Don’t be im­po­tent about this

The in­ti­mate link be­tween erec­tile dys­func­tion and heart dis­ease.

The Star Malaysia - Star2 - - HEALTH - By HOWArD CO­HEN

GUYS, par­don the frank­ness, but a cou­ple of fail­ures in the bed­room on your end could ac­tu­ally be a life­saver if you put aside the enor­mous male ego and take ac­tion.

Erec­tile dys­func­tion – the in­abil­ity to get and keep an erec­tion suit­able for sex – can be an early warn­ing sign of heart dis­ease.

“Some­thing like erec­tile dys­func­tion is a great av­enue to get men into the clinic to see their pri­mary care doc­tor so they can get screened for car­dio­vas­cu­lar dis­ease,” said Dr Bernard Ashby, a Mount Si­nai Med­i­cal Cen­ter car­di­ol­o­gist in the US.

“A lot of time men don’t come in,” he said. “They don’t ap­pre­ci­ate the im­pli­ca­tions of a poor life­style and are not see­ing a doc­tor. Men don’t come into the doc­tor un­til some­thing hap­pens.” Men, you know who you are. Ashby gives an ex­am­ple of the com­mon pa­tient who over­looks cer­tain things, like early heart fail­ure and breath­ing prob­lems, but when it’s re­lated to sex­ual per­for­mance, well, at­ten­tion perks up.

At least, there is good news in that re­spect.

“They won’t come into the hos­pi­tal un­til they no­tice swelling in the tes­ti­cles. They don’t think it’s a prob­lem un­til some­thing is wrong down there – some of the things we place a pri­or­ity on. Any way we can get them to see us is a great way for us to get guys screened,” Ashby said.

The same process that creates heart dis­ease may also lead to erec­tile dys­func­tion – only ear­lier, hence the im­por­tance to screen for a pos­si­ble re­la­tion.

The in­abil­ity of the ar­ter­ies to di­late fully and to sub­se­quently har­den, through the buildup of plaques in the ar­ter­ies of the body, can lead to stroke, heart at­tack and even sud­den death.

The process is called ath­er­o­scle­ro­sis, and the plaque buildup re­duces the blood flow to the pe­nis, ren­der­ing a male im­po­tent.

But, as South Florida urol­o­gist Dr Ge­orge Suarez ex­plains, the small­est ar­ter­ies, not the heart, but the ar­ter­ies of the pe­nis, which are very small, be­come blocked first. This shows up in the in­abil­ity to be­come erect or to stay erect to en­gage in a sat­is­fy­ing sex­ual ac­tiv­ity.

Erec­tile dys­func­tion pre­ced­ing heart dis­ease is a func­tion of en­dothe­lium, or the dys­func­tion of the in­ner lin­ings of the blood ves­sels and smooth mus­cle.

En­dothe­lial dys­func­tion leads to both poor blood flow to the heart and the pe­nis and de­vel­ops into ath­er­o­scle­ro­sis.

A re­port pub­lished in the Jour­nal of the Amer­i­can Col­lege of Car­di­ol­ogy in 2008 de­tailed an Ital­ian study of men with se­vere heart dis­ease.

Nearly all of the men, 93%, had erec­tile dys­func­tion two years be­fore their heart at­tack or the on­set of heart dis­ease symp­toms.

Im­po­tence, how­ever, doesn’t al­ways in­di­cate fu­ture heart prob­lems.

“Ev­ery man is go­ing to have a bad day, an off day, a tired day, a stress­ful day, a what­ever day,” Suarez said.

He coun­sels con­cern if im­po­tence is hap­pen­ing about 25% of the time. “One out of four, then you can say, ‘ I have a prob­lem.’ Ob­tain­ing means you’ve got enough blood flow to the pe­nis to have an erec­tion, main­tain­ing means to keep the blood flow in there. More than 25%, it’s time to start look­ing for some so­lu­tion.”

There are four things doc­tors and pa­tients should then look at, he sug­gests.

Is there an or­ganic cause, which could be a his­tory of high choles­terol, high blood pres­sure? Doc­tors can check the pa­tient’s med­i­ca­tions, if ap­pli­ca­ble, ad­just them or pre­scribe treat­ment for the choles­terol and blood pres­sure is­sues and screen for heart dis­ease.

Is there a hor­mone de­fi­ciency, such as low testos­terone? Sim­ple test and fix, Suarez says.

Are there neu­ro­log­i­cal is­sues, any back is­sues, any nerve dam­age? Have you been in­jured? A phys­i­cal exam could be telling.

Is it all in your head? “Then we look for psy­cho­log­i­cal is­sues and put that as the last thing we should look at,” Suarez says.

There are other risk fac­tors for heart and erec­tile prob­lems, too, such as di­a­betes, smok­ing, over­con­sump­tion of al­co­hol, obe­sity and age.

How­ever, age, when look­ing for the cor­re­la­tion be­tween im­po­tence and heart dis­ease, is es­pe­cially a con­cern for younger men un­der 50 who are at much higher risk for a link. In se­niors 70 and over, erec­tile dys­func­tion is less likely to be a sign of heart dis­ease. Not that the se­nior set is idle. “I see more el­derly peo­ple that are sex­u­ally ac­tive in my prac­tice than I did 20 years ago,” Suarez said.

“I have a friend who owns a nurs­ing home and he was telling me the other day that sex­ual ac­tiv­ity in the nurs­ing home is hu­mon­gous.”

Ap­par­ently, gone are the days of sit­ting on the porch, hand in hand, re­flect­ing on mem­o­ries. “Now th­ese old peo­ple just want to get with it all the time.”

Pe­nile im­plants, gen­er­ally a 30- minute out­pa­tient pro­ce­dure most of­ten cov­ered by in­sur­ance, and Vi­a­gra, not of­ten cov­ered by in­sur­ance, are some of the reme­dies for im­po­tence – once en­dothe­lium and ath­er­o­scle­ro­sis are ruled out.

“If there is a plumb­ing prob­lem be­cause of ath­er­o­scle­ro­sis, there can be med­i­cal man­age­ment or Vi­a­gra that can help in­crease blood flow,” Ashby said.

“The more im­por­tant is­sue is once there is ev­i­dence of ath­er­o­scle­ro­sis, heart dis­ease, the chance of dy­ing of heart at­tack in­creases ex­po­nen­tially. If we catch it at that point and know you are at higher risk, [ we] need to be more ag­gres­sive in pre­vent­ing a car­dio­vas­cu­lar event.”

The mes­sage is to lis­ten to your body and speak up when some- thing isn’t right, even if it causes mo­men­tary em­bar­rass­ment.

“A sense of in­ti­macy has be­come a vi­tal part of hu­man na­ture in our so­ci­ety to­day, and it is nor­mal for a cou­ple to seek that in­ti­macy with­out fear and with­out shame and with­out per­for­mance anx­i­ety.

“If there’s any chance or risk that is go­ing to in­ter­fere with in­ti­macy and that they can’t have sex, they should seek help,” Suarez said.

He added: “We work all of our lives to get to the golden years and they are sup­posed to be golden.” – Mi­ami Her­ald/ Tribune News Ser­vice

Ath­er­o­scle­ro­sis, or the nar­row­ing of the ar­ter­ies. — TNs

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