Men’s Health: Sexual dysfunction and its underlying complications among Malaysians

Prof Dr Christopher Ho Chee Kong
Sexual dysfunction in men may not be fatal but will lead to other underlying diseases. — Picture from Pexels.com pic

KUALA LUMPUR, March 26 – Sex is a taboo subject.

It is all due to culture, however, this should not be so.

Sex in fact is one of the basic physiological needs besides food, water and shelter as described by the Maslow’s Hierarchy of Needs theory.

Therefore, men should not be embarrassed to discuss sexual health with their doctors.

Sexual health issues in men can be broadly classified into arousal/desire, erection and ejaculatory disorders.

Sexual dysfunction in men will not kill but the underlying diseases associated with these disorders can do so.

That is why it is vital for men and doctors not to sweep sexual health problems under the carpet.

It is important to screen further for underlying problems that could have contributed to this sexual dysfunction, and by treating the underlying contributory diseases, sexual health can be further improved.

Hypoactive sexual desire disorder (HSDD) is characterised as persistently or recurrently deficient (or absent) sexual/erotic thoughts or fantasies and desire for sexual activity.

This is sometimes known as lack of libido or low sex drive.

These men usually are not interested in sex and do not have sexual fantasies like what normal men do.

There are various causes for this to happen, which is often caused by low testosterone levels in the blood, also known as testosterone deficiency syndrome (TDS) or hypogonadism.

Testosterone deficiency has been shown to be related to the development of diabetes and can also affect the optimisation of sugar levels in the blood of diabetics.

Besides that, testosterone deficiency may also affect the bones in men, leading to osteoporosis (brittle bones).

Therefore, this increases the risk of bone fracture. It can also cause loss of muscle mass and increase the waist to hip ratio, resulting in obesity.

Additionally, TDS has also been found to be associated with a higher risk of getting dementia, irritability and depression.

The much-dreaded “metabolic syndrome” consisting of hypertension, diabetes, hyperlipidaemia and obesity, is also closely related to the presence of low testosterone.

Erectile dysfunction can also arise when testosterone levels are low, and it is also associated with coronary heart disease.

Studies have shown that when a man has erectile dysfunction, there is a 50 per cent chance of him getting a heart attack in three to five years’ time.

This can be explained by the “endothelial dysfunction theory” where inflammation and cholesterol plaques in the blood vessels can impede blood flow.

The penile artery (blood vessel) is one of the smallest in the body and therefore would be the first to be affected if there is any problem.

It is, therefore, an early signal that something is not right with the blood vessels.

If things are not corrected, there will be progressive damage and dysfunction of the arteries/blood vessels throughout the body.

The next smallest blood vessel or artery is the artery supplying blood to the heart (coronary arteries), and if it gets blocked, it will result in a heart attack (myocardial infarction).

The cerebral arteries (blood vessels supplying the brain) can also be affected later on, causing a stroke.

What is more worrying is the fact that the younger the man when he is diagnosed with erectile dysfunction, the higher the risk of him getting a heart attack or stroke in the near future.

It goes without saying that men with erectile dysfunction should have a cardiac assessment.

Ejaculatory disorder

Ejaculatory disorder, on the other hand, encompasses premature ejaculation, anejaculation and delayed ejaculation.

Premature ejaculation occurs when there is a loss of control of the ejaculatory process which occurs too quickly and causes distress to the man.

The average ejaculatory time for men is about five minutes but in men with premature ejaculation, it is usually less than three minutes.

Causes of premature ejaculation include hyperthyroidism (high levels of a hormone called thyroxine) and prostatitis (inflammation of the prostate).

Therefore men, with premature ejaculation should be screened for hyperthyroidism and get his prostate checked.

Taking too long to ejaculate?

Delayed ejaculation is when a man takes too long too ejaculate during sex.

This has been arbitrarily defined as longer than 30 minutes.

Anejaculation, on the other hand, is defined as no ejaculation at all.

Causes for delayed or anejaculation include hypothyroidism, low testosterone levels, problems with the nerves and diabetes.

Again, ejaculatory problems may unearth underlying medical problems in a man.

In a nutshell, sexual health is important in men.

Any sexual dysfunction should trigger further evaluation of the man’s overall health.

Many medical illnesses have been proven to be closely related, and may also be the root cause of sexual dysfunction.

However, sexual dysfunction can be treated.

What is more important is managing the medical illnesses surrounding it in order to minimise mortality and morbidity.

The Men’s Health World Congress (MHWC), which was slated to take place at the Borneo Convention Centre in Sarawak in July has been postponed to next year due to the developments of the Covid-19 situation.

“It has been a very difficult decision for the organising committee as we have assembled a team of world-class faculty members in this very exciting congress.

“However, your safety is of the utmost importance and in the best interests of everyone, we have decided to postpone the MHWC,” said the organiser in a statement.

The organiser also said the venue will remain unchanged and a new date will be announced soon.

For more information, click here.

 * Prof Dr Christopher Ho Chee Kong is a consultant urologist and an adjunct professor at Taylor’s University’s School of Medicine. He was previously professor of surgery and Urology at Universiti Kebangsaan Malaysia(UKM). He is a member of the International Consultation of Urological Diseases (ICUD), the Secretary-General for the Malaysian Society of Andrology and the Study of the Aging Male (MSASAM), Treasurer of the College of Surgeons Malaysia, Committee Member of the Asian Society of Men’s Health and Andrology (AMSHA) and also a Fellow of the Royal College of Surgeons of Edinburgh (FRCSEd), and Glasgow FRCS (Urol)(Glasg), European Committee of Sexual Medicine (FECSM), International College of Surgeons (FICS), European Committee of Sexual Medicine (FECSM), American College of Surgeons (FACS) and Academy of Medicine Malaysia (FAMM). Ho has published over 140 publications in peer-reviewed journals as well as five book publications on issues in Men’s Health.

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