Increased awareness of their sexuality and an increase in the number of people experiencing erectile dysfunction and premature ejaculation have renewed attention to men’s sexual health. Urologist Dr Sadashiv Bhole says good sexual health also helps in maintaining the overall well-being and overall health of men. In an exclusive interview with TOI, Dr Bhole breaks taboos and highlights fundamental issues related to the subject.
Excerpts…
Q. What are the recent improvements in men’s health?
A. Men’s health means that there are some unique issues related to their lifestyle, sexual health and urological symptoms. These can include issues associated with prostration, sexual health, and generally harmonious issues in an aging male population. For men’s health, prostate-related problems begin at the age of 50 or sexual health declines. To solve these problems, we need a new approach and a new attitude. Urologists are closely related to these topics. While practicing urology, they also receive education and training in andrology, which deals with men’s sexual health and male infertility.
Q. Should only middle-aged or elderly people pay attention to men’s health?
A. Men of all ages, once they become adults, require a health assessment. When people are young, they have a hard time understanding their sexuality. They have problems regarding wet dreams – ejaculation during sleep. This worries them to the point that they cannot think straight. People come to me totally depressed, thinking that ‘dhaat’ (ejaculation) is some kind of illness. This is a normal physiological state of a person who becomes a man from a boy. Any extra sperm produced by the body is ejaculated. Since time immemorial, the popular perception has been that wet dreams will weaken you, cause blindness, mental instability, impotence, etc. In this context, a young man loses his concentration, he cannot study or carry out daily activities properly. .
Q. How can men deal with such problems?
A. Through counseling we teach men that it is not an illness but a normal bodily activity. The medications are needed in people who think they will cause erectile dysfunction (ED) and impotence when they get married. This helps them and gradually they gain confidence to develop a normal sexual relationship with a regular partner and also that the “dhaat” will disappear. If a person has sex daily, they ejaculate every day. If a person does not have a regular sexual partner, all semen produced is naturally ejaculated. So even if you use it or not, it will be produced daily.
Q. Does it cause erectile dysfunction (ED)?
A. The number of patients with erectile dysfunction is steadily increasing. Doctors are unsure whether this is due to increased awareness among couples or men coming forward to seek treatment themselves or whether there is a real increase in the disorder. My personal view is that it’s both. Erectile dysfunction is now also recognized as a condition. Initially, erectile dysfunction was called impotence, which is not a technical term. Premature ejaculation involves having a normal erection but ejaculating within one minute of vaginal penetration. This leaves a man and a woman unsatisfied. This has a very bad impact on a man’s psychology. Many times premature ejaculation can also cause psychogenic erectile dysfunction. Erectile dysfunction is of two types: one without any anatomical problem but due to various psychological or social factors and the other is organic type. People with diabetes mellitus, excessive smokers and alcoholics have a decrease in the caliber of blood vessels, which is an organic phenomenon.
Q. Why are cases of erectile dysfunction increasing?
A. There are three aspects of health: physical, mental and sexual. All three are important and people understand that too. Alcoholism has increased and is now accepted as a social norm. People started drinking from a very young age. Increased smoking, drug use, fast food culture and high saturated fat content add to erectile dysfunction. Basically, if you see, there is also an increase in coronary heart disease. This means that ED also increases. There is a curious relationship between heart disease and organic erectile dysfunction, as both involve the arteries. So, if a middle-aged man is suffering from organic erectile dysfunction, we strongly recommend him to make lifestyle changes, have a regular cardiac assessment and lipid profile. Penile dysfunction precedes an active heart attack or stroke by about a decade. It’s an indicator.
Q. Is the younger population getting involved?
A. Surprisingly, young people who do not have a regular sexual partner realize that they suffer from erectile dysfunction and seek treatment. These may not be organic but psychological because there is so much pornographic material available on the phone. People also have unrealistic expectations.
