| Erection problems
not all in the mind
April 10, 2004
MODERN life is taking a toll on Australian
men's health – and their virility may
be the first casualty.
"Erections are a barometer of male health,"
Brisbane Health Institute for Men director Michael
Gillman. "If you have erection
difficulties then you need to start looking
for other health problems."
The cliche used to be that erectile dysfunction
(or ED) – traditionally known as impotence
– was "all in the mind", but
it is now known that in most cases it has a
physical cause.
While this ailment and the health problems
associated with it can produce emotional distress,
the distress is not the root cause of ED, according
to Adelaide urologist Peter Sutherland.
"Erectile
dysfunction is usually a sign that much
more dangerous problems are developing,"
Dr Sutherland says.
In about 80 per cent of cases, erectile dysfunction
occurs in men over the age of 40 and is usually
a form of vascular dysfunction – the blood
is simply not getting into the penis every time
it is supposed to.
"Risk factors for erectile dysfunction
are essentially the same as those for heart
disease, strokes and diabetes – blood-vessel
problems, high blood sugar, high blood pressure
and high cholesterol," Gillman says. Smokers
are particularly vulnerable, he says.
But stress, poor diet, lack of exercise and
alcohol abuse can all lead to erectile dysfunction.
In most cases more than one lifestyle risk
factor is present.
Reliable figures are scarce, as many men never
discussed their problem with anyone, even their
partners, and are often reluctant to seek treatment.
But Gillman and Sutherland agree that sedentary
lifestyles, poor diet, smoking and over-consumption
of alcohol cause more men to develop erectile
dysfunction.
Our ageing population also increases the rates
of this ailment.
They agreed that probably about one in five
Australian males have some degree of erectile
dysfunction.
This is a large market, and many companies
seem to believe the market for impotence
treatments is lucrative and growing. Viagra
has been a great commercial success
story, and new drugs – Cialis and
Levitra – have recently emerged to challenge
Viagra.
In addition, advertisements for "men's
health clinics" seem to be becoming more
common, and treatments for erectile dysfunction
are a staple of email spam.
Gillman and Sutherland warn against following
up health clinic advertisements and spam.
They say men with erectile problems should
see their GPs, even if they are not particularly
interested in sex, so that the underlying health
issues can be identified and treated.
"In most cases your GP can provide the
necessary treatment, and if you need further
treatment he can refer you to a reputable clinic,"
Gillman says.
GPs and reputable specialists usually address
underlying health issues as well as the impotence
itself, he says.
"I'm sure that many men's lives have been
significantly prolonged because they sought
medical help for their erectile dysfunction,"
Gillman says.
If men treat these medical problems through
lifestyle changes it can also help them regain
control of their erectile function.
"In some cases men have needed drugs to
kick-start their erectile function, but have
gone on to recover full erectile function after
changing their lifestyles," he says.
"But in the vast majority of cases, tablets
or some other form of medical support will be
needed for the long term."
This was because, in cases of ED, the penis
has not been oxygenated enough.
"Men get about five or six erections every
night, which keeps the tissues oxygenated,"
Gillman says.
"If they stop getting morning and night
erections then these tissues are no longer oxygenated
and erections no longer naturally come up.
"One of the first markers for ED is when
morning erections are no longer as strong as
they used to be."
The good news is that the choice of effective
treatments for erectile dysfunction has grown
in recent years, Gillman says.
Oral medications known as phosphodiesterase-5
(PDE5) inhibitors restrict the PDE5 enzyme that
causes erections to go flaccid, so that when
sexual stimulation occurs blood can more easily
swell up the penis.
Three PDE5 drugs are available in Australia:
Viagra (produced by Pfizer); Cialis (Eli Lilly);
and Levitra (GlaxoSmithKline).
The pills are relatively convenient and have
a positive effect in about four out of five
men, Sutherland says.
Most patients get a positive effect the first
or second time they try the drug, but a man
may need to try any of these drugs up to six
times before concluding that it can't work for
him. This is because performance anxiety and
the deoxygenation of penile tissues can initially
impair the effect of these drugs.
However, the drugs have some side-effects and
are not suitable for all patients.
Common side effects include headaches, blurred
vision and muscle aches.
Patients using nitrate drugs for angina can't
take PDE5 inhibitors and men with serious damage
to the penis or its blood vessels may need to
use penile injections or implants, Gillman says.
But for most new patients, the tablets are
the starting point for treatment.
Viagra has been available in Australia for
five years.
The first of the PDE5 inhibitors, it has had
enormous impact on the popular consciousness
and on millions of men's lives.
"Twenty-three million men around the world
have used Viagra, and it has helped many of
these men regain confidence and helped restore
strained relationships," Pfizer Australia
medical director Edward Watson says.
"It's a treatment with a good side-effect
profile that is easy to take – injections
and implants are much less comfortable.
"Without a doubt Viagra has raised awareness
of erectile dysfunction and made it easier for
men to seek medical treatment."
Levitra has a similar action and biochemical
profile to Viagra.
The remaining drug, Cialis, was released in
Australia in February 2003 and already has about
a third of the PDE5 market, according to Eli
Lilly Australia clinical research physician
Karen Mullen.
"The main attribute that differentiates
Cialis
from its competitors is that its effects last
for up to 36 hours, rather than just four or
five hours," Dr Mullen says.
"This gives patients more flexibility
– they can take the tablet on Friday night
and still achieve an erection on Sunday morning.
"So it allows more spontaneity and romance."
Sutherland agrees: "It means you can have
sex when it suits you, and if the in-laws suddenly
drop around just after you've taken the tablet
you haven't done your money."
But Watson argues that Viagra is the tried
and true alternative among the PDE5 drugs.
"There are about 1600 journal
articles on Viagra, about 48 on Cialis and
about 80 on Levitra," he says.
"As a result of this, we are very confident
of the side-effect profile and the long-term
effects of taking Viagra."
But Sutherland claims this argument is used
with any new product.
"Viagra is very well researched, but I
think with time Levitra and Cialis will also
be shown to be very safe and effective."
Sutherland and Gillman say they prescribe all
three of the PDE5 inhibitors.
"I would normally trial each patient on
all three tablets then see what they choose
– and different patients prefer different
tablets," Sutherland says.
source:-http://www.theaustralian.news.com.au
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