Increased awareness about their sexuality and a rise in the number of people facing erectile dysfunction and premature ejaculation have renewed focus on men’s sexual health. Urologist Dr Sadashiv Bhole says a sound sexual health also helps in maintaining the overall well-being and general health of men. In an exclusive interview with TOI, Dr Bhole dispels taboos and stresses on the core issues related to the topic.
Q. What are the recent improvements concerning men’s health?
A. Men’s health means there are certain unique problems related to their lifestyle, sexual health and urological symptoms. These may include problems associated with prostrate, sexual health and in general harmonal issues in an ageing men’s population. For men’s health, prostrate-related issues begin at the age of 50 or the sexual health declines. To address these problems, we need a new approach and attitude. Urologists are closely related with these subjects. While practising urology they are also taught and trained in andrology which deals with men’s sexual health and male infertility.
Q. Do only the middle aged or the elderly population need to pay attention to men’s health?
A. Men of all ages, once they become adults, require health evaluation. When people are young, they have issues about understanding their sexuality. They have issues regarding wet dreams — ejaculation during sleep. This worries them to the extent that they can’t think straight. People come to me totally depressed assuming ‘dhaat’ (ejaculation) as some kind of a disease. It is a normal physiological condition of a person who is becoming a man from a boy. Whatever extra semen is produced by the body is ejaculated. From time immemorial, the popular perception is that wet dreams would weaken you, cause blindness, mental instability, impotency, etc. With this background, a young man loses his focus, he can’t study or carry out his day to day activities properly.
Q. How can men deal with such issues?
A. Through counselling, we teach men that this is not a disease but a normal body activity. Medication is required in persons who believe it will cause erectile dysfunction (ED) and impotency when they get married. It helps them and slowly they gain confidence to develop a normal sexual relationship with a regular partner and also that ‘dhaat’ will go away. If a person has sex daily, then he ejaculates every day. If a person doesn’t have a regular sex partner, all the semen produced is naturally ejaculated. So even if you use it or not, it is going to be produced daily.
Q. Does this cause erectile dysfunction (ED)?
A. The number of ED patients is steadily increasing. Doctors are not sure if this is due to increased awareness among couples or men who come themselves seeking treatment or whether there is an actual increase of the disorder. My personal view point is it is both. ED is also recognized as a condition now. Initially, ED was called impotency which is not a technical term. Premature ejaculation is having normal erection but ejaculating within a minute of vaginal penetration. That leaves a man and woman dissatisfied. It has a very bad repercussion on a man’s psychology. Many times premature ejaculation can also cause psychogenic ED. ED is of two types: one without any problem with the anatomy but due to various psychological or social factors and other is organic type. People with diabetes mellitus, excessive smokers and alcoholcis have a decrease in the calibre of blood vessels which is an organic phenomenon.
Q. Why are cases of ED increasing?
A. There are three aspects of health: physical, mental and sexual. All three are important and people too have realized it. Alcoholism has increased and is now accepted as a social norm. People have started drinking from a young age. Increased tobacco, drug use, fast food culture, high content of saturated fat are adding to ED. Basically, if you see, there is also an increase in the coronary heart diseases. This means ED is also increasing. There is a curious co-relation between heart disease and organic ED because both involve arteries. So, if a middle-aged man has an organic ED, we strongly recommend him to change his lifestyle, seek cardiac evaluation and lipid profile regularly. Penile dysfunction precedes active heart attack or strokes by about a decade. It is an indicator.
Q. Is the younger population getting involved?
A. Surprisingly, youths not having a regular sexual partner are realizing they are having ED and they are seeking treatment. These may not be organic but psychological because there is so much pornographic material available on the phone. People also have unrealistic expectations.
Q. Are couples hesitant to seek treatment?
A. There are young couples, even in the city, who had been married for three to four years but never consummated their marriage. It was surprising that people adjusted themselves to live together. But a time came when they sought help as now, women are also aware that men have problems. Women know that always the problem is not with them but in men who can’t have a normal intercourse. So, couples these days are straight forward in seeking consultation. They belong to all social backgrounds and even villages.
Q. Does the treatment differ from case to case?
A. Most anxiety related problems are solved through counselling. Clinical examination, erectile function test and investigation are done. In patients with severe ED, we need medication or surgeries if the vessel is damaged. There are certain medications with a very low dose of stimulation. On demand, these medicines help in the long run. The treatment is not focussed on having an intercourse tonight. We need to ensure that the patient has a good erectile function through his active life. Sildenafil, commonly known as Viagra, is used for short term activity while the effect lasts for 48 hours in tadalafil. Avanafil, taken 15 minutes before a sexual activity, helps couples with a busy schedule. So, the dosage is customized as per the need.
Q. These pills are used for recreation especially as aphrodisiac in betel leaves. Is it safe?
A. Sildenafil is one of the most abused recreational drugs. It is not recommended for a normal person. These drugs cause hypotension. People taking sorbitrate, NTG or those having low blood pressure can face life threatening complications with recreational drugs. Visual disturbance can occur.
Q. What is the treatment for premature ejaculation?
A. Until now, there was no specific treatment for premature ejaculation. The US FDA has approved a safe drug which prolongs ejaculation. Non-ejaculation is also another problem affecting people with neurological disorders, diabetes, people with pelvic surgeries. This is also a dysfunction. It is also seen among patients coming for infertility treatment.
Q. What is the impact of hormonal dysfunction?
A. Testosterone or growth hormones are at the peak in young age. After 40, testosterone starts declining. This is the most important harmone to maintain vigour, muscle mass, energy, bone health and also sexual function like desire. 40s and 50s are the new 20s or 30s. During this time, the testosterone goes down and men feel tired or loss of desire. We have to pay attention to a healthy and safe testosterone level in a ageing population. That is not just for sexual health but for general health and well being. At the same time, these men are developing prostatic cancer symptoms. Most of today’s youth population will be in that age group in the next 10 years. We need a particular speciality to look after the needs of urological and sexual issues among this subset of patients. Like we have different specialists, we need people who are trained in andrology. Men’s infertility is a unique and complex problem. It not only involves inability to have normal sexual intercourse, proper ejaculation and also good seminal parameters for siring a child.