Dr. Lee was born in Shanghai, China, and received his college and medical training in the United States. He is fluent in English and three Chinese dialects. He graduated with chemistry departmental honors from Harvey Mudd College. He was appointed president of AOA society at UCLA School of Medicine. He underwent internal medicine residency and gastroenterology fellowship training at Cedars Sinai Medical Center.
Dr. Nabili received his undergraduate degree from the University of California, San Diego (UCSD), majoring in chemistry and biochemistry. He then completed his graduate degree at the University of California, Los Angeles (UCLA). His graduate training included a specialized fellowship in public health where his research focused on environmental health and health-care delivery and management.
Jay W. Marks, MD, is a board-certified internist and gastroenterologist. He graduated from Yale University School of Medicine and trained in internal medicine and gastroenterology at UCLA/Cedars-Sinai Medical Center in Los Angeles.
Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
The ability to achieve and sustain erections requires
a healthy nervous system that conducts nerve impulses
in the brain, spinal column, and penis,
healthy arteries in and near the corpora cavernosa,
healthy smooth muscles and fibrous tissues within the corpora cavernosa,
adequate levels of nitric oxide in the penis.
Erectile dysfunction can occur if one or more of these requirements are not
met. The following are causes of erectile dysfunction:
Aging: There are two reasons why older men are more likely to experience
erectile dysfunction than younger men. First, older men are more likely to
develop diseases (such as heart attacks, angina, cardiovascular disease, strokes, diabetes mellitus, and
high blood pressure) that are associated with erectile dysfunction. Second, the
aging process alone can cause erectile dysfunction in some men, primarily by
decreasing the compliance of the tissues in the corpora cavernosa, although it
has been suggested, but not proven, that there is also decreased production of
nitric oxide in the nerves that innervate the corporal smooth muscle within the
penis.
Diabetes mellitus: Erectile dysfunction tends to develop 10-15 years
earlier in diabetic men than among nondiabetic men. In a population study of men
with type I diabetes for more than 10 years, erectile dysfunction was reported
by 55% of men 50-60 years of age. The increased risk of erectile
dysfunction among men with diabetes mellitus may be due to the earlier onset and
greater severity of atherosclerosis that narrows the arteries and thereby
reduces the delivery of blood to the penis. When insufficient blood is delivered
to the penis, it is not possible to achieve an erection.
Diabetes mellitus also
causes erectile dysfunction by damaging both sensory and autonomic nerves, a
condition called diabetic neuropathy. Smoking cigarettes, obesity, poor control
of blood glucose levels, and having diabetes mellitus for a long time further
increase the risk of erectile dysfunction in diabetes. In addition to atherosclerosis
and/or neuropathy causing ED in diabetes, many men with diabetes also develop a myopathy
(muscle disease) as their cause of ED in which the compliance of the muscles in
the corpora cavernosa is decreased, and clinically this presents as an inability
to maintain the erection.
Hypertension (high blood pressure): People with essential hypertension or arteriosclerosis have an increased risk of developing erectile dysfunction. Essential hypertension is the most common form of hypertension; it is called essential hypertension because it is not caused by another disease (for example, by kidney disease). It is not clearly known how essential hypertension causes erectile dysfunction; however, those with essential hypertension have been found to have low production of nitric oxide by the arteries of the body, including the arteries in the penis. High blood pressure also accelerates the progression of atherosclerosis, which in turn can contribute to erectile dysfunction. Scientists now suspect that the decreased levels of nitric oxide in patients with essential hypertension may contribute to erectile dysfunction.
Cardiovascular diseases: The most common cause of cardiovascular
diseases in the United States is atherosclerosis, the narrowing and
hardening of arteries that reduces blood flow. Atherosclerosis typically
affects arteries throughout the body and is aggravated by hypertension, high
blood cholesterol levels, cigarette smoking, and diabetes mellitus. When
coronary arteries (arteries that supply blood to the heart muscle) are
narrowed by atherosclerosis, heart attacks and angina occur. When cerebral
arteries (arteries that supply blood to the brain) are narrowed by
atherosclerosis, strokes occur. Similarly, when arteries to the penis and
the pelvic organs are narrowed by atherosclerosis, insufficient blood is
delivered to the penis to achieve an erection. There is a close correlation
between the severity of atherosclerosis in the coronary arteries and
erectile dysfunction. For example, men with more severe coronary artery
atherosclerosis also tend to have more erectile dysfunction than men with
mild or no coronary artery atherosclerosis. Some doctors suggest that men
with new onset erectile dysfunction should be evaluated for silent coronary
artery diseases (advanced coronary artery atherosclerosis that has not yet
caused angina or heart attacks).
