When should you see an andrologist?

Erectile dysfunction is a common health problem affecting not just the quality of life of men but one that can also be an indicator of an underlying undiagnosed medical problem, writes Dr Seshagiri TV

Erectile dysfunction (ED) is defined as the inability to achieve or maintain a penile erection sufficient to permit satisfactory (for all partners involved) sexual activity. Just about every man has had the experience of not being able to maintain an erection long enough to have sex. Although the occasional letdown is a bummer, it is normal. But if the issue is persistent, then one should take note.

Reports suggest that the incidence of ED in the below 40 age group in India is in the range of 25-30%. By the time men reach their 40s, almost 50% of them will have had erectile dysfunction. This incidence of ED is increasing across all age groups.

ED is a common health problem affecting not just the quality of life of men and (indirectly of women) but can also be an indicator of an underlying undiagnosed medical problem. To get normal erections we need to have a healthy blood supply, nerves and hormones. Anything that affects any of the above, can cause ED. Erectile dysfunction may have a physiological cause (blood supply, nerves or hormones) or a psychological cause. The most common cause is thought to be related to the narrowing of blood vessels in the penis. The narrowing of blood vessels is a generalised problem affecting all organs in the body and not just a local issue affecting the penis alone. Having said that, blood vessels in the penis are much smaller and start to narrow long before those in your heart, brain or kidneys.

For that reason, ED can be one of the first signs of a more serious health problem, such as high blood pressure, high cholesterol, diabetes, or heart disease. So don’t delay making an appointment with your doctor if you think you may have ED.

The prevalence of erectile dysfunction is significantly higher in men suffering from certain chronic diseases like hypertension, high cholesterol, heart diseases and diabetes, thyroid diseases, liver diseases, renal diseases, asthma and psychiatric illness. Stress, lack of sleep, and excess drinking can also cause ED. Many recreational drugs can lead to erection trouble.

How to prevent/ delay the onset of ED

Anything that’s good for your heart is good for your penis. Treating any underlying condition, such as stabilising the blood sugar or BP, can improve ED. Lifestyle changes, such as losing weight, quitting smoking, avoiding too much alcohol and managing stress can also help.

To help maintain erectile function, choose whole-grain foods, low-fat dairy foods, fruits and vegetables, and lean meats. Avoid foods high in fat, especially saturated fat, and sodium. Physical activity increases blood flow through your body, including the penis.

When to see an andrologist

If it is temporary or only happens occasionally, it isn’t a cause for concern. There could be any number of reasons for this including fatigue, stress, drinking alcohol or even as a side effect of a medicine you just started taking recently. If you are having trouble keeping it up persistently or if it is causing stress in the relationship, you should seek help.

If there is a family history of diabetes or heart problems and you suffer from ED, seek help.

If you are over 40 years old and have ED, see a specialist anyway to ensure there isn’t an undiagnosed medical problem that can cause ED.

If in doubt, seek medical advice.

If your partner is under 35 and has been unable to get pregnant after a year of trying, see the specialist.

If your partner is above 35 and has been unable to get pregnant after 6 months of trying.

If your partner has had an abortion or miscarriage and then been unable to get pregnant after six months of trying.

If you feel you are suffering from erectile dysfunction or premature ejaculation which may be contributing to the issue, seek medical guidance.

Male infertility

If a male and a female have repeated, timed and unprotected sex and the female doesn’t get pregnant for over a year, then the male, female or both may have infertility issues.

Infertility affects one in every six couples who are trying to conceive.

In at least half of all cases of infertility, a male factor is a major or contributing cause.

Some men are more likely than others to experience infertility. You may have issues with your fertility if you have any of the below:

You are overweight or obese, aged over 40, diabetic, been exposed to radiation, certain chemotherapeutic agents, environmental toxins including lead, pesticides or mercury, you are a tobacco, marijuana or alcohol abuser, you take certain medications, you are around the heat that raises the temperature of your testes like those who frequently use a sauna or a hot tub, you have a history of undescended testicle(s), you have a history of varicoceles, which are widened veins in the scrotum, you’ve been exposed to testosterone, history of heavy alcohol use, smoking, illegal drug use and anabolic steroids use, trauma to the testes, hormonal disorders or if you have had mumps orchitis.

(The author is a consultant renal transplant surgeon & andrologist.)