A Discussion with Mr Ivor Cullen, Consultant Urologist & Andrologist, at Aut Even Hospital, about the field of Andrology and the treatment & incidence of Erectile Dysfunction.

Why did you choose to specialise in the field of Urology?

I chose Urology because I had been exposed to it during my medical training and I was particularly interested in it. I liked the blend of surgery, medical therapies and a lot of patient contact was very important for me. The beauty of Urology is that a lot of problems and pathologies that we encounter are fixable and solvable, either with medical or surgical therapies.  So there is a tremendous satisfaction in improving people’s quality of life, in solving their problems or in better managing their long term problems.

What are your specific areas of interest and expertise?

I work as a General Urologist and see the full gambit of general urology problems, ranging from stones, lower urinary tract symptoms, incontinence problems, and a variety of urology cancers, such as kidney cancers, bladder cancers, testis and penis cancer, prostate cancer.  I have a particular interest in Andrology; I work a lot with people who have problems with fertility, erectile dysfunction, and sexual dysfunction, congenital and acquired penal abnormalities, penal shape abnormalities and operations that require surgery for erectile dysfunction

What exactly is an Andrologist?

Andrology is a sub-speciality of Urology which has particular focus on managing infertility, sexual and erectile dysfunction and congenital, anatomical and acquired anatomical abnormalities of the genitalia. So, for example, I work a lot with men who have compromised fertility, men who have no sperm in their ejaculate (so called azoospermia), gentlemen who have congenital and acquired curvature of the penis, (called peyronie’s disease), gentlemen with erectile dysfunction, particularly those that are not responding to the traditional Viagra type medication, where implant surgery is required.

What options are available for the management of erectile dysfunction?

With erectile dysfunction there are a number of different modalities available, which is very encouraging and promising for men.

These range from oral medication to medications directly treating the penis itself.  There is a cream or a gel which can be used, there is an intro intra-urethral device,  or we have direct injection therapy. All of these medications directly treat the penis for a gentleman who is resistant to treatment with the oral tablets.  We also have more invasive therapies for more significant erectile dysfunction.

Does erectile dysfunction typically affect a certain age group of men?

Erectile dysfunction can occur at any age, dependent upon other medical problems. Sometimes, it affects gentlemen who are younger, for example, patients with diabetes, neurological problems, vascular problems and so on.  Sometimes, erectile dysfunction can affect these men in their twenties and thirties, which is devastating for them.  More commonly, however, traditional erectile dysfunction does appear to become more prevalent in the ageing male.  But early stages of erectile dysfunction and erectile compromise often appear in the fourth and fifth decade.

Is there still a hesitancy among men to discuss erectile dysfunction with their GP or health care practitioner?

I think that is changing in Ireland. I think Irish men are realising and recognising there are very acceptable treatments for this very common problem which can have a huge effect on someone’s quality of life and quality of relationships etc.  So I do think that men are engaging with their primary care doctors and specialists earlier and requesting these treatments and meeting this problem head on.