Erectile dysfunction: why men don’t talk to doctors about it enough – penis transplant pioneer and fellow expert explain
Few men get help. Fewer men know impotence is a warning sign of heart disease, diabetes, or worse. Hong Kong doctor, and another who did first US penis transplant, talk about why men need to take their health more seriously
Men are notoriously reluctant to visit doctors, even more so for help on intimate below-the-belt problems.
Dr Andrew Yip, a veteran urologist in Hong Kong, recalls one case when a forty-something patient arrived at his clinic to talk about his penis crisis, having struggled to get his manhood up for the occasion for the last eight to nine years.
Why did you wait so long to seek help? asked a stunned Yip. “He told me his wife was 38 years old and wanted to have a child; it’s a special request, or duties like this, that get patients to see a doctor,” Yip says.
Based on past surveys Yip has done on impotence and men’s health, he says only about 10 per cent of Hong Kong men with this problem seek help. And the rest? “They don’t want to talk about it, they don’t think it’s a disease,” he said. Most Hongkongers do not consider erectile dysfunction a life-threatening condition worthy of high-priority attention.
Causes behind impotence are many – hormonal imbalances, psychological issues, relationships, to mention a few. But most men reading this article will not make the connection that erectile dysfunction could indicate coronary heart disease, diabetes, hypertension, cholesterol problems and more.
“Once they start having symptoms of [erectile dysfunction], what you are actually finding is that it is a symptom of something deeper happening within them – their blood pressure could be out of control, they could be diabetic, they could have kidney disease or high cholesterol,” says Dr Dicken Ko, director of regional urology for Massachusetts General Hospital and one of the surgeons that performed the first penis transplant in the US last year.
Impotence can be a prism into one’s overall health and Dr Ko says a whole picture view of all aspects of the patient’s life is vital since – and this is often the case with men’s health – the problem is not just about erectile dysfunction.
Much research shows a link between these conditions and erectile dysfunction, including a 2008 study in the Journal of American College of Cardiology. Dr Peter C.Y. Yong found this sexual problem was a harbinger of cardiovascular trouble.
Based on more than 2,300 Chinese mid-life men, those with type 2 diabetes and impotence were almost twice as likely to face a cardiac event than non-diabetic men, and faced about a 60 per cent risk of developing cardiovascular-related issues later.
A more recent survey published in the Asian Journal of Andrology in 2014 by Hong Kong researchers looked at type 2 diabetic Chinese men and found that, of its 603 subjects, 79.1 per cent had this sexual symptom but less than 10 per cent sought treatment. Diabetes can impair blood supply and nerves that can result in erectile dysfunction.
Lack of awareness of these issues reflects how men’s health awareness has lagged far behind women’s, according to Ko. This lapse contributes to men’s shorter lifespans, a longevity gap that has persisted for decades in North America.
This disparity exists worldwide. This month, Japan’s health and welfare ministry released data showing that the average Hong Kong man lives about six years less than the average woman (81.32 years for men and 87.34 years for women).
Macho attitudes and societal norms are also at play, including men’s sense of invincibility and self-reliance that make them prone to brush off the need to visit the doctor.
Ironically, men have more reasons to seek medical attention. Extensive evidence shows they tend to engage more in high-risk behaviour and activities and have higher incidences of cardiovascular disease, diabetes and other conditions that can benefit from earlier diagnosis, says Ko.
“We never changed the culture or tell men that you have problems, too, just [as] women have health problems, and if you don’t take care of them early, you’ll get into a lot more trouble down the road,” he said.
Attitudes and societal views about masculinity and the penis were also roadblocks for Ko and his surgical team at Massachusetts General Hospital when they first aired a proposal five years ago to perform a penis transplant.
“Colleagues said to us, ‘You’re going to do … what?!’” the doctor recalls. The medical community and the Boston public alike laughed at them, many vexed at the futility of replacement surgery “when the penis is not a life-sustaining organ”.
The architects of this radical feat did not see it that way, having learned about the depths of suffering soldiers with severe genital injuries experienced, as described by a hospital colleague who previously worked as a US naval surgeon. The recipient of the procedure was Thomas Manning, a penile cancer survivor who was left with a stump of about 2.5cm after having a tumour removed in 2012.
Their goals were to give him back a sense of normality appearance-wise, to restore urinary function, and, they hoped, sexual function, too.
Three-and-a-half years of preparation culminated in the landmark 15-hour procedure in the spring of 2016 known as “vascularised composite allotransplantation.” Since the surgery, Manning can pee standing up; some sexual function has returned, too. Whenever Manning visits the hospital, he arrives with ebullience.
“It’s safe to say there’s been improvement when you see him come into the clinic with a smile and he says, ‘Hey, Doc, I feel good’.”
Ko notes that in reconstructive surgery for women, a tremendous amount of breast augmentation after breast cancer surgery is available, including implants to rebuild the breast, to help restore a woman’s sense of femininity. It is likewise with men. Manning survived penile cancer for years and felt it was time to get his penis back to make him feel “whole” again, says Ko.
Both experts encourage men to talk to their doctors about erectile dysfunction. Most medical experts do not ask patients enough about this symptom, particularly those in high-risk groups such as diabetics.
According to Yip, most Hong Kong specialists, including cardiologists and endocrinologists, don’t ask about erectile dysfunction as they have their own priorities, whether it is managing patients’ heart health, or keeping sugar levels at bay.
“When I asked men [with diabetes] that come to my clinic whether they talked about [erectile dysfunction] with their previous doctors, they usually say ‘No, they never asked,’” says Yip.
Ko says this happens worldwide, as many doctors practise within their guidelines. “In the past five to 10 years, women’s health has had a collaborative structure, where a group of people work together and say women’s health encompasses A, B, C, D, so you need doctors that specialise in A, B, C, D to address those issues on a patient as a team,” he says, adding that this model ought to be used in men’s health, too.
What men with this problem should do
Macho hang-ups aside, talk to your doctor about erectile dysfunction. Educate yourself about this condition and the high-risk groups that should get health checks. For example, diabetics battling impotence should visit the doctor, as further screenings may be necessary from an endocrinologist to monitor sugar levels or other complications related to this disease.
Limit alcohol and quit smoking. In Hong Kong, these habits are common contributors to performance problems, says Yip. Too much booze lowers your sexual response and smoking damages blood vessels that affect blood flow to this organ.
“I often say to patients: if your vessels in the heart can be blocked, your vessels to the penis can be blocked, too,” says Yip.
Treatments vary depending on the patient; options include oral medication, injection therapy (directed into the shaft of the penis), pumps and penile implants. For example, medications (Viagra is a well-known example) vary. Some are faster acting or stronger than others. Follow directions from your doctor, who will prescribe medication in a dose most appropriate for you, says Ko.