By Dr. Sanjiva Wijesinha
It wasn't until a few years
ago that doctors began to realise that the field of male health is as important in its scope as women's health.
Men's diseases such as impotence, male infertility, prostate disease and testicular cancer are responsible for much ill-health in our communities, but perhaps because men used to stiffen their upper lips and bear their problems with stoicism, their ailments were not afforded the same attention as gynaecological disorders.
Having learnt about Gynaecology as a separate speciality for years, doctors have only recently even dignified the subject of male health with a proper name, Andrology?
One consequence of Viagra hitting the markets a couple of years ago has been that patients are now less inhibited about discussing impotence with their doctors.
But whether you call it impotence or by its more politically correct name Erectile Dysfunction, both the community and the profession lack information about the subject. What exactly is it, how common is it, how do relationship issues affect a man's inability to get and maintain an erection?
Recent research has shown that the condition is much more common than previously realised. Whereas in the past, 80% of cases of impotence were thought to be in the man's head, we now know that medical conditions are found in about 80% of cases. We have moved from an era dominated by psychotherapy and penis stiffeners to one where effective tablets and vacuum devices are available.
Dr. Chris McMahon of the Australian Centre of Sexual Health points out, "Erectile Dysfunction is one of the most untreated treatable medical disorders today."
Adds Endocrinology specialist Prof. Doug Lording "One of the most important messages we should give the community is that men with Erectile Dysfunction should seek medical advice, because it is closely associated with the risk factors for heart disease."
Another field where doctors can now do something where in the past little could be done is that of Male Infertility. Today approximately one in 20 married couples is naturally infertile - and in about half the couples who seek assisted reproduction, the cause lies with the male. Procedures such as Intracytoplasmic Sperm Injection (ICSI) now allow previously infertile couples to use their own eggs and sperms for conception - so there is much less reliance on donor sperm. Sperms are aspirated under local anaesthesia from the testis.
As In-vitro Fertilisation
(IVF) becomes more reliable, men can even store sperm before they undergo vasectomy in order to obviate the future need for vasectomy reversal. Pregnancy rates of 30 to 35% for ICSI are now the rule.
The commonest male organ to harbour disease is the prostate. As a population ages (and Sri Lanka is only second in Asia to Japan and Singapore in the proportion of old people in our population) it experiences a greater prevalence of prostate enlargement. This is a condition that can interfere with a man's ability to pass urine because the gland obstructs the bladder outlet as he gets older. Although surgery for the enlarged gland remains the treatment of choice, several safe and effective drugs have now appeared on the scene. Medical therapy has now become a practical treatment option for a condition that in the past was only amenable to operation.
The incidence of prostate
cancer - the second commonest cause of cancer deaths in men and one that, though slow growing, can progress through an unpleasant and protracted course to death - is still high. However the past decade has seen a dramatic change in the way patients with prostate cancer approach their doctors.
It used to be the case that by the time a prostate cancer caused enough symptoms to bring a patient to his doctor, the cancer had often spread beyond the prostate and was beyond cure.
The introduction in the late eighties of a blood test for prostate cancer (the PSA test) resulted in more detection of cancer in its early stages. Recent research from all over the world reveals that the number of men having incurable cancer at the time of diagnosis has fallen dramatically, and more men now undergo curative rather than palliative treatment. Observes urologist Prof. Mark Frydenberg who did one such study in Australia, "With this change has come an increased expectation of cure, and an increase in the number of men with prostate cancer living in the community."
As to whether routine PSA testing is justified is still controversial. Until more research studies are available, the current consensus is that doctors should only proceed with PSA testing combined with DRE (a specific clinical examination of the prostate) for their patients if they are convinced that making the diagnosis will benefit the patient. In pragmatic terms, this equates to testing otherwise healthy men who have a reasonably long life expectancy. As for cancer of the testis, modern methods of treatment have drastically changed this condition over the last 25 years from one that was fatal in the majority of those affected, to one where the outlook can truly be described as "excellent" with a 5-year survival of 95%.
In almost all patients who are detected early and treated appropriately, the condition is now curable. Affected patients can return to a normal life style after treatment. A good example is Lance Armstrong, three-time winner of the Tour de France who won this gruelling cycle race AFTER undergoing surgery, radiotherapy and chemotherapy for testicular cancer.
Twenty five years ago, one would hardly have expected that impotence would be treated with tablets, that babies would be conceived using sperms removed from the testis with an injection needle - or that a man diagnosed with testicular cancer would recover such a degree of health that he would compete and win the Tour de France. The outlook for men is certainly looking better as the new year dawns.
(Dr. Sanjiva Wijesinha is a senior lecturer in the Faculty of Medicine at Monash University.)
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