Erectile dysfunction previously called impotence, affects a substantial number of normal males. Almost all men experience some degree of erectile dysfunction at some stage of their life. Global statistics suggest a figure of 30 per cent at 40 years of age and 70 per cent at the 70th year onwards being affected.
Men in Fiji are no different from their international brethren, incidence wise. However, our men delay seeking assistance in many instances. The causes of erectile dysfunction are multi-factorial but the good news is that help is at hand, locally.
Common causes of erectile dysfunction:
o Stress;
o Medical conditions — hypertension, diabetes mellitus;
o Hormonal deficiencies — neurological conditions, micro-vascular diseases; and
o Local genital conditions — peyonies disease.
Stress
Concerns about education, careers, financial burdens, work and family pressures can all contribute to a lowered sex drive. Modern living can leave a normal male with significant residual/accumulated stress at the end of a normal working day. These stressors can block sensate focusing, sexual imagery and physical stimulation which contribute to desire and arousal. This absence of arousal leads on to its associated poor sexual/physiological effects.
A transient erectile dysfunction leads to concerns on performance anxiety in subsequent situations and worsens performance. Active means to destress our lives can contribute to improved sexual performance.
Medical condition
Certain diseases like hypertension damage the blood vessels. The disturbed blood flow can result in low libido, flaccidity, premature ejaculation and erectile dysfunction.
By double jeopardy, some medication used to treat hypertension, also reduces the blood flow and further worsens the sexual function. This situation contributes to an unsatisfied male and couple. Readjusting the medication and altering the lifestyles can help reduce the sexual insult.
Many cases of erectile dysfunction are the primary presentation of diabetes mellitus. Diabetes directly or indirectly can result in damage of the nerves and vessels which supply the genitals. Treating the primary cause of a medical condition generally results in improved sexual function.
Hormonal deficiency
Hormonal deficiency because of disturbed testicular production of testosterone and can lead to low or lowered libido. Such deficiency’s can arise out of several conditions which include:
1. Chromosonal abnormalities.
2. Testicular hormone deficiency secondary to childhood infections, testicular tumours and sexually transmitted diseases.
Hormone replacement has been misused by many patients and their medical practitioners. One needs to be cautioned that, only if a deficiency exists, then benefits will accrue with its use.
We must not forget that some men have a placebo effect even with non-pharmacological agents such as creams, injections and tablets. There are many generics on the market but none carry any evidence of usefulness.
The good news is that blood tests to assay the serum testosterone and sex hormone binding globulin (SHBG) are now available locally to effectively evaluate affected individuals.
Local genital conditions
Peyronies disease, through rare has been found in several individuals attending the Suva Male Clinic and the diagnosis can be problematic. A thorough examination is all that is needed for diagnosis. Management with intra-cavernous steroids may have some benefit. Males are shy beasts and fearful of exposing their genitals even to a good physician. The diagnosis are hence missed.
What can be done
Male need to address their medical condition with an appropriate medical practitioner trained in the area of male health.
Specific measures to reduce stress go a long way in solving part of the problem. Specific antidotes and readjustment of medication for hypertensive will self connect the erectile dysfunction. Control of diabetes mellitus and specific treatment for erectile dysfunction will go a long way in enhancing self image and relationship issues for couples.
Medication —
what’s available
* Sildenafic — viagra;
* Tadafil — cialis;
* Prostadil injection —
caver-jet;
* Testosterone injection
— hormone replacement; and
* Dapoxetine — SSRI for
premature ejaculation.
With generics now available, the initial costs of medication by originator pharmaceutical companies have fallen dramatically. Medication costs are within range of the common male.
Local scenario
t Stress reduction with a healthier lifestyle contributes to general wellbeing ie regular exercise and diet measures.
t Reduction of kava, alcohol and cigarette consumption cannot be over emphasised.
t Screen for medical conditions with a physical examination and blood tests will determine the extent of involvement and duration of therapy.
t Specific measures to treat medical conditions such as hypertension, mellitus, and neurological, vascular and testicular conditions will help.
t Specific measures of counselling on separate focusing to treat premature ejaculation will help.
Conclusion
Too many men do not respond to what their body tells them. Erectile dysfunction is an issue on its own but remembers it may also be your first signal of other metabolic diseases.
* Dr Neil Sharma works out of the Bakshi St Medical Centre in Suva. The views expressed are his and not of this newspaper.
