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Facts and fallacies about erectile dysfunction (ED).

Sunday, 24 November 2013
Getting to know ED

ERECTILE dysfunction (ED) is the inability to achieve or maintain an erection of the penis, which is satisfactory for sexual intercourse. Being a taboo subject, there are many myths circulating around that are worsened by men not talking openly about it with their doctors.

Here are some of the common misconceptions about this condition.

ED affects only elderly men

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Although the majority of men affected by ED are elderly, younger men are not exclusively exempted. In Malaysia, data collected to date are for men above 40 years of age, and it showed a higher prevalence among men above 60 years of age.

However, in a study done in Brazil, the prevalence rate was 35% in men 18-40 years of age.

So if you are young and have ED, do not fret. You are not alone.

If you are above 40 years, up to 50% of men in Malaysia share your problem. In fact, in a recent local study, the prevalence of ED in those above 40 years of age was 69.5%.

ED is not dangerous or life-threatening

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While it is true that ED on its own does not lead to death, it is actually an indicator of other underlying diseases that can shorten your life.

It has been proven that ED predicts coronary artery disease, with a lead time of two to five years. In other words, if you have ED, you are at risk of a heart attack in two to five years.

Therefore, if you have ED, you should be examined for the health of your heart as well. Both are equally important to men.

The presentation of ED by men in the clinic is an opportunity for doctors to screen for other diseases associated with it, and these include diabetes mellitus, testosterone deficiency syndrome, hypertension and high cholesterol levels (hyperlipidaemia).

ED is the partner’s fault

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ED is not to be blamed on the partner for not being attractive anymore. Although psychological factors do affect ED, there are other physiological or organic factors involved as well. These include diseases affecting the blood vessels and/or the nerves supplying the penis.

Often, men shy away from sex when they are unable to perform, and this can construed by their partners that they are not attractive any more. This misconception can lead to relationships breaking down.

Men with ED have no sexual desire

This is not entirely true. Men with ED usually do have the desire, but due to the underlying disease affecting the blood vessels or nerves, they are unable to perform.

There are men with ED who lack desire. These men either have low levels of testosterone or are affected psychologically by stress or emotion.

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Masturbation causes ED

There is no concrete evidence for this.

In normal men, erection is automatic

This is not true. Men need stimulation for sexual erection. Non-stimulated erection may occur during sleep or on awakening in the morning, but this is not related to sex.

There is also a refractory period before men can have an erection again, and this can last from minutes in younger men to days in older men. This is not ED.

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An erection means men want sex

Again, this is not true. Men may experience a normal physiological erection during sleep or on getting up in the morning. It is not always related to sexual activity.

ED needs extensive investigations and treatment is usually delayed

ED is diagnosed through doctors asking you some simple questions (taking a history). A questionnaire known as the International Index of Erectile Function (IIEF) may be used.

A physical examination and some blood tests will follow to detect any other associated diseases. Treatment will usually then be given.

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Only in certain complex cases, and this is very rare, will further tests like a Duplex ultrasound, cavernosogram or nocturnal penile tumescence test, be needed.

The first step in treatment is lifestyle modification, and this includes maintaining an ideal body weight, cessation of smoking, moderate exercise and a balanced diet.

This on its own may improve ED. Needless to say, blood pressure, sugar and cholesterol needs to be controlled. Any psychological factors such as stress need to be tackled as well.

The next step is oral medication (tablets to be swallowed). Phosphodiesterase-5 (PDE-5) inhibitors such as sildenafil, vardenafil and tadalafil, are effective in 80% of cases.

Caution is needed for those with heart problems. They will need to be assessed carefully by the doctor. If the heart disease is deemed mild, they can be given PDE-5 inhibitors.

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In moderately severe cases, further tests will be required, while those who have severe disease should not be taking such drugs.

Those on nitrate medications also cannot be given PDE-5 inhibitors.

The other treatment options are injection of medication (like prostaglandin) directly into the penis using a small needle and syringe, using a vacuum pump device or inserting a penile prosthesis (requiring surgery).

Treatment is only temporary and the condition can be cured

This is another misconception where some people think that taking just one magical pill will solve it all. If lifestyle modification does not help and taking medication is required, you will probably need to continue taking the medication as long as you want to have erections.

The only exception is if it is solely psychological in nature, where counselling or behavioural therapy may cure the problem, and further treatment may not be required.

Circumcision reduces ED

There is no evidence that circumcision reduces ED.

ED treatment increases the size of the penis

This is another misconception. ED treatment solves erection, i.e. rigidity and hardness. It does not increase the length or size of the penis.

Traditional treatment is cheaper and much better than seeing a doctor

Unapproved medications are risky and may contain substances that are detrimental to health. It is not worth the risk. Most of these medications have not undergone stringent tests, and unlike conventional medication prescribed by doctors, have not been proven effective by robust trials.

In a review by Ho et al., most of the herbal treatments for ED were tested in animals, and only yohimbine, ginseng and butea superba were tested in humans.

ED can be helped. An open discussion with the doctor, especially a urologist, would be beneficial. Do not be embarrassed.

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The Peruvian root Maca is pure hype. It has zero effect on any hormonal parameters in humans, as evidenced by the following study publushed in the famous Journal of Endocrinology.

The study URL is here:

http://m.joe.endocrinology-journals.org/content/176/1/163.short

Effect of Lepidium meyenii (Maca), a root with aphrodisiac and fertility-enhancing properties, on serum reproductive hormone levels in adult healthy men Authors

GF Gonzales,
A Cordova,
K Vega,
A Chung,
A Villena and
C Gonez

Abstract

Lepidium meyenii (Maca) is a Peruvian hypocotyl that grows exclusively between 4000 and 4500 m in the central Andes. Maca is traditionally employed in the Andean region for its supposed aphrodisiac and/or fertility-enhancing properties. This study was a 12-week double-blind, placebo-controlled, randomized, parallel trial in which active treatment with different doses of Maca Gelatinizada was compared with a placebo. The study aimed to test the hypothesis that Maca has no effect on serum reproductive hormone levels in apparently healthy men when administered in doses used for aphrodisiac and/or fertility-enhancing properties. Men aged between 21 and 56 Years received 1500 mg or 3000 mg Maca. Serum levels of luteinizing hormone, follicle-stimulating hormone, prolactin, 17-alpha hydroxyprogesterone, testosterone and 17-beta estradiol were measured before and at 2, 4, 8 and 12 weeks of treatment with placebo or Maca (1.5 g or 3.0 g per day). Data showed that compared with placebo Maca had no effect on any of the hormones studied nor did the hormones show any changes over time. Multiple regression analysis showed that serum testosterone levels were not affected by treatment with Maca at any of the times studied (P, not significant). In conclusion, treatment with Maca does not affect serum reproductive hormone levels.

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