Men’s health – from the couch to the laboratory and back again
It’s not so long ago that Masters and Johnson, acclaimed experts in sexual life and function, wrote that “90 percent of all impotence is caused by some form of psychological or emotional conflict…and is a reversible process for all men regardless of age”. How wrong they were!
The serendipitous discovery that a drug, originally developed for cardiovascular use, restored erectile function has led to a burgeoning of research into the link between erectile function and cardiovascular health.
Our audit of the screening biochemistry of 1500 men presenting to the Keogh Institute with erectile dysfunction (ED) has shown that dyslipidaemia is by far the most prevalent abnormality, far more common than a low testosterone. Prevalence studies led by Dr Kim Chew in Western Australian general practice and in the community have confirmed that men with ED are at high odds of having cardiovascular disease and vice versa.
The big question has been whether ED by itself is an independent sign of underlying cardiovascular disease. Our clinical laboratory experiments, using measures of endothelial function in conduit and resistance arteries in the forearm, have suggested that this is so. Men with ED, without any known cardiovascular disease or any measurable cardiovascular risk factors were found to have demonstrable generalised vascular disease. This finding is consistent with the “artery size” hypothesis where endothelial dysfunction and disease presents first in small arteries, such as in the penis, causing ED, before being clinically evident in larger diameter arteries like the coronary circulation, causing angina or myocardial infarction. Presently, using data from our own clinic and the WA Morbidity and Mortality Database we are examining the time interval between those two events. We believe that this time interval represents a window of opportunity for cardiovascular risk reduction.
The prime focus of the management of ED has now moved from psychological counselling to identification and correction of cardiovascular risk factors.
ED is not the only men’s health issue moving from the psychological to the organic sphere of interest. Premature ejaculation (PE) is said to the most common male sexual complaint and is divisible into primary PE, which occurs and persists from the first sexual encounter, and secondary or acquired PE, which may be psychological but is commonly acquired in the older patient when erectile function begins to fail. Primary PE is now recognised to have an organic, probably genetic, basis although the exact mechanisms by which it occurs are yet to be fully elucidated. PE has been previously managed, rather unsuccessfully, by psychological and behavioural interventions. However, the recognition of the role of serotonin receptors in the control of ejaculation has led to the use of selective serotonin reuptake inhibitors and the development of newer SSRIs in the management of primary PE. However there is more to unravel in the complex imbalance in neurotransmitters and autonomic nervous control which leads to primary PE and, led by Dr Neil Palmer, the Keogh Institute is taking PE from the examination couch back to the clinical laboratory.
Tags: erectile dysfunction, men's health