|Year : 2006 | Volume
| Issue : 3 | Page : 213-214
From the closet to the clinic, and beyond: The erectile dysfunction journey
UroAndrologist, Director - Diacon Institute of Neurourology and Andrology, Rajajinagar, Bangalore - 560010 and Head - Male Reproduction and Neurourology, NU Hospitals, Padmanabhanagar, Bangalore - 560070, India
S S Vasan
UroAndrologist, Director - Diacon Institute of Neurourology and Andrology, Rajajinagar, Bangalore - 560010 and Head - Male Reproduction and Neurourology, NU Hospitals, Padmanabhanagar, Bangalore - 560070
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Vasan S S. From the closet to the clinic, and beyond: The erectile dysfunction journey. Indian J Urol 2006;22:213-4
Normal erectile function requires the involvement and coordination of multiple regulatory systems and is thus subject to the influence of psychological, hormonal, neurological, vascular, and cavernosal factors. The World Health Organization defines sexual health as "a state of physical, emotional, mental and sexual well-being related to sexuality." This broad definition goes beyond simply inquiring about sexual dysfunction and suggests the concept of patient-centric goal specific primary care. Sexual problems have a clear negative impact on both the quality of life and emotional state regardless of age. Learning about specific sexual dysfunctions among men can reveal a variety of as yet undiagnosed co-morbid pathologic conditions such as: (i) depression and other emotional illnesses (ii) psychosocial stress (iii) actual cardiovascular disease as well as related risk factors such as hypertension, diabetes, and/or hyperlipidemia (iv) hyperprolactinemia and (v) low serum testosterone. Independent risk factors for cardiovascular disease, such as diabetes mellitus, hypertension, dyslipidemia, sedentary lifestyle, obesity, and cigarette smoking, are well recognized, and risk factor modification reduces the risk of incident and existing disease.
The pathophysiology of erectile dysfunction (ED) is multifactorial. The emerging awareness of ED as a barometer for vascular health and occult cardiovascular disease represents a unique opportunity for primary prevention in all men. Efforts at prevention and treatment will benefit from a deeper understanding of the genetic, cultural, and pathological underpinnings of cardiovascular disease. The identification of the nitric oxide pathway and its effect on the vascular endothelium was a significant breakthrough in understanding complexities of ED.
The era of pharmacotherapy was initiated by Giles Brindley, who revealed his pharmacologically induced penile erection at the 1983 AUA meeting in Las Vegas. This was followed by an era of penile arterial revascularization and venous leakage as a surgical treatment for ED, often involving extensive dissection, such as, spongiolysis, superficial and deep dorsal vein stripping, emissary vein and cavernosal vein excisions and ligations with several groups reporting persistently patient reported "high success rates" which eventually did not stand the test of time. Peyronie's disease, one of the most controversial areas of ED management, has various medical and surgical therapies as the ultimate answer, but the number and variety of these attempts at treatment stands as a testament to their relative lack of total effectiveness.
Not too long ago we laughed at the concept of a penile implant, as it was considered unnatural. The high success rates of the prosthesis were at odds with the clinical experience of many practitioners who observed significant number of failures. Though surgeons were slow to learn the technique, as device technologies advanced, penile implant surgery became more popular among urologists, though now there is an emphasis on international patient registries to assess actual patient and partner satisfaction.
Till recently, we all found the notion of a pill allowing impotent men to achieve an erection on demand, hilarious, but, the concept changed forever in 1998 and became history. Over two billion men have used and tested phosphodiesterase type 5 inhibitor (PDE5) tablets, which form an established therapy today.
There has been, over the years, worldwide proliferation of treatment options for sexual dysfunctions, including new guidelines for management of endocrine disorders in men and recommendations for penile prosthesis insertion. Despite several new therapies and management plans, patients are besieged with advertisements for alternative treatments such as alternative medicines, dietary supplements and herbal-based remedies. It is thus even more important that evidence-based medicine be used to determine patient's individual sexual health needs. The current issue has tried to address such relevant aspects of sexual health, to provide concise, high-level evidence-based scientifically derived outcome data, which will be highly useful in practical management. The symposium has focused on areas of practical interest in sexual medicine and I am personally pleased to see the article on corpus cavernosum electromyography, focusing on basic research in this field. The symposium offers the readers new opportunities to learn for the ultimate benefit of the patient. I thank all the contributors for their contributions.
The purpose of this symposium is to share advances in a field of sexual medicine, as that itself represents a change from the norm and was not too long ago, a taboo subject. We do know the impact of sexual dysfunction on the couple and instead of ignoring either the biologic or the psychosocial aspects of a patient's care, as was traditionally the case, to a new paradigm of the need to accommodate their needs, needs comprehensive multidisciplinary approach, though there are no departments in sexual medicine.
We as healthcare providers and researchers will continue to search for safer and more effective treatments for sexual health issues and I am sure further delivery of scientific data from evidence-based research in sexual medicine, will empower clinicians with newer options to decide on more effective and practical solutions, as sexual health has gained critical mass and is the need of the day and with this principle, we have endeavored to deliver strict evidence-based resources, to guide sexual medicine management in 2006.
Finally, our role is primarily to help alleviate the pain and suffering from sexual dysfunction as well as deal with any accompanying frustration, humiliation and distress, from both the biologic and psychological points of view. Treating patients safely and effectively with established well-defined practice guidelines, may improve the overall quality of life of our patients.