It is the last resort for an ailment that many a man is reluctant to admit and society goes hush-hush. The good news is that it is available in Sri Lanka. Five operations have already been carried out, three at the National Hospital and two in the private sector to correct erectile dysfunction (ED) when all else has failed, MediScene understands.
The last salvo to safeguard that erection comes in the form of penile prosthesis and since 2009 it has been performed by Consultant Urological Surgeon Dr. Ajith Malalasekera who is also a Senior Lecturer of the Department of Anatomy, Colombo Medical Faculty.
Explaining that an erection is due to blood inflow into the penis, the male reproductive organ, due to sexual arousal, Dr. Malalasekera points out that impotence or ED is the inability to get and keep an erection firm enough for sexual intercourse.
Going into the complexities of an erection, he stresses that it involves the brain, nerves, hormones and blood vessels. The shaft of the penis consists of two erectile bodies each dubbed the corpus cavernosum – spongy tissue of smooth muscle and blood vessels -- which start at the pelvic bone and stretch to just below the head of the penis.
When there is psychological or physical stimulation, the brain sends messages through the nervous system to the penis which relax the smooth muscles in the blood vessel walls of the corpus cavernosum making them open wider. This allows the blood to flow freely through the vessels, filling the corpus cavernosum while the veins that carry blood away from the penis shut down, making the blood pressure in the penis rise. Therefore, the blood trapped in the corpus cavernosum makes the penis not only hard but also erect.
Although no prevalence rates in Sri Lanka are available, a major study in Boston, America, among men in the age group 40 to 70 had found that around 52% had ED ranging from mild to severe, MediScene learns.
Those days, according to Dr. Malalasekera, though it was thought that ED was a “problem of the mind” or psychological, it has now been ascertained as being 90% organic with psychological issues arising as a consequence. The number of men suffering from ED due to purely psychological issues is very small.
Dealing with the final step in the treatment of ED, which is penile prosthesis, he says that all other options such as oral treatment, injectibles and vacuum devices should be tried first. “Penile prosthesis should be considered only if they fail and that too after intense discussion with both the patient and his partner. The couple should also be counselled.”
Penile prosthesis or implant carried out under spinal anaesthesia is considered “intermediate” and not major surgery, it is learnt.
Under this surgery, a pair of rods is surgically implanted within the erectile chambers or corpus cavernosum after dilation of those chambers. There are two types of rods, explains Dr. Malalasekera, adding that they are either malleable (bendable) non-inflatable silicone rods or inflatable ones which give rigidity to the penis. In Sri Lanka so far the implants have been the non-inflatable malleable ones.
The inflatable device is activated on necessity by a pump which allows fluid to go into the rods and is very much more expensive, it is understood.
Referring to the complications that can arise, Dr. Malalasekera says that with the insertion of a foreign body, there can be an infection, while the inflatable device can have mechanical failure as well. The mechanical failure rate is about 2% per year and in the case of infection there would be an urgent need to replace it causing serious concern. Sterility in the operating theatre is of utmost importance as well as a trained surgeon who will follow the procedural steps meticulously, he says.
The good news for men and their partners who suffer in silence is that not only can ED be treated but all forms of ED management are now available in the country. So if frequently you cannot get that rise, don’t write it off as inevitable or due to old age, see a doctor.
ED: What you should know
There are many issues that need to be taken into account with regard to ED, underlines Dr. Malalasekera.
- ED could be a warning of a systemic illness such as diabetes and a red alert for vascular disease. Atherosclerosis not only affects the vessels of the heart but the vascular network of the entire body. While the heart vessels are 2-4mm, those in the penis are 1-2mm and could be the first to get affected by this process resulting in ED. The blockage of penile blood vessels could be the first sign of vascular problems.
- As smoking could be a major contributory factor for ED, quit the fag.
- With other risk factors being diabetes and cholesterol, get a lifestyle change with exercise and the right diet to bring down your weight and also proper rest.
- A healthy life is a requirement for a good sexual life.
Dr. Malalasekera also gives a word of advice to all those involved in the health care profession -- when taking the case history of a patient and important risk factors such as smoking and alcohol-intake, assess his sexual health as well. “Sexual health is one window to overall health,” he says, advising patients not to hide ED, as this could be a missed opportunity to identify and tackle a bigger and more life-threatening problem. |
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