Experts warn of the implications of erectile dysfunction on overall health.
Millions of men around the word suffer from this condition in varying degrees, and doctors now know that while the psychological and physical effects of ED may affect the quality of a man’s life, the development of ED itself is very likely to point to more serious illnesses that lie ahead.
WE’VE all made jokes about those “uplifting pills” and a man’s waning ability to stand to attention when he so desires it, but in truth erectile dysfunction (ED) is no laughing matter.
First off, let’s be clear on what ED or impotence is. Simply put, it is the inability of a man to achieve or maintain a penile erection sufficient for his sexual needs or the needs of his partner.
According to the European Society for Sexual Medicine (ESSM), it is estimated that around 152 million men worldwide (that is to say 16% of all men aged 20 to 75) experience erection difficulties. Despite this, no more than 20% of those suffering from ED seek treatment from a doctor.
Implications on overall health
Associate Prof Dr Zulkifli Md. Zainuddin is a consultant urologist who has been treating ED for more than a decade. In a recent interview, he explained: “The most important thing about erectile dysfunction is that it is actually a symptom of more serious diseases. A man who suffers from ED will usually also feel fatigue, his body will have more fat and less muscle.
“ED could be a sign of anything from heart disease to osteoporosis and anaemia. It makes sense that ED is linked to the early onset of heart disease when you think about the narrowing of the vessels.
“Aside from this, there are lots of psychological effects because a man might feel that he is somehow less of a man if he is unable to maintain an erection.”
“Luckily there are ways to treat the ED itself. Testosterone deficiency (which is also known as hypogonadism) can be treated. Hormone replacement therapy is more commonly known for women, but we can replace the testosterone for men through injections. Of course the use of PDE-5 inhibitors is usually the first option.”
Dr Zulkifli emphasised that while ED can be treated, there is no substitute for a healthy diet and exercise regime. “There is no miracle cure. This is not the fountain of youth.”
As to what constitutes a healthy sex life, Dr Zulkifli says there is no universal standard that can be applied. “You can’t simply refer to a table. As long as both partners are satisfied, that can be considered a healthy sex life.
According to consultant urologist Assoc Prof Dr Zulkifli Md. Zainuddin, embarrassment and other cultural factors play a major in whether or not a man seeks treatment for ED.
“This really varies from individuals as sometimes it can be once or twice a day, but with other couples it might be just two or three times a month. Of course younger couples tend to have sex more often, but even in younger men, ED can occur, usually because of performance anxiety.”
Cultural factors
Embarrassment and other cultural factors play a major in whether or not a man seeks treatment for ED. Dr Zulkifli said that Asian men are particularly reluctant to consult a doctor about the problem.
“In the West, maybe 20% of men seek treatment, but here there was a study conducted by the Lembaga Penduduk dan Pembangunan Keluarga Negara (National Population and Family Development Board) a few years ago which shows that only 6% of Malaysian men will seek treatment through a doctor.”
Indeed Asian men are famous for turning to all kinds of traditional treatments, from the the tongkat ali root to bear bile and rhino horns. However Dr Zulfili advises against it. “These are traditional treatments that have been passed down from ancient times but I have seen no indication that they work. Even the urut batin (a sensual massage designed to increase the libido) doesn’t work, as far as I see.”
Malaysian men who don’t resort to such traditional methods are also likely to take “performance-enhancing” pills on the sly. “A majority of our men don’t want the women to know that they are having problems so they self-administer, but this is not advisable,” said Dr Zulkifli.
Another condition that concerns the function of the male sexual organ is that of premature ejaculation. Dr Zulkfili says that while this too is a treatable condition, it is not related to ED, not is it as serious an indicator of a man’s overall health.
“ED should not be confused with premature ejaculation, although they can co-exist. In the first case, the male is unable to satisfactorily achieve an erection, whereas in the latter he can achieve an erection but he ejaculates too soon after achieving it, usually during intercourse.”
“Premature ejaculation is not usually associated with co-morbidities, in other words unlike ED it is not a signal of more serious conditions. They have found that one of the side-effects of anti-depressants is that it retards ejaculation so this treatment can be made.”
European sexual conference
Dr Zulkfili’s comments certainly echoed that of a panel of experts who spoke at the 10th Congress of the ESSM, which was held at Portugal, Lisbon in late November 2007.
Speaking on the issue of ED and its impact on a man’s relationship and life, ESSM Secretary-General Dr John Dean emphasised the importance of ED as an indicator of more serious health issues.
“While most people look at the immediate sexual health issue as one of paramount importance, and indeed it is important, ED is most important as a barometer of men’s health.
President of the World Association For Sexual Health, Dr Eusebio Rubio-Aurioles ... ‘We do not recommend the use of PDE-5 inhibitors for the healthy man.’
“Research has also shown that a man’s partner plays a great role in whether he decides to seek treatment or not.
“If he has a proactive and supportive partner, then he is much more likely to go to a doctor to discuss the issue. Otherwise he is liable to withdraw into himself and not seek any sort of treatment for the condition.”
Dean’s colleague Dr Eusebio Rubio-Aurioles is a Mexican professor who is the President of the World Association For Sexual Health. He has conducted numerous studies regarding sexual health since first qualifying as a doctor in 1978.
He warned against the usage of drugs to enhance a man’s libido when there is actually nothing wrong with him. “ We do not recommend the use of PDE-5 inhibitors for the healthy man. We cannot say that it is unsafe, but neither is it recommended.”
Dr Zulkifli concurs. “It doesn’t really work ... if you don’t have a problem, you should not be taking all these pills. It wouldn’t surprise me
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