Published: Sunday November 24, 2013 MYT 12:00:00 AM
Updated: Sunday November 24, 2013 MYT 9:21:38 AM
Getting to know ED
In normal men, erection occurs automatically, not.
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Facts and fallacies about erectile dysfunction (ED).
ERECTILE dysfunction (ED) is the inability to achieve or maintain an erection of the penis, which is satisfactory for sexual intercourse. Being a taboo subject, there are many myths circulating around that are worsened by men not talking openly about it with their doctors.
Here are some of the common misconceptions about this condition.
ED affects only elderly men
Although the majority of men affected by ED are elderly, younger men are not exclusively exempted. In Malaysia, data collected to date are for men above 40 years of age, and it showed a higher prevalence among men above 60 years of age.
However, in a study done in Brazil, the prevalence rate was 35% in men 18-40 years of age.
So if you are young and have ED, do not fret. You are not alone.
If you are above 40 years, up to 50% of men in Malaysia share your problem. In fact, in a recent local study, the prevalence of ED in those above 40 years of age was 69.5%.
ED is not dangerous or life-threatening
While it is true that ED on its own does not lead to death, it is actually an indicator of other underlying diseases that can shorten your life.
It has been proven that ED predicts coronary artery disease, with a lead time of two to five years. In other words, if you have ED, you are at risk of a heart attack in two to five years.
Therefore, if you have ED, you should be examined for the health of your heart as well. Both are equally important to men.
The presentation of ED by men in the clinic is an opportunity for doctors to screen for other diseases associated with it, and these include diabetes mellitus, testosterone deficiency syndrome, hypertension and high cholesterol levels (hyperlipidaemia).
ED is the partner’s fault
ED is not to be blamed on the partner for not being attractive anymore. Although psychological factors do affect ED, there are other physiological or organic factors involved as well. These include diseases affecting the blood vessels and/or the nerves supplying the penis.
Often, men shy away from sex when they are unable to perform, and this can construed by their partners that they are not attractive any more. This misconception can lead to relationships breaking down.
Men with ED have no sexual desire
This is not entirely true. Men with ED usually do have the desire, but due to the underlying disease affecting the blood vessels or nerves, they are unable to perform.
There are men with ED who lack desire. These men either have low levels of testosterone or are affected psychologically by stress or emotion.
Masturbation causes ED
There is no concrete evidence for this.
In normal men, erection is automatic
This is not true. Men need stimulation for sexual erection. Non-stimulated erection may occur during sleep or on awakening in the morning, but this is not related to sex.
There is also a refractory period before men can have an erection again, and this can last from minutes in younger men to days in older men. This is not ED.
An erection means men want sex
Again, this is not true. Men may experience a normal physiological erection during sleep or on getting up in the morning. It is not always related to sexual activity.
ED needs extensive investigations and treatment is usually delayed
ED is diagnosed through doctors asking you some simple questions (taking a history). A questionnaire known as the International Index of Erectile Function (IIEF) may be used.
A physical examination and some blood tests will follow to detect any other associated diseases. Treatment will usually then be given.
Only in certain complex cases, and this is very rare, will further tests like a Duplex ultrasound, cavernosogram or nocturnal penile tumescence test, be needed.
The first step in treatment is lifestyle modification, and this includes maintaining an ideal body weight, cessation of smoking, moderate exercise and a balanced diet.
This on its own may improve ED. Needless to say, blood pressure, sugar and cholesterol needs to be controlled. Any psychological factors such as stress need to be tackled as well.
The next step is oral medication (tablets to be swallowed). Phosphodiesterase-5 (PDE-5) inhibitors such as sildenafil, vardenafil and tadalafil, are effective in 80% of cases.
Often, men shy away from sex when they are unable to perform, and this can construed by their partners
that they are not attractive any more. – AFP
that they are not attractive any more. – AFP
Caution is needed for those with heart problems. They will need to be assessed carefully by the doctor. If the heart disease is deemed mild, they can be given PDE-5 inhibitors.
In moderately severe cases, further tests will be required, while those who have severe disease should not be taking such drugs.
Those on nitrate medications also cannot be given PDE-5 inhibitors.
The other treatment options are injection of medication (like prostaglandin) directly into the penis using a small needle and syringe, using a vacuum pump device or inserting a penile prosthesis (requiring surgery).
Treatment is only temporary and the condition can be cured
This is another misconception where some people think that taking just one magical pill will solve it all. If lifestyle modification does not help and taking medication is required, you will probably need to continue taking the medication as long as you want to have erections.
The only exception is if it is solely psychological in nature, where counselling or behavioural therapy may cure the problem, and further treatment may not be required.
Circumcision reduces ED
There is no evidence that circumcision reduces ED.
ED treatment increases the size of the penis
This is another misconception. ED treatment solves erection, i.e. rigidity and hardness. It does not increase the length or size of the penis.
Traditional treatment is cheaper and much better than seeing a doctor
Unapproved medications are risky and may contain substances that are detrimental to health. It is not worth the risk. Most of these medications have not undergone stringent tests, and unlike conventional medication prescribed by doctors, have not been proven effective by robust trials.
In a review by Ho et al., most of the herbal treatments for ED were tested in animals, and only yohimbine, ginseng and butea superba were tested in humans.
ED can be helped. An open discussion with the doctor, especially a urologist, would be beneficial. Do not be embarrassed.
References:
1. Martins FG et al. J Sex Med 2009; 7(6):2166-73
2. Ho CCK et al. Curr Urol Rep 2011;12(6):470-8
3. Tong SF et al. Asia Pac J Public Health 2012;24(4):543-55
4. Tan HM et al. J Sex Med 2012;9(3):663-71
> This article is contributed by The Star Health & Ageing Panel, which comprises a group of panellists who are not just opinion leaders in their respective fields of medical expertise, but have wide experience in medical health education for the public. The members of the panel include: Datuk Prof Dr Tan Hui Meng, consultant urologist; Dr Yap Piang Kian, consultant endocrinologist; Datuk Dr Azhari Rosman, consultant cardiologist; A/Prof Dr Philip Poi, consultant geriatrician; Dr Hew Fen Lee, consultant endocrinologist; Prof Dr Low Wah Yun, psychologist; Datuk Dr Nor Ashikin Mokhtar, consultant obstetrician and gynaecologist; Dr Lee Moon Keen, consultant neurologist; Dr Ting Hoon Chin, consultant dermatologist; Prof Khoo Ee Ming, primary care physician; Dr Ng Soo Chin, consultant haematologist.
For more information, e-mail starhealth@thestar.com.my. The Star Health & Ageing Advisory Panel provides this information for educational and communication purposes only and it should not be construed as personal medical advice. Information published in this article is not intended to replace, supplant or augment a consultation with a health professional regarding the reader’s own medical care. The Star Health & Ageing Advisory Panel disclaims any and all liability for injury or other damages that could result from use of the information obtained from this article.
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