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Magazine
Men’s health matters
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Despite medical advances, men still have poorer health outcomes. DR. SANJIVA WIJESINHA
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When discussing men’s health, it is important to note that there are two different aspects: diseases common to both men and women, where it is important to prevent the poorer outcomes that men suffer as a result of these conditions; and diseases that affect the male reproductive organs such as erectile dysfunction, testicular cancer and prostate disease.
Despite significant medical advances over the past century, men still have poorer health outcomes; a simple example being the current average male life expectancy in most countries is about five years less than for females.
Ignoring symptoms
Doctors regularly see their male patients (as well as male friends, family and colleagues!) ignoring warning symptoms, denying health problems and dying prematurely from diseases like heart disease, kidney failure and cancer. Males in the most productive age — the 25-64 year group — run a much greater risk of dying from heart attacks, cancer and alcoholic liver disease when compared to females of the same age.
Whether these differences are due to the presence of a male chromosome (Nature) or the result of broader issues such as lifestyle, attitudes, social expectations and upbringing (Nurture) is a matter of speculation but the typical male, in India as well as in other cultures, is brought up to deal with problems without asking for help. The result: that he doesn’t readily seek medical advice and will not let pain or discomfort show,which means that he ignores signs of ‘dis-ease’.
Two basic problems encountered by doctors are to get men to consult them when they develop symptoms, and to present for a regular check-up.
In fact, if people, particularly men, can be taught to see their doctors for an annual check up, just like they take their cars for a regular service, the incidence of ‘breakdowns’ in India will be far less than it is now!
Basic minimum
Since most people remember their birthdays, a useful policy is to arrange to have the check up during that month. As a minimum, in addition to a basic clinical examination (with or without a prostate check, which really depends on age), a man should measure his “Two Ws and Two Bs” — Weight, Waistline, Blood pressure and Blood tests for glucose (blood sugar), lipids (cholesterol) and liver function.
Other examinations and investigations may be indicated depending on the individual but this constitutes the basic minimum.
With the advent of medications like Viagra for erectile dysfunction and interest becoming focused on prostate diseases as lifespan increases, doctors now see more men asking for advice about these conditions. Impotence, now referred to by the more euphemistic Erectile Dysfunction or its simple acronym ED, is defined as the persistent inability to attain and/or maintain an erection adequate to permit satisfactory sexual intercourse.
One of the first studies to explore this problem was the 1994 Massachusetts Male Ageing Study, which studied 1290 American men and found that approximately 40 per cent of men at age 40 had some degree of impotence rising to almost 70 per cent at age 70.
The recent MATES research study in Australia revealed that one in five of the 6000 men surveyed reported erectile problems but only one third actually consulted a doctor.
It is important to be aware that Erectile Dysfunction is common and, in a majority of men, it is not caused by a deficiency of male hormones or even a lack of masculinity.
Erection is essentially caused by increasing blood flow to the penis so anything that stops blood flowing into the penis will stop the erection happening.
Inadequate blood flow
The strong association of ED with blood circulation is easy to understand if one appreciates that the inadequate blood flow in the arteries of the penis is a manifestation of what is happening in the blood vessels in the rest of the body.
This explains why ED is more common in patients with conditions like heart disease, high blood pressure, elevated cholesterol and diabetes.
A recent study in the U.S. found that patients who had been diagnosed with ED at the start of the study and followed over nine years had a higher incidence of heart attacks and strokes than a control population.
The message here is that Erectile Dysfunction can be an early warning sign of heart disease.
Treatment for Erectile Dysfunction has been revolutionised by the introduction of medications (the best known being Viagra) that can be taken orally. These tablets are effective in about 70 per cent of men with ED.
For those in whom this type of tablet proves ineffective, other techniques (injections, vacuum pumps and inflatable prostheses that have to be inserted by a surgical operation) are available.
The important message is that Erectile Dysfunction is common, can be effectively and easily treated in the majority of men – and MAY be the first symptom of a more generalised serious diseas of the cardiovascular system.
The writer trained as a surgeon in England and as a general practitioner in Australia and now practices as a family physician.
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