bring men into the office, they don’t always come in at they’re having chest pain or if their sugars are high because sometimes they don’t even know and we’re the first line to get them to disease modification steps.

Brad Means: What’s the common thread between those sexual issues, ED, Peyronie’s and the other issues you mentioned diabetes, heart disease, does it all start with the vascular system of the human body?

Dr. Sherita King: Typically, it starts with diabetes or hypertension and then you start to have injury to the vascular system. So like I said erectile dysfunction is one of the first markers for endothelial damage and that comes for me from either having high blood pressure where the blood is forcing up against the wall of the blood vessel and causing micro-tears or diabetes where the elevated sugars are causing damage to the vasculature or it could also be high lipids where you’re having deposits of lipids in cholesterol in the vasculature.

Brad Means: I wanna talk about a couple of these issues certainly during the course of our conversation today, but I just wanna ask you in general, did we ever even talked about this stuff before the advent of Cialis and Viagra and some of the other products we see. It seems like back in the day and that wasn’t too long ago, this was all pretty hush-hush, is that true?

Dr. Sherita King: Yes, usually men would eventually bring it up to their primary care doctors and then they would usher them over to urology. But it became widespread once Cialis and Viagra came out but to be clear there have been treatments for erectile dysfunction well before that you had injections and then we also had the penile implant which came out in like the 70s.

Brad Means: Talk about some key ways that men can know that it might be time to mention it to their primary care physician or to go to a urologist directly. Is it just after one or two times when an encounter with your partner doesn’t go well. How do we know when okay, we need to get this checked out?

Dr. Sherita King: I would say after a couple of times and you start noticing that it’s becoming a pattern, that’s definitely a marker. Some men they come into this vicious cycle, so they can’t get an erection and they get anxious about getting one the next time and then it just snowballs. So I also like to get sex therapists involved to help bring the psychologic portion into it because if you have really high anxiety you’re gonna increase your adrenaline levels and epinephrine and then what happens is that fights your erections. So I would say in the first couple of times when you start to see a pattern and it doesn’t have to be just not been able to achieve one it’s either you can’t achieve one, you’re not maintaining long enough to be able to have intercourse.

Brad Means: How long does it take till you can fix this, till you can get somebody back on the road to better sexual health?

Dr. Sherita King: It depends, I let the patient be the driving force to that, some people need a little bit more hand-holding and discussing the options and going through it in a systematic fashion. Typically, I like to try, so like if I look at my algorithm of treatment of ED, I try pills first, if those don’t work on a consistent basis then we move to injections and if that doesn’t work, then we move onto surgical options which is the penile implant.

Brad Means: You sound like someone who thank goodness treats the whole person instead of just a specific issue.

Dr. Sherita King: Yes.

Brad Means: I would suspect though Dr. King a lot of people come to urologists and just say I’ve seen the ads please give me the pill and I’ll be on my way, so how do you convince them to move past that and say wait a second this runs deeper than just popping a pill to fix it?

Dr. Sherita King: I typically well I’ll inquire if they come to me and they do not have a primary care physician because some I do get self-referrals, I’ll make sure that they don’t leave my office without one. They’ll be seeing somebody in our system, at least just so we can get them checked out to make sure there’s nothing else going on. If I have a hard time convincing the patient then I’ll have them bring their partner in. Typically, we don’t take care of ourselves as much as we should but when our loved ones are the ones that’ll kinda convinced us like hey, you really should go get checked out for other things, especially if they come in with no diagnosis and we need to figure out what’s going on.

Brad Means: I know I asked you about your youngest patient, but what typically is the age when you see the onset, if that’s even the right word of erectile dysfunction. Is it our 30s, our 40s, what do you see out there?

Dr. Sherita King: I see some men that’ll start having issues in their mid-40s to early 50s. There’s a like a percentage always give patients, if you have 100 men that are 50 years old half of them are gonna have erectile dysfunction. If you have 100, 60-year-olds 60% and it keeps going up as you go up every decade. So I would say usually men will start seeing it around mid 40s and going into their 50s.

Brad Means: Can a man’s sexual health impact his life span, we see studies where women on average live longer than men, can a man sexual health if it’s good, help him live longer?

