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EDITORIAL
Year : 2006  |  Volume : 22  |  Issue : 3  |  Page : 187
 

Erectile dysfunction: The barometer of men's health


Department of Urology, Christian Medical College, Vellore - 632 004, Tamil Nadu, India

Correspondence Address:
Nitin S Kekre
Department of Urology, Christian Medical College, Vellore - 632 004, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0970-1591.27620

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How to cite this article:
Kekre NS. Erectile dysfunction: The barometer of men's health. Indian J Urol 2006;22:187

How to cite this URL:
Kekre NS. Erectile dysfunction: The barometer of men's health. Indian J Urol [serial online] 2006 [cited 2019 Jun 18];22:187. Available from: http://www.indianjurol.com/text.asp?2006/22/3/187/27620


Erectile dysfunction is defined as the inability to achieve erection that is adequate for intercourse to the mutual satisfaction of both partners. It is estimated that approximately 10% of the general population suffers from erectile dysfunction. In the US approximately 30 million men suffer from erectile dysfunction. No such data is available for the Indian population, but it may not be very different, especially considering the high prevalence of coronary artery disease in Indian men.

Not long ago, it was believed that erectile dysfunction is a natural sequelae of ageing and when it occurred in younger men it was often labeled as psychogenic. But the situation has changed significantly and younger men are presenting with erectile dysfunction of organic etiology. Many factors like obesity, smoking, sedentary lifestyle, diabetes, coronary artery disease have been identified as potential risk factors.

Erections are very closely tied to men's vascular health. So if a man is at a risk of vascular disease, he is also at a risk for erectile dysfunction and vice versa. One could assume that a normal erectile function to a large extent indicates a healthy individual with a healthy vascular system. So erectile function can serve as a barometer to men's health.

Normal coital activity produces a modest increase in the heart rate and blood pressure and is associated with work load between 3-4 METs (Metabolic Equivalent of Energy). If this is compared to other normal physical activities, walking on a flat surface at a speed of 3 miles / hour puts a work load of 3-4 METs while cycling at 10 miles / hour produces a work load of 5-6 METs. It is clear from this data that normal sexual activity is at best a mild physical exercise and should be possible for every average healthy individual. The presence of erectile dysfunction should serve as a warning signal not only towards the sexual health but to diseases like CVA and CAD and should prompt the treating physician to perform basic screening. Thus urologists have a very important position in monitoring men's health. It is well known that men usually do not seek medical advice till it is very late. They are usually not aware of the association of erectile dysfunction with vascular and cardiovascular diseases. The education and counseling about regular exercise, diet, reduction of alcohol intake, stopping of smoking could play a vital role in improving the health as well as maintenance of virility. Time and money spent on such programs by either organizing a men's health clinic or disseminating this information through the media could go a long way in improving the overall health standards and quality of life. The strategy of primary prevention probably would save many more lives than screening for cancers. The management of erectile dysfunction has undergone significant changes in the post Sildenafil era. Availability of simple and effective pills has forced us to take a fresh look at the way we manage these patients.

Is it necessary to investigate these patients with sophisticated investigations? What is the role of penile prosthesis today? Are there any exciting developments in the pharmacotherapy? Should we evaluate only the male partners in assessment of sexual satisfaction?

With these questions in mind, I requested Dr. Vasan to organize a symposium on erectile dysfunction. Dr. Vasan has put together a wonderful collection of articles by well-known international experts in this field and I sincerely thank them for their effort.

Drs. VanderBrink and Badlani have reviewed the issue of minimally invasive therapies for BPH. "I have prostate - do you have laser" - How does one answer this question? I guess all men have prostates but not all urologists have laser. Should we invest into a technology which is changing every year? What about much lesser invasive techniques like TUMT and TUNA? What are we treating in BPH? Is it necessary for an elderly gentleman to pass urine with a flow > 20ml/min? The debate on various minimally invasive technologies continues. TURP still remains the most offered operation worldwide. In this review they have carefully analyzed all these modalities and have given a balanced perspective. Dr. Cherian, Professor of Anesthesia has highlighted the anesthetic issues related to urological patients and the impact of operative positions which are required for various urological procedures like PCNL etc. This article would provide a valuable insight for practicing urologists and help us to look at the patient from head-end.




 

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