An inside anecdote has it that a local urology professor in his fifties takes Viagra to improve his lung circulation and blood oxygenation during long distance running. Viagra is well known for the treatment of erectile dysfunction (ED) and is a brand name for sildenafil, a type of oral phosphodiesterase 5 inhibitor. In fact, sildenafil was originally researched for treating pulmonary hypertension or high blood pressure in the lungs. Pulmonary hypertension is a rare and serious lung disorder and is very different from the more common high blood pressure. That said, the professor in the legendary story does not actually have pulmonary hypertension. It is just an anecdote and I really do not advise taking sildenafil to improve your exercising ability! In pulmonary hypertension, sildenafil dilates blood vessels in the lungs. Interestingly, penile erection is a side effect noted during the early sildenafil research trials for treatment of pulmonary hypertension.

This chance discovery triggered a cascade of research into the role of oral sildenafil in ED treatment and soon, Viagra was born. There are other medical treatments for ED that existed before Viagra, including urethral insertions, penile injections, the vacuum device and psychotherapy, but none of these methods come close to the popularity of the “blue diamond” in ‘raising the roof’ that works so well and is so easy to use. Its success is such that other oral phosphodiesterase-5 inhibitors soon had to follow, viz Cialis and Levitra.

I mentioned last month that sensible men do not take risks when they have ED. They do not self-medicate and more importantly, they do seek medical attention. Aside from not taking any risks in consuming counterfeit drugs from the internet or roadside touts, sensible men who are informed would not even consider taking a genuine oral phosphodiesterase-5 inhibitor for ED without first consulting a doctor. For that matter, informed men would seek medical attention even if they do not want any treatment for ED per se. The following explains this sensible approach to ED and health.

ED is common. ED is, in fact, very common from middle age onwards. As a rule of thumb, 50% of men aged 50 years, 60% of men at the age of 60 and 70% of 70 year-old men do have some form of ED. Back then when the science of erectile function was less understood, ED was often dismissed as a psychological condition or as an inevitable ageing problem. Doctors and many men now see it as a readily treatable disorder.

ED is easy to diagnose. A man has ED when he is consistently unable to achieve or maintain a penile erection sufficient for satisfactory sexual performance. Since the diagnosis of ED mainly depends on how men perceive and describe the condition, doctors need to standardise diagnosis by using a set of structured questions. These questions can also be self-administered in privacy. It is this internationally validated 5-item International Index of Erectile Function (IIEF-5) questionnaire that confirms ED and assesses or scores its severity.

The most common cause of ED is vascular disease. ED generally shares the same risk factors with cardiovascular disease (CVD), and risk factors of a disease increase the likelihood of that disease developing. Doctors treating men now also include the IIEF-5 questions in adult male health screenings not only because ED is common, easily diagnosable and treatable, but more importantly because ED is seen as a powerful risk-marker for CVD. ED can be an indicator of CVD to come, like the proverbial “calm before a storm”. ED can come about anytime before the onset of CVD and hence serves as a ‘warning’ of heart disease to follow. Both ED and the graded severity of ED from IIEF-5 scores correlate well with CVD risk factors such as high blood pressure, diabetes, high blood lipids and obesity. The last four conditions make up what is known as the metabolic syndrome.

Population studies indicate that men with ED also have many of the major CVD risk factors like ageing, smoking, high blood pressure, diabetes and high blood lipids. On the other hand, the likelihood of having ED is directly related to the number of CVD risk factors present. That is, the more CVD risk factors as mentioned above that a man has, the more likely it is that he has or will have ED. This likelihood is highest in men with more than three CVD risk factors. Furthermore, it is noted that men with coronary artery disease frequently have ED and also that men with vascular ED are likely to have at least one partially blocked coronary artery. Other population studies show that the likelihood of having ED increases with the number of conditions that make up the metabolic syndrome. 40% of men with four components of the metabolic syndrome have ED. ED is especially likely in men with diabetes.

In a nutshell, population studies show that CVD and its risk factors predict ED. And vice versa, ED is seen as an independent predictor of CVD. ED can come before the symptoms of coronary disease develop. For the individual man who is with or without any medical conditions, the relevance of these population studies findings lies in the importance of having a comprehensive medical investigation when ED develops. Go get that medical check-up done!

Complex tests that employ ultrasound imaging and measure of penile blood flow with drug stimulation can be used to confirm a vascular cause of ED for the individual. However, they are not routinely done for men seeking ED management. These costly tests are usually done in research or in preparation before surgical treatment for severe ED. The need is to specifically look for or exclude high blood pressure, diabetes, high blood lipids and obesity, the four components of metabolic syndrome, and other CVD risk factors. Any lifestyle changes and specific medical treatment can then follow, with or without an oral phosphodiesterase-5 inhibitor for ED.

Mere pill popping in ED without medical investigation is thus a missed opportunity in the promotion and advocation of good adult male health. This is the heart of the matter for a sensible and informed approach to total health when a man has ED.

Many infections are sexually transmitted, but the one which commonly threatens fertility in men is gonorrhea as it may cause obstruction of the male reproductive system by preventing the sperm from passing into the sperm duct. Chlamydia may also result in similar symptoms. However, there are also other non-sexually transmitted diseases and infections which can cause acute inflammation of the testicles and its seminal glands, resulting in infertility.