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Go limply into the night...

Monday, Jun 21, 2010
The Star/Asia News Network
By Dr S.Y. Chong

ALL men (but not many will admit it!) will have experienced erectile dysfunction or ED at one time or another in their lives - it's only when the problem becomes persistent, occurring more than 50% of the time, or becomes a source of distress for you or your partner, should you be concerned.

ED is considered one of the most commonly occurring male sexual disorders. It is defined as the inability to develop or maintain an erection of the penis sufficient for satisfactory sexual performance. It is different from premature ejaculation, where an erection can be achieved but ejaculation happens too soon.

How common is it?

Over 150 million men worldwide suffer from erectile dysfunction. The prevalence of ED is 52% in men aged 40 to 70 years and 70% in men aged 70 years and above, according to the Massachusetts Male Aging Study conducted in 2000.

In Malaysia, the prevalence of self-reported ED has been estimated to be around 41%, occurring most commonly in those aged 50 and above.

What causes it?

The causes of ED can be psychological or physical. Psychological causes are responsible for 10 to 20% of ED. In some cases, the psychological effects of ED may stem from childhood abuse or sexual trauma.

However, the most common psychological causes of ED include stress and anxiety due to a previous experience of ED, performance anxiety, low self esteem, and depression.

Depression is a common psychological cause of ED as it is a disease that affects a person psychologically and physically, and requires appropriate medical treatment. Unfortunately, some depression medications, such as selective serotonin reuptake inhibitors (SSRI), may also cause ED.

The physical causes of ED include testosterone deficiency, diabetes, coronary artery disease, and neurological disorders. In fact, there is increasing scientific evidence to indicate that ED may be a marker for silent cardiovascular disease and may precede cardiovascular events such as a heart attack or a stroke by at least two to three years. Hence, seeking medical attention for ED may not just be a lifestyle issue, it may very well be a life-saving one.

In Malaysia, ED is strongly associated with hypertension and diabetes.

The strong association between ED and cardiovascular disease is due to the fact that both conditions involve progressive blockage of arteries by artherosclerotic deposits. In the case of cardiovascular disease, the arteries of the heart are involved, while with ED, the arteries supplying the penis are involved.

Diabetes also contributes to the increasing blockage of arteries, which accounts for its association with ED.

Erectile dysfunction affects the quality of life of patients and their partners. However, many patients are reluctant to discuss ED with their physicians, and many physicians are still uncomfortable when discussing or evaluating sexual (dys)function.

A study in Belgium showed that two-thirds of men waited one year before addressing issues of ED with their physician, with the associated detrimental effects on their sexual relationships. Furthermore, most men in the study were in a stable relationship, with the partner present in one-fifth of consultations and often responsible for initiating the discussion on ED. This means that partners too have a role to play in getting their men to seek medical attention for this issue.

There is no specific test that will confirm the diagnosis of ED. A full medical history is usually obtained to distinguish between psychological and physiological causes. Blood tests are also performed to rule out diseases such as diabetes or hormonal deficiency.

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