Dr. Sherita King: It’s not I don’t… It’s hard to say is it sexual health itself but it’s the indicator that since he has good sexual health that means he probably doesn’t have all the cardiovascular disease, the diabetes and the hypertension. And again, that’s why we’re like the first line sometimes because men don’t like to go not all men but some men don’t like to go to the doctor. And they’re not being able to perform will definitely get them in to see someone.

Brad Means: We are having a conversation about men’s health, men’s sexual health in particular with Augusta urologist, Dr. Sherita King on The Means Report, more topics important to men and their loved ones for their overall health, when The Means Report continues, we’ll be right back.

Part 2

Brad Means: Welcome back to The Means Report, we’re talking about men’s health today, in particular men’s sexual well-being and Dr. Sherita King is a urologist with Augusta University Health kind enough to join us today. Let me pick back up Dr. King on a topic we’re talking about before we went to the break and that’s that a man’s sexual health can be an indicator of other issues cardiovascular disease, diabetes, so let’s go at it this way, if you can treat a man for diabetes because your find out okay you have this which is impacting your performance. Can you address the diabetes and then the sexual function returns without a pill, without treatment in that area?

Dr. Sherita King: It’s not so much that it will completely return because what happens is you start to have damage to the tissues and that’s what’s going on. So when you start to have erectile dysfunction, it’s a symptom of other diseases. And just treating the diabetes, yes, you will prevent hopefully worsening of the erectile dysfunction but is not so much that I can reverse the changes that have already happened. That’s why it’s very important that people take care of themselves early on in life and form good habits so they won’t unfortunately get these diseases that lead to sexual dysfunction.

Brad Means: All right in our last segment, you mentioned Peyronie’s disease curvature of the penis. Is that something that somebody might be born with or is it because of an injury?

Dr. Sherita King: So Peyronie’s disease itself infers that you’re having an injury to it and it’s not something you’re born with, so it’s not congenital. There is congenital curvature of the penis that’s called chordee and as usually pointed downward. But with Peyronie’s disease, typically what I see is men who have had injury during intercourse, either they missed when they were trying to penetrate or they weren’t rigid enough to be able to penetrate smoothly and then they end up having a bend in the penis. And the way it works is that once you get set that bend, you start to have a tear within the tunica albuginea, that’s the covering of the erectile chambers and you bleed into the surrounding structures and you form of a scar. So basically your body is forming a scar but it’s in a place that it just perpetuates and gets worse and doesn’t really go away.

Brad Means: In most cases with the proper treatment, can you return everything to the way it was?

Dr. Sherita King: Yes, so the good thing about Peyronie’s disease now is we have an FDA approved treatment for that and that is Xiaflex it’s a collagenase. That means that basically it just breaks down, acts like a pacman and it breaks down that scar tissue that way, it allows it to expand back out instead of being a jumbled mess. And then you won’t have the curvature once you get the erection.

Brad Means: What about prostate issues, how can you tell if it’s time to go see a doctor, is it just frequent urination is that the number one indicator at home?

Dr. Sherita King: Typically, it’s more of not being able to completely empty or feeling that you’re having the strain to start or you’re having a slow weak stream.

Brad Means: Yeah.

Dr. Sherita King: Or getting up a lot at night, those are the typical signs of enlarging prostate.

Brad Means: Somebody may have those indicators and be reluctant to go to the doctor because they don’t wanna find out that they have cancer, that’s not necessarily always gonna be the case, right?

Dr. Sherita King: No, typically prostate cancer when we by the time when we diagnose it, you don’t have any symptoms and that’s because when they started doing PSA checks, we no longer are getting patients after the fact so when they get so bad and the cancer has spread to other organs and now they’re having major symptoms from it.

Brad Means: What about if you do have to get treated for prostate cancer as so many men are these days or bladder issues or colon issues that can impact sexual function can’t it? And how much optimism can you give us when it comes to being able to get back to a normal life after that?