Cigarette smoking: Cigarette smoking aggravates atherosclerosis and
thereby increases the risk for erectile dysfunction.
Nerve or spinal cord damage: Damage to the spinal cord and nerves in the pelvis can cause erectile dysfunction. Nerve damage can be due to disease, trauma, or surgical procedures. Examples include injury to the spinal cord from automobile accidents, injury to the pelvic nerves from prostate surgery for prostate cancer (prostatectomy), radiation to the prostate, surgery for benign prostatic enlargement,
multiple sclerosis (a neurological disease with the potential to cause
widespread damage to nerves), and long-term diabetes mellitus.
Substance abuse: Marijuana, heroin, cocaine, methamphetamines, crystal meth, and alcohol abuse contribute to erectile dysfunction. Alcoholism, in addition to causing nerve damage, can lead to atrophy (shrinking) of the testicles and lower testosterone levels.
Low testosterone levels: Testosterone (the primary sex hormone in men) is
not only necessary for sex drive (libido) but also is necessary to maintain
nitric oxide levels in the penis. Therefore, men with hypogonadism (diminished
function of the testes resulting in low testosterone production) can have low
sex drive and erectile dysfunction.
Medications: Many common medicines produce erectile dysfunction as a side
effect. Medicines that can cause erectile dysfunction include many used to treat
high blood pressure, antihistamines, antidepressants,
tranquilizers, and appetite suppressants. Examples of common medicines that
can cause erectile dysfunction include propranolol (Inderal) or other beta-blockers,
hydrochlorothiazide, digoxin (Lanoxin), amitriptyline (Elavil), famotidine
(Pepcid), cimetidine (Tagamet), metoclopramide (Reglan), indomethacin (Indocin),
lithium (Eskalith, Lithobid), verapamil (Calan, Verelan, Isoptin), phenytoin
(Dilantin), and gemfibrozil (Lopid).
Depression and anxiety: Psychological factors may be responsible for
erectile dysfunction. These factors include stress, anxiety, guilt, depression, widower syndrome, low self-esteem, posttraumatic
stress disorder, and fear of sexual failure (performance anxiety). It is
also worth noting that many medications used for treatment of depression and
other psychiatric disorders may cause erectile dysfunction or ejaculatory
problems.
Diabetes mellitus is a chronic condition characterized by high levels of sugar (glucose) in the blood. The two types of diabetes are referred to as type 1 (insulin dependent) and type 2 (non-insulin dependent). Symptoms of diabetes include increased urine output, thirst, hunger, and fatigue. Treatment of diabetes depends on the type.
Liver disease can be cause by a variety of things including infection (hepatitis), diseases such as gallstones, high cholesterol or triglycerides, blood flow obstruction to the liver, and toxins (medications and chemicals). Symptoms of liver disease depends upon the cause; however, common symptoms may include nausea, vomiting, upper right abdominal pain, and jaundice. Treatment depends upon the cause of the liver disease.
Low testosterone can affect both men and women. Causes of low testosterone in males include undescended testicles and injury to the scrotum. Low testosterone in females includes ovary conditions. Treatment for low testosterone in men includes testosterone replacement therapy. Currently there is no FDA approved testosterone treatment for women.
Cholesterol is naturally produced by the body, and is a building block for cell membranes and hormones. Low-density lipoprotein (LDL) cholesterol is the "bad" cholesterol, conversely, high-density lipoprotein (HDL) cholesterol is the "good" cholesterol. High cholesterol treatment includes lifestyle changes (diet and exercise), and medications such as statins, bile acid resins, and fibric acid derivatives.