Q. Are couples hesitant to seek treatment?
A. There are young couples, even in town, who have been married for three or four years but who have never consummated their marriage. It was surprising that people adapted to live together. But there came a time when they sought help: today, women are as aware as men have problems. Women know that the problem is still not with them but with men who cannot have normal sex. So, couples these days easily seek consultation. They belong to all social strata and even villages.
Q. Does the treatment differ from case to case?
A. Most anxiety-related issues are resolved through counseling. A clinical examination, erectile function test and investigation are carried out. In patients with severe erectile dysfunction, we need medication or surgical interventions if the vessel is damaged. Some medications have a very low dose of stimulation. On demand, these medications help in the long term. Treatment is not focused on sexual intercourse tonight. Care must be taken to ensure that the patient has good erectile function throughout his active life. Sildenafil, commonly known as Viagra, is used for short-term activity while the effect lasts for 48 hours in tadalafil. Avanafil, taken 15 minutes before sexual activity, helps couples with busy schedules. Thus, the dosage is personalized according to needs.
Q. These pills are used for recreational purposes, including as an aphrodisiac in betel leaves. Is it safe?
A. Sildenafil is one of the most abused recreational drugs. It is not recommended for a normal person. These medications cause hypotension. People taking sorbitrate, NTG, or those with low blood pressure may face life-threatening complications from recreational drugs. Visual disturbances may occur.
Q. What is the treatment for premature ejaculation?
A. Until now, there was no specific treatment for premature ejaculation. The US FDA has approved a safe drug that prolongs ejaculation. Non-ejaculation is also another problem affecting people with neurological disorders, diabetes and people who have undergone pelvic surgery. This is also a dysfunction. It is also observed in patients coming for infertility treatment.
Q. What is the impact of hormonal dysfunction?
A. Testosterone or growth hormones peak in young people. After age 40, testosterone begins to decline. It is the most important harmony for maintaining vigor, muscle mass, energy, bone health and also sexual function like desire. The 40s and 50s are the new 20s or 30s. During this time, testosterone levels drop and men feel tired or losing desire. We need to pay attention to a healthy and safe testosterone level in an aging population. It’s not just about sexual health, but also about overall health and well-being. At the same time, these men develop symptoms of prostate cancer. Most of today’s young people will be in this age group within the next ten years. We need a particular specialty to address the needs for urologic and sexual issues in this subset of patients. As we have different specialists, we need people trained in andrology. Male infertility is a unique and complex problem. This not only involves the inability to have normal sexual intercourse, proper ejaculation as well as good seminal parameters to father a child.
Excerpts…
Q. What are the recent improvements in men’s health?
A. Men’s health means that there are some unique issues related to their lifestyle, sexual health and urological symptoms. These can include issues associated with prostration, sexual health, and generally harmonious issues in an aging male population. For men’s health, prostate-related problems begin at the age of 50 or sexual health declines. To solve these problems, we need a new approach and a new attitude. Urologists are closely related to these topics. While practicing urology, they also receive education and training in andrology, which deals with men’s sexual health and male infertility.
Q. Should only middle-aged or elderly people pay attention to men’s health?
A. Men of all ages, once they become adults, require a health assessment. When people are young, they have a hard time understanding their sexuality. They have problems regarding wet dreams – ejaculation during sleep. This worries them to the point that they cannot think straight. People come to me totally depressed, thinking that ‘dhaat’ (ejaculation) is some kind of illness. This is a normal physiological state of a person who becomes a man from a boy. Any extra sperm produced by the body is ejaculated. Since time immemorial, the popular perception has been that wet dreams will weaken you, cause blindness, mental instability, impotence, etc. In this context, a young man loses his concentration, he cannot study or carry out daily activities properly. .
