The Doctor’s Corner
IN the last three weeks we have been focusing on issues that affect women.
Specifically, we have been focusing on “bleeding between menstrual periods”, the most common causes of abnormal vaginal bleeding including fibroids and cancer of the womb among others.
These are huge topics and we will continue to look into them and discuss the important issues.
For now, let’s turn over to the medical issues that affect men.
Erectile dysfunction is one of the issues that top the list of male concerns because it has psychological and fertility implications.
The term impotence means the inability to attain or sustain an erection satisfactory for coitus (sexual intercourse).
The term impotence has been replaced by the less pejorative erectile dysfunction.
An estimated 10 to 20 million men aged above 18 are affected in the USA. The prevalence is 52 percent in men aged 40 to 70 and increases with age.
However, men can enjoy sexual activity throughout life.
Although the amount and force of ejaculation and muscular tension decrease, erectile dysfunction is not inevitable with ageing — even into the 70s and 80s.
The regional and Lesotho statistics are not readily available, and it is debatable whether the problem is bigger overseas especially because African men have been found to be less likely to come forward to the doctor with erectile problems.
Primary erectile dysfunction is when the man has never been able to attain or sustain erections in his life.
This is rare, and is almost always due to psychological factors (sexual guilt, fear of intimacy, depression, severe anxiety) and rarely due to biological factors (usually associated with low testosterone levels and reflecting disorders of the glands that make hormones in the brain down to the testes).
Secondary erectile dysfunction occurs when a man who previously could attain and sustain erections no longer can.
More than 90 percent of these cases are organic in nature — ie a specific disease process having being recognised in the body.
Transient erectile dysfunction for any reason may lead to secondary psychological difficulties that compound the problem.
Erectile dysfunction may be situational, involving place, time, a particular partner, some perceived competitive defeat, or damaged self-esteem.
The major cause of erectile dysfunction originates from the blood vessels.
Other major causes include hormonal disorders, drug use and problems of the nerves.
There are conditions/situations that cause problems of the blood vessels such as diabetes mellitus (high blood sugar) and high blood pressure (hypertension), while ageing itself can be a factor as well as smoking.
Hormonal problems such as with the glands as we have mentioned are important especially when the “gonads” are producing too low testosterone, and this is associated with a decline in libido (sexual desire).
There are drugs that may compound this problem and that accounts for about 25 percent of the cases.
A general medical evaluation includes history of drugs, alcohol, smoking, diabetes, hypertension and other problems of the blood vessels, examination of the genitalia as well as evaluation for signs and symptoms of blood vessel, nerve and hormonal problems.
Laboratory procedures include assessment of diabetes, function of the thyroid gland — a gland in your neck that is responsible for the production of some hormones.
The levels of testosterone in the blood should also be checked.
The absence of erections at night strongly suggests that something within the body is wrong other than just psychological problems.
However, the presence of erections at night does not necessarily equate to usable erections when awake.
In the assessment of a patient with erectile dysfunction, depression will be screened for, including personal relationships, and if conflict is present or communication with a partner is difficult, counselling may be beneficial.
When a cause has been found, the treatment is then directed toward the underlying problem.
It is very important for the patient’s partner to be present, especially when it comes to the choice of treatment options.
There are many options available such as the use of viagra and other tablet medications only after discussion with your doctor.
Some injections are available that can result in erections with an average duration of about 60 minutes but the risks include bruising of the penis, bleeding into the penis and persistent erection ending up in the need for surgical intervention.
Many of the tablets work with concomitant sexual arousal and should be taken 30 to 60 minutes before sex, but causes headaches in about 16 percent of users.
Surgery can result in the return of erections but involves the risks of anesthesia and infection.
Testosterone therapy can result in marked improvement in libido.
Behavioral and other therapies for anxiety and depression and counselling for dysfunctional relationships are part of therapy.
Any man who has this problem should see their doctor as soon as they can.