DON’T SHY AWAY, TAKE A STAND
These days the medication Viagra has become as familiar a household word as Panadol and Disprin and Dettol. And the ailment for which Viagra is prescribed - erectile dysfunction - is a common one, the latest estimates indicating that around 150 million men the world over suffer from it.

It is interesting to speculate why this high prevalence is not reflected in the number of men coming to consult doctors in Sri Lanka about erection problems. Is it that erections and regular sexual activity are not as important for Sri Lankans as they are, for example, for Americans - who spend a few million dollars each year on Viagra? Is it because men in this country feel that as they get older, having difficulty in obtaining a proper erection is an inevitable part of ageing? Is it that Sri Lankan men feel embarrassed to discuss the question of erection with their doctors? Is it that many men in our country do not know that there is now an effective treatment for their condition?

I must admit that I do not know the answers to these questions.
And Sri Lankan men are not alone in being backward about coming forward to ask their doctors about erectile dysfunction. In a study of over 1200 Australian men a few years ago, it was found that as many as 34% of those between 40 and 69 years of age admitted to having erectile dysfunction - but only 11% of those affected had actually consulted their doctors about it.

What is erectile dysfunction?
It is defined as the inability to achieve or maintain an erection that is sufficient for satisfactory sexual intercourse. In the past this was referred to as impotence - but today (because the word impotence carries the connotation of lacking power), the term erectile dysfunction (or ED) is preferred.

While in the past, a man with ED was thought to have a "psychological" problem, today we know that in the majority of cases, ED is the result of a medical condition. And to correct another misconception, it is very rare for erectile dysfunction to be due to testosterone deficiency. Most men with ED have perfectly normal levels of male hormones.

An erection takes place when blood flow to the penis increases. Sexual stimulation causes the release of certain chemicals in the region of the penis that enlarge the blood vessels and allow blood to flow in and engorge the organ. Consequently, any disease that damages blood vessels has the potential to hinder this process, and so impair the ability to achieve an erection.

Among the conditions that damage the penile blood vessels are high blood pressure and diabetes - which explains why ED is twice to three times more common in men with these two conditions when compared to the rest of the population. And if you consider that the arteries carrying blood to the heart muscle (coronary arteries) are the same size as the arteries going to the penis (penile arteries), you can appreciate that any condition that damages the former, like smoking and high cholesterol, will simultaneously affect the penile arteries.

Certain drugs that doctors prescribe can also, as a side effect, affect the ability to mount an erection. Obviously, while the majority of patients taking these drugs will NOT be affected, a few will. Drugs that are well known to cause ED in some patients are antidepressants and blood pressure medications. Also, if the nerves supplying the penis get damaged, as may happen in surgery or radiotherapy for prostate cancer, this can result in ED.

What can be done for erectile dysfunction?
The first step is to consult your doctor if you have a problem - because you are certainly not the only man to be affected by ED! It is much more common than people realize, but we don't know how common it is because those who have it don't talk about it!

Your doctor will examine you to make sure that your symptoms are in fact due to ED, and that you are not having one of the rare causes of ED. He or she will then check your blood pressure and get some blood tests and an ECG done to check for diabetes, cholesterol and coronary disease. Sometimes, ED may be an early sign of diabetes or heart disease - and the fact that you consulted your doctor for it could well save your life because the tests the doctor orders will show up early heart disease before you get a heart attack!

You may have to make some lifestyle changes - such as quitting smoking, losing weight and reducing your cholesterol - to improve the blood flow in your penile arteries (and the rest of your body). Coupled with this, you could be prescribed a tablet like Viagra, Cialis or Levitra that will help to enhance the erectile response of your penile arteries. Although expensive, these tablets are effective in over 70% of men with ED. For those in whom the tablets don't work, there are other treatment options.

If you feel that you have a problem with erections, go and see your doctor. It could well be the first step that prevents you getting a heart attack - or diagnoses early diabetes or high blood pressure and gets these under control. And it will almost certainly improve your sex life.

-Dr. Sanjiva Wijesinha of Monash University in Australia is the Rotary Foundation Visiting Professor for 2004 at the Faculty of Medicine, Kelaniya University.