Erectile dysfunction: you are not alone
Most men are too embarrassed to talk about erectile dysfunction; Jeff MacLeod is starting the conversation for them.
Of great concern to the physician is that it's a problem affecting “relatively young, healthy men”, some of whom go without sex for years before they get the courage to walk into his office at Northshore Medical and Aesthetic Centre.
“In general, men just aren't as good at seeking out healthcare to begin with — for anything,” Dr MacLeod said. “[When it comes to erectile dysfunction] most are fairly embarrassed.
“There's also the sense sometimes that sexual function is not that important, that it's not a serious health issue; it's more about a pastime or something pleasurable, but not essential. Whereas when you think about it, it really is a very important part of what is probably the most important thing in your life — and that's your relationship with your partner. You should be able to have a happy and satisfying sex life, but a lot of men just aren't.”
The Australian physician joined NMAC last December as a GP and sports medicine specialist, having worked 12 years with the British Army in northern Germany. With Jonathan Makanjuola, a leading urological surgeon in the UK and an NMAC consultant, he is trying to help men understand that erectile dysfunction should not be ignored as it is also an important indicator of heart health.
“It's really important. It's not just for the sexual function. The penis is an organ like any other in the body and it relies entirely on blood supply.
“If something's going wrong with the penis you'd be expecting that ten years later the same problem's going to arise in the heart.
“So, if we can pick it up early, we can also screen them for cardiovascular health in general — and there's a lot that can be done about that. So it's a really important sign for another preventable and manageable and fatal illness.”
Erectile dysfunction describes an inability to get and keep an erection. Although it's not uncommon for men to experience it from time to time, particularly during periods of stress, medical advice should be sought if it happens repeatedly.
According to Dr MacLeod, it's “very common” here.
“I see several cases a week,” he said. “It is particularly associated with diabetes and high blood pressure and anything which can affect blood supply — that includes medications as well.
“Women are pretty good at accepting mammography screening and cervical smear screening — fairly personal sort of stuff. They understand that it's good for their health in general. Men are just a bit more reluctant to seek healthcare appropriately and when they do, they just won't talk about it. And that's why we're trying to reach out and make it more of an open issue.”
At the moment, he has to wait for patients to work up the nerve to talk to him about their problems. Outside of that he does his best to pick up on cues.
“I've had men come in who haven't been able to have sex for two or three years and who are relatively young and healthy. I'm talking forties and fifties. That's quite young for a physiological erectile dysfunction and it's taken them that long to come in and seek help,” he said, adding that even when they did come in many struggled, reluctant to discuss their concerns.
“If I can pick up on cues and patterns I'll just spring the question on them: how are things going as far as sexual function's concerned? And it's so often that they then admit ‘not very well'. And then you start to talk about it and find out it's not actually happening at all. They're reluctant to admit anything. Part of it is that sense of masculinity. It's just embarrassing for them to admit that things aren't working properly.”
Once the problem has been diagnosed, patients have “a number of options” for treatment. A change of lifestyle can usually make a difference.
“If you're overweight, if you're not exercising, if you're smoking ... that's a big one. People don't realise cigarettes are about the most destructive thing out there [when it comes] to blood supply. They don't just destroy the blood supply over a long period of time but also, every single time you have a cigarette, you get a 60 to 90-minute window when the blood supply to all parts of your body is reduced fairly significantly.
“So there are a lot of lifestyle factors that they can address which usually take months, but sometimes even years, to have an impact.”
In the meantime, there are “quick fixes”. Viagra was the first PDE5 inhibitor put on the market to address erectile dysfunction, but today there is “a whole range”, most of which are more useful, Dr MacLeod said.
“We get a really good success rate with those.”
Where erectile dysfunction is a side effect of a particular medicine the patient is on, he searches for an alternative or might take them off it completely.
Another option is extracorporeal shock wave therapy, a “newly recognised treatment” that was recommended by the European Association of Urology in its guidelines this year.
“It uses a small, handheld jackhammer that puts sound waves through tissue and causes microscopic damage and this then prompts the immune system to heal it,” Dr MacLeod said, explaining he began using it on soldiers with injured tendons while he worked in Germany.
“It just so happens it's exactly the same machine you use for erectile dysfunctions. When I came to Bermuda, the machine wasn't being used here and I brought it in and started working on tendons, but erectile function is something that is standard care for a general practitioner to be managing.
“It's a non-pharmacological treatment which might involve six to ten weeks of once-weekly sessions to try and improve the blood supply running to the penis.”
Medications and injections are additional options and “at the very end of the line, if we haven't got the desired result and they really want to go to extremes, there is surgery as well”.
However, Dr MacLeod said, that is “always an absolute last resort”.
As a health issue, erectile dysfunction is something he has tried to draw awareness to since he joined NMAC.
“I think the really important thing is to come forward about health problems in general, to be more willing and more open. So many of the conditions that they suffer from are preventable.
“I know men that have lost their lives because they've come forward so late, just being reluctant to seek out help. With the incidence of diabetes and high blood pressure in Bermuda here, it's such a common thing.”
For every man he treats, there are “another four or five” he ends up helping because he has picked up on clues in their medical records.
“I ask them about it and they admit it. I'm always bemused. I think, ‘Why on earth didn't you come forward?'. [Finding a solution] is really satisfying. It can be a simple as giving them medication and they come back next week and say everything's all up and firing again.”
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