Let's talk about a condition which is very much prevalent among elderly people and sometimes, with people who were taking some medications for their depression. Any statistical data provided with this article is based on the data presented by a few studies regarding the incidence of erectile dysfunction in Asia. Even if topics related to men's health are considered as taboo in some cultures, we have to admit that this kind of problem is quite significant and potentially debilitating, especially since the late of the twentieth century, all over the world. Even though the term "men's health" seems to refer to a specific kind of condition, it is not comprised solely of sexual health but rather physical, psychological and emotional well-being in which we can consider it as a broad-spectrum health model which would influence how men interact in a specific community.
As we all know, various studies have been conducted to investigate the discrepancy between men and women life expectancy which is significantly differs by 6 years in almost any cultures. Let's take Japan, for example, the average life expectancy in 2018 for people who are living in Japan is 84.2 years old. The life expectancy for men and women, however, differs by 6 years in which men have the life expectancy of 81.1 years old while women have the life expectancy of 87.1 years old (Source). Even with the statistical data provided by studies regarding the number of years on average regarding people who live in Japan would live for, Japan remains as one of the countries inhabited by the most number of centenarians (people who live beyond 100 years old). It is a complex model and can be influenced by a multitude of factors. The figure would differ between countries which are usually influenced by multiple sociocultural factors but generally, the trend remains the same; women do live longer than men for a significant number of years.
This phenomenon motivates researchers to conduct various studies to understand the biological, psychological and social implication towards life expectancy. Men and women do operate differently and most of the studies which are conducted in South East Asia, especially in Malaysia to study the cause of such differences were disease-oriented. This raises the possibility of sexual health being one of the factors that could have influenced the quality of life thus leading to various kind of diseases especially cardiovascular, which has been found to correlate significantly with the incidence of erectile dysfunction among men (Source). Even though cardiovascular diseases are potentially the most lethal killers of all time in Malaysia, road traffic accidents have been the major factors which contribute to the morbidity and mortality rate of men, occupying more than half of the total burden of injuries (according to a study conducted by Seng Fah Toh et al, it was 62% in 2011).
It is essential for us (including the laymen) to understand that men's health is one of the most critical components of medicine which could influence the life expectancy of men in regards to mortality and morbidity rate. Although some studies suggested that the occurrences of depression (a debilitating mental illness) among men are quite low compared to women, it is imperative for us to understand that men exhibited high-risk behaviours in other areas of psychological abuses such as drug abuse, alcohol consumption, and violence. The data presented by Seng Fah Toh et al regarding non-fatal injuries among men and women in Malaysia could somehow illustrate the tendency of men to involve in various kind of high-risk activities at all area except for injuries at home:
| Type Of Injuries (By Location) | Men (%) | Women(%) |
|---|---|---|
| Injuries In Schools | 7.0 | 6.0 |
| Injuries At Works | 4.8 | 3.1 |
| Injuries On The Road | 4.4 | 2.5 |
| Injuries During Recreation Activities | 1.7 | 0.7 |
| Injuries At Home | 6.5 | 6.8 |
Overall, according to a study conducted in 2000, the total disability-adjusted life year for men is significantly higher (16%) compared to women (6%).
The disability-adjusted life year (DALY) is a measure of overall disease burden, expressed as the number of years lost due to ill-health, disability or early death.
This can be the reason (one of them) why women live longer than men. Men's health is an essential area of medicine which concerns the health (in all aspect) of men as they progressed from a young adult to an elderly.
Erectile Dysfunction
How common is erectile dysfunction (ED) particularly in Asian countries? There are a lot of definitions when it comes to understanding what is erectile dysfunction exactly. Once, I confused between ED and infertility, I thought people who have ED can't have children unless we are talking about alternatives such as adoption or manual insemination of sperms. Turns out I was wrong, people who have ED can be thought as people who seem to have a heavy loaded gun, they can't seem to lift those guns, point it in the right direction and shoot. People who are infertile, however, can lift their guns easily, but they are shooting blanks. It's an analogy that I've always used to explain to my patient when they were asking for an explanation (without medical jargons) regarding this topic. The standardized definition of erectile dysfunction can be found in an article which was published in the Journal American Medical Association (JAMA):
Erectile dysfunction (ED) has been defined as the inability to achieve or maintain an erection sufficiently rigid for achieving satisfying sexual intercourse.
According to a paper written by Nehra A. et al in 2002, as much as 50% of men who aged 40 years and above are affected by this condition. You might just conclude that you don't have a problem related to this condition, but like any other diseases, ED manifested itself in different stages/severity. No definite diagram can be shown to laymen regarding the severity of erectile dysfunction as the assessment is often carried out using a five-item questionnaire known as the Sexual Health Inventory for Men (SHIM). Clinically speaking, it will vary between medical practitioners based on a few factors such as duration of practice, educational level (degree, master or PhD), clinical exposures etc. but in some cases, you would know for sure that the problem is ED.
