University Malaya Specialist Centre (UMSC) urologist Associate Professor Dr Ong Teng Aik (right) and UMSC’s interventional cardiologist Dr Ramesh Singh Veriah after the interview with Bernama on erectile dysfunction at the centre recently. — fotoBERNAMA by Zulaikha Zainuzman
X (First of a Two-Part Interview)
By Salbiah Said
KUALA LUMPUR, July 10 (Bernama) — Erectile dysfunction (ED) is a common medical condition that affects the sexual life of millions of men worldwide. This condition can be a precursor or an early warning sign of a heart disease, say health experts.
University Malaya Specialist Centre (UMSC) urologist Associate Professor Dr Ong Teng Aik says, “If a person has ED, he should not ignore it. It could signify a more serious problem involving not only the penis, but also the heart or the brain.”
“ED involves dysfunctional blood supply to the penis. For a man to have a hard erection, he needs adequate blood supply to the penis,” he told Bernama in an interview at UMSC recently.
If a person’s blood vessel is affected, that is with the blood supply being less circulated to a specific organ, then that organ will face problem.
“So, with less blood flowing to the penis, he will get ED, and if there is not enough blood going to the coronary blood vessels in the heart, he may suffer a heart attack. And if there’s not enough blood going to the brain, he may get a stroke,” he adds.
INCIDENCE OF ED
The incidence of ED increases with age and is common in the older generation, Dr Ong says, citing an urban-rural scientific survey which he and his team conducted in Malaysia in 2008 involving 350 adults.
Seventy per cent of the respondents aged between 50 to 60 suffered from ED.
Of those with ED, 30 per cent were classified as mild, 20 per cent moderate and 15 to 20 per cent in the severe category.
UMSC’s interventional cardiologist Dr Ramesh Singh Veriah says that ED worsens with age and is closely linked with heart disease.
“One should not be confused between ED or impotence with libido or urge. A lot of people have the libido or urge for sexual intercourse, but they are unable to maintain sufficient erection,” he told Bernama during the joint interview.
He says, most of his patients who were admitted after a heart attack would ask questions such as what happens to their lifestyle later, their relationship with their wife and whether they can be involved in sports and these are pertinent questions.
This prompted Dr Ramesh and his team to carry out a study in 2005 at the centre, which was later presented in Washington in 2008. Of 510 high-risk male patients aged between 36 to 92 with established heart disease surveyed, ninety per cent reported some degree of ED.
“Two-third actually reported significant ED for them not to be able to have a proper life. Based on their history, ED had started way back before the heart attack,” says Dr Ramesh.
He says the sexual disorder does not directly affect the heart as it has many possible causes. Other causes to be considered include trauma to the spine, psychological causes or certain medications that could affect the younger age group.
“Risk factors such as diabetes, high blood pressure, high cholesterol, smoking, obesity contribute to fat or plaque build up in these vessels,” says Dr Ramesh.
Dr Ramesh says if the patient starts getting fat build-up in the blood vessels or what is termed as atherosclerosis, naturally the perfusion of the blood flow into the organ such as penis will be diminished and the patient gets erectile dysfunction.
Atherosclerosis is a generalised disorder that affects arteries in different organs at the same rate.
“But in the heart, sometimes you may not know as it is slowly building up. What actually happens is that these patients end up having some form of symptoms later after many years of ED,” he adds.
Dr Ramesh further explains that when the blockages in the heart are very tight at 70 per cent or more, the patient may start feeling short of breath or chest pain.
“On an average, ED precedes heart disease by about three years. Many patients with borderline blockages often suffer sudden heart attacks and this may be prevented if we were able to screen those with pre-existing ED. While ED does not kill, a heart attack may,” he adds.
LOSS OF LIFE
Dr Ramesh also shares that if the patient has ED, the doctor will examine whether his heart is in good condition, noting that such test is easy and can be cost effective, preventing loss of life and loss of income from a heart attack.
“Once a patient gets a heart attack, he may suffer from heart failure. If he survives, not only is his personal life compromised, he may not be able to work and earn a living for his family. This effect can be devastating,” he adds.
He further explains that ED does not cause heart diseases. “The mechanism as to how ED comes about or how a heart attack or stroke comes about is atherosclerosis.”
On whether ED is related to other diseases, Dr Ramesh says most of the patients have what is called multiple comorbidities. They have higher incidence of diabetes, hypertension and high cholesterol.
“We have found that those with ED, and when you do a blood test on them, they may be newly diagnosed diabetics or have high blood sugar levels which they may not be aware of. They are generally more sick or have the potential of becoming more sick than others. The onset of ED is a sign of poor health,” he adds.
SUFFERING FOR MANY YEARS
Says Dr Ong, “Many patients have been suffering for many years. They start having ED before they even know they even have a heart problem. So if we can identify those patients, we can help them earlier. This is the main message.”
On whether ED affects the younger people, he says the incidence is low as they do not have manifestation of the blood vessel disease at an early age such as atherosclerosis.
“The fact that they are young, the disease will take some time to develop. They do get ED for other reasons such as psychological stress, depression and problem with relationship with their spouse.
“But as they get older, there will be problems with blood vessel, diabetes, hypertension and high cholesterol,” adds Dr Ong.