It is open season on erectile dysfunction. First, a politician in South Carolina introduced a bill to make it hard to get Viagra and then a politician in Kentucky. If the bills pass, they will hold patients with erectile dysfunction hostage to unrelated agendas. You might think that erections would be as politically untouchable as guns. After all, erections are nearly as popular as they are common. So how can erectile dysfunction be politically impotent?

Our society has a bipolar relationship to erections. It is so extremely bipolar that it leaves little room for authentic conversation: Real men, who are neither studs nor eunuchs, talking authentically about real dysfunction. At one pole, our society glorifies erections. Just look at the prevalence of gentlemen’s clubs and pornography, which very poorly represent the real lives of common men. At the other pole, our formal structures, including the work environment, permit no mention of erections, libido, or anything else remotely sexual. The overall message to common men is that they need to be Casanova, which most men are not, or silent, which most men are.

As a related problem, the doctors that men see when they have erectile dysfunction are generally busy typing into EMRs, learning ICD-10, and churning patients. They may be too distracted to attend to what many may see a transient issue (i.e., erections needed for momentary sex). That is like conceiving that breasts are needed merely for serving food to babies. The fact is that many physical dysfunctions and deformities have long lasting and potentially very profound ill effects on mood and social functions. They can bring on social isolation, melancholia, and depression. And in the case of erectile dysfunction, it can be a sentinel of diabetes, hypertension, and heart disease. Erectile function can be the busy doctor’s most useful and efficiently informative sign of health, yet it is roundly ignored.

There is another problem: the public airwaves are saturated with ads for medication. This is a general and problematic phenomenon and it applies to erectile dysfunction. To be sure, medications have a role in treating some cases of erectile dysfunction, but they are not the only treatment for erectile dysfunction. More to the point, there are many cases of erectile dysfunction that medications do not effectively treat. Their disproportionate public presence thus biases conversations and crowds out awareness and consideration of injections, suppositories, vacuum devices and penile implant surgery.

Perhaps as a consequence of the silence of men with erectile dysfunction, treatments for lousy erections are poorly covered by insurance. And as a related issue, our healthcare delivery is inhospitable to self-pay healthcare consumers. It provides essentially no help with regards to cost, quality, or logistics. While this is starting to change – flat-fee penile implant surgery packages are starting to appear — access to care without insurance is broadly difficult.

Men with erectile dysfunction want to restore erections, overcome depression, and re-establish marital relationships. They are not hostages for political agendas, but patients who deserve quality, convenience, and choice.

Arnon Krongrad is a surgeon-scientist in South Florida. In 1999, he became the first surgeon to perform laparoscopic radical prostatectomy in the United States, and he coauthored Laparoscopic Radical Prostatectomy: A Technical Monograph, which standardized the operation now performed robotically worldwide. A board-certified urologist, he founded the Krongrad Institute, America’s longest-running program devoted to the procedure.

His basic and clinical research has appeared in JAMA and Cancer Research, and he was a coauthor on Larry Clark’s landmark selenium trials, among the first to show that a dietary supplement could reduce cancer incidence. His current research centers on metabolic health, including early-stage clinical trials of the peptide Pep19 in adults with obesity, with results published in Diabetes/Metabolism Research and Reviews and forthcoming in iScience.

He earned his BA in chemistry at Columbia College and his MD at the College of Physicians & Surgeons, completed a surgical internship at the University of Hawaii and a urology residency at Mount Sinai Medical Center, and completed a fellowship in endocrinology and metabolism at UT Southwestern Medical Center.

He is a cofounder and chief medical officer of Proteimax Biotechnology, a peptide discovery company focused on metabolic health, and founder of Ezz, a knowledge club devoted to maximum health. He shares updates on LinkedIn and X.

Kimberly Langer is chief product officer, Surgeo.

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