Dr. Kardi Suteja, SpU

ONE of the important factors that leads to the joint happiness of a married couple is a harmonious sexual life. Husband or wife can provide sexual satisfaction to their partners. If a man’s weak point is like a rooster who can’t crow, the husband can be inferior not only regarding sexual matters but can also progress to wider domestic and social problems.

Many are mistakenly related to male sexual function problems. There is a myth that develops that only a few men experience impotence. In fact, based on a large study in America, impotence in some degree affects 52% of men aged 40-70 years. Epidemiological studies of the incidence of impotence conducted in Japan and Malaysia have received very encouraging results.

There is a mystical myth that crocodile stalks, rhino horns, seahorses, animal testes are effective treatments for impotence. But in reality, they are symbolic treatments that are suggestive. Until now there has been no scientific evidence of an increase in male sexual potential after consuming the exotic foods.

In fact, there is a severe myth that impotence cannot be treated. In fact, currently available treatment options’ effectiveness is according to patient’s impotence. However, it must be observed whether the drugs taken can overcome erectile dysfunction or only increases libido? Often drugs or herbs taken have more effect on libido. Libido is a prologue for sexual intercourse while the main part of sexual intercourse is erection (derived from the word erect = standing tall). The epilogue of sexual relations is ejaculation. If you drink a lot of ingredients to increase libido, while not being able to erect, there will be a big appetite for less energy.

Male Sexual Dysfunction

Impotence, now expanded into erectile dysfunction, is one of the sexual dysfunctions in men. Sexual dysfunction in men is the inability to get a satisfying sexual relationship due to inadequate erection or problems with emissions, ejaculation, or orgasm. Which includes male sexual function problems, namely erectile dysfunction and ejaculatory dysfunction.

Erectile dysfunction is the inability to reach or maintain an erect penis that is sufficient to have satisfying intercourse. Patients should consult a doctor if the condition lasts consistently for more than six months or more than 50% of sexual relations.

Another male sexual dysfunction is a matter of ejaculation (sperm discharge). There are three types of ejaculatory dysfunction: premature ejaculation, late ejaculation and retrograde ejaculation (sperm turned into the bladder).

Today erectile dysfunction is still somewhat taboo to be discussed in general. When the disorder occurs, adult men will seek help in a variety of ways, but of course confidentially. Which is understandable considering erectile dysfunction problems involve the genitals.

Erectile Dysfunction

An erection involves several factors, namely psychology, neurology (innervation), hormonal, arterial (arteries), and cavernous vessels (arteries and back of the penis). Broadly speaking, the causes of erectile dysfunction are psychogenic, organic or a combination of both.

In the 1950s many researchers stated that almost 90% of the causes of erectile dysfunction were psychogenic. But now many researchers believe that more than 50% of the cases are due to organ abnormalities. On the other hand, excessive anxiety can be a cause of erectile dysfunction in patients who are recovering from heart, lung or other serious diseases.

Erectile dysfunction can be caused by abnormalities in the brain, spinal cord, pudendal nerve and cavernous (direct innervation of the penis). In patients who suffer from complete upper motor paralysis, 95% are found to suffer from erectile dysfunction. Only 25% of people who are paralyzed with complete lower motor innervation still get an erection.

Hormonal abnormalities in diabetes mellitus (diabetes) are most often associated with erectile dysfunction. Erectile dysfunction in diabetes mellitus is mostly caused by vascular, neurological, and psychological factors. While other hormonal disorders, such as decreased testosterone, estrogen or antiandrogen therapy, thyroid gland abnormalities, are more associated with libido.

Some researchers have encountered an incident of erectile dysfunction parallel to increased age and coronary artery disease. More often, cavernous vascular disease in the penis can be a direct cause of erectile dysfunction with a variety of mechanisms.

Other causes include drugs, and kidney disease. Almost all antihypertensive drugs can cause erectile dysfunction. The effects of this drug suppress the central nervous system associated with erections, increase the hormone prolactin, and decrease libido. These drugs include methyldopa, clonidine and reserpine. Antidepressant drugs, estrogens, antiandrogens reduce libido more. Narcotics cause the same effect in the form of decreased libido. While alcohol through the mechanism of peripheral innervation and estrogen increase due to damage to liver function, erectile dysfunction is due to smoking through the mechanism of venous leakage and blood vessel constriction.

Erectile dysfunction is found in 50% of patients with kidney failure who are treated with dialysis. Many factors occur in patients with kidney disease, including: decreased testosterone levels, peripheral neuropathy, blood vessels, excessive drug administration, and psychological pressure due to disease.

Therapy

There are several lines of treatment for erectile dysfunction that has been agreed internationally. The first line is the administration of oral medicines and psychotherapy. The second line is injection drug administration in the penis, intraurethral application or the use of vacuum devices. The third line is surgery for reconstructive anatomical abnormalities (crooked penis, vascular leakage) and lastly is surgery by attaching a prosthesis to the penis.

Oral drugs that have been developed include sildenafil citrate, apomorfin and fentolamin. Not all disorders of erectile dysfunction can be given oral medication. The drug that has been popular these days sildenafil citrate is not one that can just be taken any time. It must be known that the patient does not take vasodilators such as ISDN (isosorbid dinitrate) at the same time. ISDN is often used for the treatment of heart disease.

Erectile dysfunction due to psychogenic causes, obviously not in place given oral medication alone. The right one is certainly psychotherapy by a psychiatrist. If the cause of erectile dysfunction is a due to organic disorders, of course drugs, and psychotherapy is not enough. Drugs that work directly on the penis in the form of intracavernosal injection can be done. Only in our society do the injection itself is still very difficult to do. The use of vacuum equipment can even be cheaper and more efficient in the long run. Anatomic disorders required operative measures according to the patient’s condition.

The role of his partner to overcome erectile dysfunction in man is also needed. If erectile dysfunction associated with psychogenic causes the partner must be able to provide encouragement, and actively help find solutions to the man’s erectile dysfunction problems.

Dr. Kardi Suteja, SpU.  is a specialist in urological surgery at Karsuneka Clinic Denpasar, and several private hospitals in Bali.