Erectile dysfunction (ED) / impotence is prevalent in over 10% of men above the age of 40 years. Due to lack of awareness amongst men and clinicians alike, it remains undiagnosed for a substantial period of time. Men and their macho attitude does not particularly help them in seeking early help and advice about this rather embarrassing but indeed a serious problem. What we see in clinical practice as a consequence of this apathy on part of men is a tip of the iceberg as a vast majority of men carry on with their ED without a proper diagnosis given and as such remain untreated.
Most men are driven to their GPs by their partners / wives as they are not only concerned about their partners health but have been silent sufferers as a consequence of their partners plight.
If only men could put their pride aside, come out into the open and talk about their problems with their friends or family doctors, they will benefit from help and treatment available out there for their ED.
It has been proven beyond doubt that impotence or ED is a mainly a vascular disease or condition like angina or heart attack, unfortunately preceding such episodes by at least 36 months. It is therefore imperative that young / middle aged men must report ED to their family doctor to be appropriately investigated and managed so that they can stop progression to more serious events namely heart attack / stroke.
Diabetes, high blood pressure and its drug treatment, high cholesterol and its drug treatment with statins, sedentary lifestyle (lack of exercise), obesity, smoking, stressful lifestyle are the most common and important factors contributing to development of impotence. In addition, surgery on the prostate gland either for benign, age related prostate enlargement or for cancer of the prostate gland is also most likely to cause impotence. Most of these factors barring surgery are modifiable /correctable causative factors so that impotence can be reversed and further progression of this dreadful condition effectively controlled. Another important association emerging from recent research is the link between ED and prostate / urinary symptoms in that 66% men with prostate symptoms also admit to ED and 70% men with ED have co-existent urinary / prostate related symptoms. With this finding, one drug is shown to address both symptoms which makes the treatment all the more patient friendly.
With advances in medical science, several treatment options are now available to address ED and these include oral agents such as Viagra, Levitra and Cialis and local agents such as injections into the penis, pellets down the waterpipe and vacuum pump devices, all of these proven to be highly effective in managing ED with dramatic fall in indications for surgery on the penis which was the only treatment available in the not too distant past.
Importance of testosterone measurement as a part of investigations for ED and the role of testosterone replacement therapy (TRT) cannot be more emphasized in this group of men presenting with ED as testosterone deficiency is seen in 20% of men suffering from ED.
Insertion of inflatable implants / rods in the penis is offered as a last resort to those men with impotence refractory to all non surgical means of treatment.
It is important we send a strong and clear message out to these men with ED that seeking help and advice on account of their embarrassing symptom is in their best interest as it can be addressed easily if diagnosed early with simple measures such as exercise and diet, supplemented with drug therapy such as Viagra / Levitra / Cialis however, failing to address this condition which is a harbinger of serious illness such as heart attack, could lead to early death which in the majority is preventable.
Are we (doctors and patients) thinking enough about ED: the answer is NO.
Is enough being done about ED to increase general awareness and removing stigma associated with this condition: the answer is NO.
Can ED be managed effectively and successfully: the answer is a definite YES.