Dr. Sherita King: Yes, so absolutely any of those types of surgeries for bladder cancer, colon cancer or prostate cancer or any of the treatment, so even like the radiation that some people get for those cancers can lead to erectile dysfunction and start to leak urine. The reason why is the nerves that control the erections and your countenance of be able to hold urine run right along all of those structures. So if you have surgery or radiation it can cause injury or damage to those nerves and that’s where you start to have the issues. But the silver lining is, as long as you go to a place where they have like a cancer survivorship program, where they’re dedicated to making sure that we get, yes we got your cancer, but we’re gonna get you back to a normal life, then you should be fine. There is lots of different things that I implement immediately post-op including like a penile rehab program where I’m trying to keep the tissues of the penis as healthy as possible. So when you do recover your nerves and you’ll be able to achieve erections again. And then if that doesn’t work, then we have like I said the whole host of different treatment options. So my message to men is that you should not keep the potential of having sexual dysfunction or leaking urine as a deterrent for getting treatment for your cancer because even if you have those things post-op, we can definitely treat you.

Brad Means: I talked to some men before I did this interview and I’ll tell you this sometimes they say they’ll urinate they’ll finish and they’ll return to their desk or whatever they were doing and they’ll find out they weren’t finished, that just a little bit more comes out. Do they have a pro… I mean, can you almost guarantee they have a prostate problem or can that just happen randomly anyway?

Dr. Sherita King: So urination is a little is very complex. So it could be that their prostate is growing and that way it’s blocking the complete emptying of their bladder or it could be a dysfunction in the bladder wall itself with contracting and being able to expel all the urine that is in the bladder. The best thing to do is if you’re having those issues to bring it up to your primary care doctor and then have them see your urologist.

Brad Means: We’ve been talking a lot about commercials, Dr. King advertisements that we see all over the place treatments for low testosterone are certainly high among those. Again same question, how can you tell when you might have low testosterone? What sort of daily impact might it have where you know, I better see somebody?

Dr. Sherita King: So some of the main symptoms that will bring men in will be low libido and erectile dysfunction. But once I talk to them and I like start asking him like are you having low energy and they’ll be like, yeah, absolutely or some people even have problems with cognition being able to focus on a task. All these things depend on testosterone for you to be able to get through your day.

Brad Means: What do you think about all those products that promise to boost it? Is there a magic pill? I know that’s probably a term you don’t use clinically but is there a low testosterone treatment that you take and your life immediately changes?

Dr. Sherita King: So a lot of the over counter medications that they have out there, I warn patients to be very wary of them because you don’t really know what’s in those things. They are not FDA approved, they’re not regulated usually, so you can’t tell what’s in it and some people have had some very scary side effects from some of those over-the-counter meds or the things you see on late night TV trying to get men to buy them.

Brad Means: Yeah.

Dr. Sherita King: Yes, there are treatments that are available that are FDA approved definitely with testosterone typically, I will either do a topical gel that they’ll apply either to the arm, chest or underarm or you can do injections of testosterone either weekly or every two weeks or you can get pellets implanted and those usually last about three to six months, it depends on how quickly your body breaks it down. But there’s definitely ways that we can treat it, I would say stick to the FDA approved treatment options though.

Brad Means: I’ve heard about that gel, have you prescribed that and someone comes back and says, Dr. King you changed my life.

Dr. Sherita King: Yes, absolutely.

Brad Means: Wow!

Dr. Sherita King: Absolutely, and everybody’s a little different, it’s just like people like different brands of tennis shoes, whatever works best for you, I’m happy to provide that service.

Brad Means: How old can a man be and still have sex?

Dr. Sherita King: Let’s see the oldest patient I’ve ever put a penile implant in I think was 85.

Brad Means: Wow, 85!

Dr. Sherita King: Yeah, he was this fry 85 and his wife was a little bit younger. But yeah, to me as long as you are heart healthy enough to engage in intercourse, I will do everything in my power to get you there.

Brad Means: Well, that’s great advice and just to wrap things up as you said at the beginning of this interview, Dr. King, it can help the whole family be healthier, right?

Dr. Sherita King: Absolutely. When a patient is happy throughout his whole life and including his sexual function. He exudes that and his family knows that and it’s just a better, is a happier situation for most.

Brad Means: Well, that’s well said. Dr. Sherita King, thank you for all you do for the men in our lives.

Dr. Sherita King: Thank you

Brad Means: And thank you for being with us today.

Dr. Sherita King: Thank you, thank you for having me.

Brad Means: Yes, ma’am, we appreciate you.

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