Erectile dysfunction isn’t just an issue that befalls older men. The condition, defined by the National Institutes of Health as the inability to “get or keep an erection firm enough for satisfactory sexual intercourse,” affects 30 million men every year. And while the prevalence of the condition does increase with age — with 40 percent of men affected at age 40, and 70 percent at age 70, according to the Cleveland Clinic — a 2013 study published in The Journal of Sexual Medicine found that one in four men seeking treatment for ED were under 40 years old.
The causes of erectile dysfunction for men of all ages are manifold, from health-related lifestyle factors like anxiety, drinking, smoking, or obesity, to side effects from certain medications like antidepressants and blood pressure pills. It can be also be an indicator of a more serious medical condition, including diabetes, heart disease and prostate cancer.
The stigma gets in the way of seeking treatment. Men, already half as likely as women to go to the doctor in a two year period, according to a 2014 CDC survey, are ashamed to discuss the issue with their primary care doctor, or even pick up meds at the pharmacy. According to a study from the Southern Illinois University School of Medicine, only 25 percent of men who received an ED diagnosis filled a prescription for it. (If they’re getting it on the internet, that’s worrisome, too: a 2011 study by Pfizer found that 80 percent of Viagra sold online is counterfeit.)
“The strength of a man’s erection is a really great indicator for their overall health,” says Zachariah Reitano, the cofounder of Roman, a new NYC-based telehealth app which evaluates and treats men for ED from the privacy of their homes. “It requires so much of your body at one time — your hormones, your nervous system, your heart." He likens ED to having your check engine light on: a visibly recognizable sign that something’s not right.
With Roman, Reitano and his cofounders Rob Schutz and Saman Rahmanian want to help fight the stigma around the condition and get men treatment for it. Reitano suffers from ED himself, first experiencing it at the age of 17, when it turned out to be the sign of a heart condition. Then, the medication he started taking for his condition gave him ED as a side effect. The now 26-year-old considers himself Roman's first customer.
Here's how Roman works: For $15, patients complete an online visit, providing medical history and answering questions about their symptoms, followed by a consultation from a physician. Upon reviewing the patient’s profile, if the doctor determines it’s “safe and appropriate,” they’ll prescribe ED medication — oral pde5 inhibitors, including Viagra and its generic, Sildenafil, Cialis and Levitra, which range from $2 to $62 a dose — and ship it out in discreet packaging. (Since its launch on Oct. 31, 2017, Roman is available for download in New York, Pennsylvania, Florida, California and Washington.)
If the doctor sees any indicators of an underlying medical condition, they might recommend lab work, which they’ll both order and review for free, before prescribing meds. In some cases, a Roman doctor might find a patient unsuitable for telehealth — for example, if they’re taking medication that contraindicates the pde5 inhibitors — and instead direct them to a doctor’s office.
Reitano describes Roman’s services as a complement to medical care, rather than a replacement. He hopes the app will encourage men to take charge of their health and not shy away from regular doctor’s visits. And he acknowledges that it takes more than medication to solve ED.
“It’s analogous to a knee brace,” he explains. “You might need it each time to walk. It costs money and it by no mean fixes your knee.” But it’s the first step to getting your sexual health back.