There are a few comorbidities which will increase the probability of a man to be affected by ED such as hypertension, diabetes mellitus, cardiovascular diseases, psychiatric conditions etc. People who were taking selective serotonin reuptake inhibitor (SSRI) for example, can be sexually dissatisfied with their erection during intercourse but that's not in any way pathological. It's a common side effect of SSRI which is commonly used to treat depression, anxiety and for some cases, premature ejaculation. If people stop taking those medications, their erection would improved. According to Cheng et al who analyzed 18 papers from the previous research which investigated the prevalence of ED among people in Asia between the year of 1986 to 2006, it was found that every study documented different outcomes from different countries; if we want to put it into some kind of statistical ranges, it is between 2 to 81.8%.
| Countries | Prevalence of ED (%) |
|---|---|
| China | 19.5 - 28.3 |
| Hong Kong | 8 - 50 |
| Indonesia | 11 |
| Japan | 13 - 81.1 |
| Malaysia | 22.4 - 59 |
| Singapore | 2 - 53 |
| South Korea | 18 - 36.6 |
| Taiwan | 9 - 17.7 |
| Thailand | 29 - 65 |
The incidence seems to increase with age and after analyzing all of the data which can be extracted by all those 18 papers, the prevalence of ED (according to age) can be concluded as follow:
| Age Groups | Prevalence of ED (%) |
|---|---|
| 20 - 29 | 15.1 |
| 30 - 39 | 29.6 |
| 40 - 49 | 40.6 |
| 50 - 59 | 54.3 |
| 60 - 69 | 70.0 |
Currently, there are three studies which provide us with important epidemiological data that would suggest erectile dysfunction is one of the commonest men problems in Asia:
- GSSAB subgroup study (Source)
- Attitudes towards life events and sexuality study (Source)
- Asian survey of the ageing male (Source)
Taking account into all of the results listed in each of the studies which have been conducted in the past, it is essential for us, medical practitioners to encourage and educate the masses regarding sexual health no matter how bad a specified community perceives the topic. It is a serious problem which can lead to severe consequences that would potentially lead to social insecurities, depression, anxiety, performance issues, dissatisfaction etc.
Erectile Dysfunction And Statins
What about people who experienced erectile dysfunction as a side effect from taking statins? Statins are one of the medications which are riddled with controversy regarding its usefulness in combating diseases related to hypercholesterolemia. It functions by blocking the major enzyme responsible for producing the primary substrate to produce cholesterol so, in concept, the drug could work in reducing the level of cholesterol in the blood. In the previous decade, some medical practitioners and academicians disagree to the notion of prescribing statins to prevent cardiovascular diseases, as low cholesterol could invite a much more severe complication compared to people who have a high blood cholesterol. I can't seem to find a valid source to present as a valid argument here, so let's leave it at that; maybe I will make a post, specifically for statins later on.
Some papers which have been published in the Journal of Sexual Medicine have concluded that statins treatment for people who are considered as a high risk of getting cardiovascular diseases can reduce the amount of testosterone in male subjects. In a study conducted by Corona G. et al in 2010, among 3,484 patients, 244 which have been treated with statins experienced symptoms and physical changes related to low level of testosterone such as hypogonadism (Source). It's quite unfortunate but that is the basis of a possible pathophysiological model of ED among people who were taking statins. It's unfortunate for them but this thing is still considered as one of the grey areas of medicine; whether we should or shouldn't prescribe statins treatment to a patient.
Of course, in this area of research, a lot of investigations should be made to identify credible sources from the others. Some studies even found that statins eventually improved ED instead of causing it. That's however, a study which was conducted on people with vascular abnormalities which is normalized by taking statins, hence improve ED. Like any other studies which have been conducted previously, this particular study would need to be reviewed again, with an even higher number of samples. Even though it seems minor, losing a healthy erection can affect an individual in a negative way. It's not the best way of living a healthy life, after all, we should enjoy every single aspect of life, which include a nice and satisfying sexual intercourse, so if you have ED, run to the nearest clinic/hospital and get a treatment.
Sources
- Prevalence and Severity of Erectile Dysfunction as Assessed by IIEF-5 in North Indian Type 2 Diabetic Males and Its Correlation with Variables
- Profile of men's health in Malaysia: problems and challenges
- Prevalence and medical management of erectile dysfunction in Asia
- Global perspectives and controversies in the epidemiology of male erectile dysfunction
- The role of statins in erectile dysfunction: a systematic review and meta-analysis
- The effect of statin therapy on testosterone levels in subjects consulting for erectile dysfunction
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