ERECTILE dysfunction (ED) is a highly prevalent and progressive medical condition, affecting an estimated 150 million men worldwide. As the life expectancy of men increases, the prevalence of ED will exceed 320 million men by the year 2025, of which about 65% of this increase will be seen in Asia. Thus, there is no doubt that ED will be a very common and increasingly important medical issue in Asia and in Malaysia.
There are currently 2.2 million Malaysian men with ED, with 52% of them aged 40 to 70. Out of this figure, 39% of these men are in their 40s, 48% in their 50s, and 57% in their 60s.
ED is commonly and often trivially considered to be non-life threatening, non-morbid and cause no obvious, immediately noticeable disabilities. This reflects the reflex thinking among both medical personnel and the lay public that ED cannot be considered as a serious disease.
However, when we delve deeper into the field of ED, we clearly see that ED is associated with many risk factors related to a whole range of serious chronic medical conditions and diseases such as diabetes, hypertension, cardiovascular diseases, depression, obesity, alcoholism, and other substance abuse, smoking, lower urinary tract symptoms (LUTS) and even urological cancer.
In a large study including over 27,000 men in eight countries, it was shown that men with recognised risk factors have a higher prevalence of ED. The prevalence rates of self-reported ED were approximately two times higher in men reporting hypertension, two to three times higher in men with coronary heart disease (CHD)/angina, three to four times higher in men with diabetes and two times higher in men with anxiety/depression than in those without these diseases.
Furthermore, ED commonly has tremendous psychological impact on the patients, and it seriously compromises the overall quality of life of the sufferers. Generally, patients with ED are 4.5 times more likely to experience low general happiness, a very important aspect of all societies.
The issue of ED is currently being used as a very important platform in promoting mens health. Primary and secondary preventive measures on major life-threatening diseases such as cardiovascular diseases and diabetes mellitus are being implemented more successfully using the ED platform.
The recent understanding of biological and molecular science has resulted in new knowledge of the pathophysiology of ED. ED is currently known to be mainly due to vascular in origin, resulting either from structural changes (atherosclerosis) or functional changes (impairment of endothelial function). It has been demonstrated that ED is an early indicator of systemic oxidative stress and endothelial dysfunction.1 Studies in the diabetic population have revealed that ED can be the result of impaired neurogenic and endothelium-dependent relaxation of corpus cavernosum smooth muscle2, reduced penile NOS activity and neuronal NOS levels3 and reduction in endothelium-dependent NO-mediated relaxation to Ach and NANC stimulation4. All of these biochemical impairments are also known to be the start of a cascade of events leading to structural damage.
Epidemiological studies have also clearly shown a high percentage of men presenting with ED has significant coronary artery diseases5 and the 10- year risk of coronary heart diseases (CHD) in patients with ED is estimated at 60%.6 In fact, in the Ed population, there is a 16% to 40% risk of severe undiagnosed coronary heart disease (CHD). There is accumulating evidence that ED is a manifestation of CHD, which is the leading cause of death in all developing and developed countries of the world.
A study including 1482 men reported that the family lives, social lives, romantic relationships, financial situations and sexual relationships of men with ED are markedly affected by their ED7. The authors concluded that ED has a tremendous impact on the quality of life. There is a strong correlation between improvements in sexual function and the relationship with ones partner, mood and quality of life.
In conclusion, ED is a very prevalent and important medical problem. It can certainly be considered a serious disease in the context that it is related to major life threatening diseases such as cardiovascular and cerebrovascular diseases and diabetes mellitus.
In many cultures, ED can also cause devastating psychological trauma and drastically affect the quality of life of the sufferers. There is no doubt that ED is certainly a very important issue in the promotion of primary and secondary preventive measures in health care.
1. Billups et al. J. Urol 2003;169(4) : 323.
2. Saenz de Tejada I et al. N. Engl J Med 1989 :320 :1025.
3. Burnett AL. J Urol 1997 ;157(1) : 320-324.
4. Keegan A et al. Diabetologia 1999 ; 42(3) :343-350.
5. Pritzker MR. Circulation 1999 ;100(S) :1-711.
6. Roumeguere TH et al. IJIR 2002 ; 14(3) :S51.
7. Goldstein I et al. IJIR 2002; 14(3) : S17.
The above article is a summary of a lecture that was presented by Datuk Prof Dr Tan Hui Meng at the recent 9th Asia Pacific Society for Sexual and Impotence Research meeting.
n This article is a contribution of The Star Health & Ageing Panel, a group of panellists who are not just opinion leaders in their respective fields of medical expertise, but have wide experience in medical health education for the public.
The members of the panel include: Datuk Prof Dr Tan Hui Meng, consultant urologist; Dr Yap Piang Kian, consultant endocrinologist; Dr Azhari Rosman, consultant cardiologist; A/Prof Dr Philip Poi, consultant geriatrician; Dr Hew Fen Lee, consultant endocrinologist; A/Prof Sarinah Low, psychologist; Dr Nor Ashikin Mokhtar, consultant obstetrician and gynaecologist; Dr Guna Sittampalam, consultant obstetrician and gynaecologist; Dr Ting Hoon Chin, consultant dermatologist.
The Star Health & Ageing Advisory Panel provides this information for educational and communication purposes only and it should not be construed as personal medical advice. Information published in this article is not intended to replace, supplant or augment a consultation with a health professional regarding the readers own medical care.
The Star Health & Ageing Advisory Panel disclaims any and all liability for injury or other damages that could result from use of the information obtained from this article.
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