Depression is an illness that involves the body, mood, and thoughts and affects the way a person eats and sleeps, the way one feels about oneself, and the way one thinks about things. The principal types of depression are major depression, dysthymia, and bipolar disease (also called manic-depressive disease).
Parkinson's disease is a slowly progressive neurologic disease characterized by a fixed inexpressive face, a tremor at rest, slowing of voluntary movements, a gait with short accelerating steps, peculiar posture and muscle weakness, caused by degeneration of an area of the brain called the basal ganglia, and by low production of the neurotransmitter dopamine. Most patients are over 50, but at least 10 percent are under 40.
Testicular pain, or pain in the testicle or testicles are caused by a variety of diseases or conditions such as testicular trauma, testicular torsion, testicular cancer, epididymitis, and orchitis. Common symptoms of pain in the testicle or testicles are abdominal pain, urinary pain or incontinence, fever, nausea, vomiting, and pain in the scrotum or testicle. Treatment depends on the cause of the testicular pain or pain in the testicles.
Drug addiction is a chronic disease that causes drug-seeking behavior and drug use despite negative consequences to the user and those around him. Though the initial decision to use drugs is voluntary, changes in the brain caused by repeated drug abuse can affect a person's self-control and ability to make the right decisions and increase the urge to take drugs. Drug abuse and addiction are preventable.
Male sexual dysfunction can be caused by physical or psychological problems. Common sexual problems in men include erectile dysfunction (impotence or ED), premature ejaculation and loss of libido. Treatment for sexual dysfunction in men may involve medication, hormone therapy, psychological therapy, and the use of mechanical aids.
Diabetic Neuropathy is a complication of diabetes that causes damage to the nerves; this is related to the blood glucose of the body being too high for a long period of time. The four types of neuropathy include peripheral, autonomic, proximal and focal.
Smoking is an addiction. More than 430,000 deaths occur each year in the U.S. from smoking related illnesses. Secondhand smoke or "passive smoke" also harm family members, coworkers, and others around smokers. There are a number of techniques available to assist people who want to quit smoking.
Penis disorders (male reproductive problems) include priapism, Peyronie's disease, balanitis, phimosis, paraphimosis, and penile cancer. Read on for causes, symptoms, diagnosis, and treatment. These disorders can affect a man's fertility and sexual functioning. A variety of treatments are available for these disorders.
Prolactinoma is an adenoma (benign tumor) of the pituitary gland. Causes of many prolactinomas are unknown. Symptoms in women include changes in menstruation and infertility, decreased libido, or painful intercourse due to vaginal dryness. The most common symptom in men is impotence (erectile dysfunction). Treatment of prolactinomas are medication or surgery.
Enjoying a satisfying sex life as we age is important to both physical and mental health. As we age, diseases and conditions may pose challenges in our sexual health, and sexual experiences. Learn how to manage your conditions and still have a gratifying sex life as you age.
Anabolic steroids are synthetic substances that are related to testosterone and promote skeletal muscle growth and the development of male sexual characteristics in both men and women. In the 1930s, it was discovered that anabolic steroids could promote skeletal muscle growth in lab animals, which lead to anabolic steroid abuse by bodybuilders and weight lifters.
Sexual health information including birth control, impotence, herpes, sexually transmitted diseases, staying healthy, women's sexual health concerns, and men's sexual health concerns. Learn about the most common sexual conditions affecting men and women.
Peyronie's disease is a condition characterized by a hard lump, or plaque, that forms within the penis. Symptoms of Peyronie's disease range from mild to severe. Treatment for Peyronie's disease includes medication, and often surgery.
Men's health is an important component to a happy lifestyle and healthy relationships. Eating healthy, exercise, managing stress, and knowing when to have medical tests for a particular age is key to disease prevention in men.
Having diabetes can mean early onset and increased severity of bladder symptoms (urinary incontinence and urinary tract infections) and changes in sexual function. Men may have erectile dysfunction; and women may have problems with sexual response and vaginal lubrication. Keep your diabetes under control, and you can lower your risk of sexual and urologic problems.
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