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An embarrassing disease

Your Health DR GITA MATHAI

Every week this column gets a number of letters from men who have — or think they have — impotence or erectile dysfunction. They are too embarrassed to consult their physicians and the letters invariably end with the request “please answer the question but do not publish my name!” Many men, as they cross the age of 40, avoid exercise, put on weight (particularly around the waist), drink alcohol and use tobacco. This unhealthy lifestyle results in a bouquet of diseases, with diabetes, high blood pressure, unhealthy lipid profiles and heart attacks topping the list. About 40 per cent also suffer from impotence or erectile dysfunction (ED). Proper erectile function requires a complex interplay between brain chemicals, blood follow to the concerned organ, psychological factors and love or desire for the partner. It is not a mechanical response. If erection never occurs, it may be due to low testosterone levels. Testosterone levels are highest in adolescents and young men — usually between 300-1200ng/dL. After the age of 40, testosterone levels decline at the rate of approximately one per cent per year. Tumours in the pituitary called prolactinomas or under functioning thyroid glands can cause hypogonadism and low testosterone levels. If erection occurred initially and then declined in frequency or ceased, the reason may be psychological. But diseases that can interfere with proper functioning need to be ruled out or tackled first. Diabetes affects not only the blood flow but also the pudendal nerves responsible for a sustained erectile response. Some people are unaware that they have “crossed over” and become diabetics. Others are unwilling to accept the illness and do not regulate their intake of food and sugar. Elevated lipids can form plaques, which block vital blood vessels, physically preventing proper erection. Blockage can also occur because of nicotine — inhaled (as cigarettes), chewed or sniffed. Alcohol affects the liver, and that in turn reduces the level of male hormones. It also produces a neuropathy in the vagal nerves. These need to work properly for erection to occur. Surgery or injury to the male reproductive organs can result in ED. Surgery to the prostrate has often been blamed. The prostrate actually does not have a role in erection. The problem can occur because the nerves in the pelvic area may be damaged during surgery. Some prescribed medications such as the SSRI group of antidepressants and some anti-hypertensives can have an adverse effect. It is important not to stop taking these medications without asking your physician for an alternative. ED is treated by specialised urologists called andrologists. They initially screen the patient with blood tests to rule out correctable causes for ED. Blood tests will pick up diabetes, elevated lipids, thyroid malfunctions, liver disease, renal diseases and low testosterone levels. Other specific tests are duplex ultrasound, tests of penile nerve function, nocturnal penile tumescence, biothesiometry, dynamic infusion caverosometry, corpus cavernosometry and magnetic resonance angiography. If all the tests are normal, the reason for the malfunction may be psychological, usually due to stress. Psychotherapy helps. In addition medications, particularly sildenafil (better known as Viagra) and its derivatives, often help. Although these medications are available over the counter (OTC) it is advisable to take them under medical supervision. They are contraindicated in heart conditions and can react adversely with other medication you take. Sildenafil takes 30-60 minutes to work and can be taken once in 24 hours. Ideal body weight (height in meter squared X 23), a healthy lifestyle with 40-60 minutes of running, jogging or cycling a day, yoga or meditation to avoid stress, a good nights sleep, avoiding alcohol and smoking and a stable loving relationship with a significant other will probably avert these embarrassing shortcomings. Dr Gita Mathai is a paediatrician with a family practice at Vellore. Questions on health issues may be emailed to her at yourhealthgm@yahoo.co.in