DEAR DR. ROACH: A man has erectile dysfunction because blood will not flow into his penis. What is the connection between this blood flow and the blood flow in the rest of his body? Also, how do medications like Viagra cause blood to flow? — T.E.

ANSWER: Male sexual function is very complicated, requiring several systems to work properly. Blood flow is vital, but a blockage in any of the arteries leading to the penis is by no means the exclusive cause of erectile dysfunction. The nerve supply to the area needs to be capable of sending information out and receiving it back again, so damage to the nerves is also a cause of ED. Hormones, especially testosterone, have significant effects, but the brain remains the most important organ involved, so psychological causes of ED are as important as any of the other three.

Treatment of male sexual trouble is a lot more complex than prescribing a medication like Viagra, although these medications are very useful for many men. They work by dilating blood vessels, helping blood flow into the penis, and constricting others, reducing the ability for the blood to get out. However, if the cause is neurological, hormonal or psychological, these medicines will be less-helpful.

You raise a good point — sometimes ED is the first clue to blockages in blood vessels in other parts of the body. More rarely, it can be a sign of nerve disease. It is the usual first sign of low testosterone levels, and an important clue in the diagnosis of depression. It also can be a sign of problems in a relationship.

A careful doctor will explore the different possibilities before deciding on a diagnostic and treatment plan.

The booklet on men’s health discusses treatment options for erectile dysfunction, as well as prostate health. Readers can obtain a copy by writing: Dr. Roach — No. 1001, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6 Can. with the recipient’s printed name and address. Please allow four weeks for delivery.

DEAR DR. ROACH: I have had pain from dry eyes for three years. My ophthalmologist had me using artificial tears several times daily. At a recent annual visit with my internist, he pronounced me in excellent health but stressed I needed to drink eight glasses of water or liquid a day. Within two weeks of following his instructions, my eye dryness cleared up completely, and I seldom need to use the artificial tears.

You recently wrote about dehydration — I am curious to know if this was causing my eye pain and dryness. I have never seen this mentioned before. — C.G.

ANSWER: I haven’t seen it before, either. However, your experience suggests that it was effective for you and may be for others as well.

Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475. Health newsletters may be ordered from www.rbmamall.com.

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