Q. How can men deal with such problems?
Develop
Q. Does it cause erectile dysfunction (ED)?
A. The number of patients with erectile dysfunction is steadily increasing. Doctors are unsure whether this is due to increased awareness among couples or men coming forward to seek treatment themselves or whether there is a real increase in the disorder. My personal view is that it’s both. Erectile dysfunction is now also recognized as a condition. Initially, erectile dysfunction was called impotence, which is not a technical term. Premature ejaculation involves having a normal erection but ejaculating within one minute of vaginal penetration. This leaves a man and a woman unsatisfied. This has a very bad impact on a man’s psychology. Many times premature ejaculation can also cause psychogenic erectile dysfunction. Erectile dysfunction is of two types: one without any anatomical problem but due to various psychological or social factors and the other is organic type. People with diabetes mellitus, excessive smokers and alcoholics have a decrease in the caliber of blood vessels, which is an organic phenomenon.
Q. Why are cases of erectile dysfunction increasing?
A. There are three aspects of health: physical, mental and sexual. All three are important and people understand that too. Alcoholism has increased and is now accepted as a social norm. People started drinking from a very young age. Increased smoking, drug use, fast food culture and high saturated fat content add to erectile dysfunction. Basically, if you see, there is also an increase in coronary heart disease. This means that ED also increases. There is a curious relationship between heart disease and organic erectile dysfunction, as both involve the arteries. So, if a middle-aged man is suffering from organic erectile dysfunction, we strongly recommend him to make lifestyle changes, have a regular cardiac assessment and lipid profile. Penile dysfunction precedes an active heart attack or stroke by about a decade. It’s an indicator.
Q. Is the younger population getting involved?
A. Surprisingly, young people who do not have a regular sexual partner realize that they suffer from erectile dysfunction and seek treatment. These may not be organic but psychological because there is so much pornographic material available on the phone. People also have unrealistic expectations.
Q. Are couples hesitant to seek treatment?
A. There are young couples, even in town, who have been married for three or four years but who have never consummated their marriage. It was surprising that people adapted to live together. But there came a time when they sought help: today, women are as aware as men have problems. Women know that the problem is still not with them but with men who cannot have normal sex. So, couples these days easily seek consultation. They belong to all social strata and even villages.
Q. Does the treatment differ from case to case?
A. Most anxiety-related issues are resolved through counseling. A clinical examination, erectile function test and investigation are carried out. In patients with severe erectile dysfunction, we need medication or surgical interventions if the vessel is damaged. Some medications have a very low dose of stimulation. On demand, these medications help in the long term. Treatment is not focused on sexual intercourse tonight. Care must be taken to ensure that the patient has good erectile function throughout his active life. Sildenafil, commonly known as Viagra, is used for short-term activity while the effect lasts for 48 hours in tadalafil. Avanafil, taken 15 minutes before sexual activity, helps couples with busy schedules. Thus, the dosage is personalized according to needs.
Q. These pills are used for recreational purposes, including as an aphrodisiac in betel leaves. Is it safe?
A. Sildenafil is one of the most abused recreational drugs. It is not recommended for a normal person. These medications cause hypotension. People taking sorbitrate, NTG, or those with low blood pressure may face life-threatening complications from recreational drugs. Visual disturbances may occur.
Q. What is the treatment for premature ejaculation?
A. Until now, there was no specific treatment for premature ejaculation. The US FDA has approved a safe drug that prolongs ejaculation. Non-ejaculation is also another problem affecting people with neurological disorders, diabetes and people who have undergone pelvic surgery. This is also a dysfunction. It is also observed in patients coming for infertility treatment.
Q. What is the impact of hormonal dysfunction?
A. Testosterone or growth hormones peak in young people. After age 40, testosterone begins to decline. It is the most important harmony for maintaining vigor, muscle mass, energy, bone health and also sexual function like desire. The 40s and 50s are the new 20s or 30s. During this time, testosterone levels drop and men feel tired or losing desire. We need to pay attention to a healthy and safe testosterone level in an aging population. It’s not just about sexual health, but also about overall health and well-being. At the same time, these men develop symptoms of prostate cancer. Most of today’s young people will be in this age group within the next ten years. We need a particular specialty to address the needs for urologic and sexual issues in this subset of patients. As we have different specialists, we need people trained in andrology. Male infertility is a unique and complex problem. This not only involves the inability to have normal sexual intercourse, proper ejaculation as well as good seminal parameters to father a child.
