HiDoc Pulse sits down with Dr Ronny Tan, a urologist practising at Mount Elizabeth Hospital and Parkway East Hospital, to share his expertise on the health issues men face and how spouses can play a role as important as the doctor’s in overcoming them.
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A kind word can go further than any drug when it comes to health issues related to male vulnerability, such as erectile dysfunction (ED). In fact, simply retiring the word “impotence” has encouraged more men to seek medical attention, because it removes the stigma of the physiological inability to constantly sustain an erection to engage in sexual intercourse or achieve ejaculation, or both.
This renaming is significant, notes Dr Tan, who sub-specialises in andrology, male subfertility, sexual medicine and urological prosthetic surgery. “The term signals that the individual suffers from a lack of potency. Being labelled ‘impotent’ can erode self-confidence and self-worth.” He also observes that those who experience this inability are gripped by the fear of being humiliated if found wanting in bed. That means they suffer in silence, burdened by a shame that keeps them from seeking the medical attention they need.
Words have the power to heal
Using the term “erectile dysfunction” instead makes the condition less threatening, by more accurately labelling it as a clinical condition. The scientific term helps patients distinguish the inability from their sense of self and masculinity, helping them to more effectively overcome it, Dr Tan notes.
Psychological comfort also comes in the form of words of kindness. Switching the conversation from inadequacy and impotence and towards acknowledgement and treatment of the dysfunction helps out not just the individual suffering from ED (or other male issues such as andropause), but also the spouse who’s equally affected by it. “Couples stand to gain when the issue is discussed in a supportive manner as otherwise, the male’s ego gets punctured and their relationship suffers from friction caused by the medical condition,” Dr Tan shares.
Opening up to your loved one is crucial
ED can impact the lives of a couple beyond the bedroom, especially in cases where spouses blame ED on infidelity, and assume that a lack of intercourse is caused by a third party. Dr Tan recommends couples come in together for a clinical consultation, so both can tackle the health issue in a more productive manner. What’s more, it can encourage the male to open up in familiar company, and take away the tension experienced because of the health issue.
The fact is, most males still remain closed up about such male vulnerability issues, especially those among the older generation, says Dr Tan. He adds: “Some men are still reluctant to talk openly about their health issues even when their wives bring them to see me.” The main barrier preventing treatment is the reluctance to acknowledge that there is even an issue.
That is why Dr Tan is a strong advocate of patient education of male health issues because it addresses the concerns of both people in the relationship. The one who suffers from ED is able to uncouple his inability to perform in bed with his sense of self and does not have to hold himself up to the unrealistic ideal of manliness known as “machismo”. The spouse also stands to gain from being educated because the underlying causes of the inability can be traced to a medical condition and not to an extramarital affair or a sense of no longer being attractive enough for the partner.
What causes ED?
ED is caused by either physical or psychological issues, but more commonly, a combination of these issues plague those who suffer from it. For example, a physical issue with the blood vessels that lowers sexual response might in turn induce increasing levels of psychological anxiety regarding the inability to maintain an erection during sexual intercourse.
Common physical causes include:
- High cholesterol
- High blood pressure
- Heart disease
- Clogged blood vessels
- Alcoholism and other forms of substance abuse
Common psychological causes include:
- Stress (whether work-related or personal)
- Mental health conditions (such as depression or crippling anxiety)
- Relationship woes
Dr Tan adds, “It is important also to test whether the patient suffers from testosterone deficiency. The first sign that the patient’s testosterone levels are not at healthy levels is usually the absence of morning erections. Unusual feelings of fatigue and low sex drives are the next most common signs.” Testosterone deficiency can lead to serious problems such as heart disease or stroke. To rule out whether underlying heart issues may be the cause of ED, Dr Tan also ropes in a cardiologist to help him treat his patients if the need arises. “Health screenings help out greatly with general health awareness and wellbeing,” he notes.
Besides drawing blood to check hormone levels, it is also crucial to rule out stress-related factors. He notes that for younger patients, the causes tend to be psychological, “For them, ED can be traced to psychogenic causes such as parental pressure to ‘perform’ in order to have children or time pressure due to wanting to capitalise on the spouse’s ovulation cycle.” For older patients above the age of 50 and who suffer from urinary problems, Dr Tan asks them if they have ED issues during his urology consultations with them as they might otherwise chalk off the inability to sustain an erection as a normal part of ageing.
With support in place, how can ED be prevented?
Like many health conditions, there is no magical cure for ED. However, there are effective treatments which can improve sexual health. The current true cure is still surgical placement of a penile prosthesis to maintain a steady erection. Dr Tan also finds promise in the use of low-intensity extracorporeal shockwave therapy (LiESWT) to treat ED for suitable patients, a treatment which he pioneered in restructured hospitals.
Patients also need to take proactive steps to better their general wellbeing, which contributes to better sexual health. Dr Tan advises, “Leading a healthy lifestyle is the most important thing that can help in preventing ED and other sexual dysfunctions. Exercise increases testosterone and eating well helps prevent early ED as well as diabetes, the latter of which causes early onset of ED.”
He recommends that people adopt the Mediterranean diet, which consists mainly of vegetables, fruits, nuts, beans and whole grains. Dairy, poultry, eggs and seafood can be enjoyed in moderation but, by contrast, red meat should only be an occasional indulgence. Smoking is also a no-no as it can damage blood vessels and lead to poor blood flow — including to the penis.
Teleconsultations: A discrete and convenient method of consultation
Teleconsultations, the use of telecommunication and information technology to provide clinical healthcare remotely, is a new and accessible channel for patients to virtually consult with Dr Tan. “Teleconsultations offer a host of benefits for patients, especially for post-op patients as well as those who have started on injections or medicine to treat ED and who find that the erection doesn’t subside, which of course poses problems with going out of the house to see me,” he smiles. For patients who use a vacuum constriction device (VCD) to achieve and maintain an erection and who find that they require assistance with it, this method of consultation is also useful as the device is conspicuous in size and might draw unwanted attention in public. It is important to note, however, that teleconsultations can only take place after an initial face-to-face consultation with Dr Tan.
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