Sexual health and function are important determinants of quality of life. Disorders such as erectile dysfunction (ED) and female sexual dysfunction are becoming increasingly more important as a result of the aging population. Because this subject is discussed widely in the media, men and women of all ages are seeking guidance in an effort to improve their relationships and experience satisfying sexual lives.

Sexual dysfunction is often associated with disorders such as diabetes, hypertension, coronary artery disease, neurologic disorders, and depression. In some patients, sexual dysfunction may be the presenting symptom of such disorders. Additionally, ED is often an adverse effect of many medications.

Successful treatment of sexual dysfunction has been demonstrated to improve sexual intimacy and satisfaction, improve sexual aspects of quality of life, improve overall quality of life, and relieve symptoms of depression.

The availability of 3 phosphodiesterase-5 (PDE-5) inhibitors, ie, sildenafil (Viagra), vardenafil (Levitra), and tadalafil (Cialis), has altered the management of ED. Patients no longer expect or are willing to undergo a long evaluation process to obtain a better understanding of their sexual problem. They are less likely to involve their partner in a discussion of their sexual relationship.

The etiology of ED is usually multifactorial. Organic, physiologic, endocrine, and psychogenic factors are involved in the ability to obtain and maintain erections. In general, ED is divided into organic and psychogenic impotence, but most men with organic etiologies usually have an associated psychogenic component. Almost any disease may affect erectile function by ltering the nervous, vascular, or hormonal systems. Various diseases may produce changes in the smooth muscle tissue of the corpora cavernosa or influence the patient's psychologic mood and behavior.

Diabetes is a well-recognized risk factor, with approximately 50% of diabetic men experiencing ED. The etiology of ED in diabetic men probably involves both vascular and neurogenic mechanisms. Evidence indicates that establishing good glycemic control can minimize this risk. Cigarette smoking has been shown to be an independent risk factor. In studies evaluating more than 6000 men, the risk of developing ED increased by a factor of 1.5

Mental health disorders, particularly depression, are likely to affect sexual performance. The MMAS data indicate an odds ratio of 1.82. Other associated factors, both cognitive and behavioral, may contribute. Also, ED alone can induce depression. The new oral agents have been shown to be effective for men who develop depression following prostatectomy. A sedentary lifestyle is a contributing factor to ED. Exercise has a beneficial effect on the cardiovascular system, and some data from the MMAS indicate that men who exercise regularly have a lower risk of ED. However, Goldstein et al reported an increased risk of ED in men who rode a bicycle for long periods. Therefore, the type of exercise may be important.

The MMAS study also showed an inverse correlation between ED risk and high-density lipoprotein cholesterol levels but no effect from elevated total cholesterol levels. Another study involving male subjects aged 45-54 years found a correlation with abnormal high-density lipoprotein cholesterol levels but also found a correlation with elevated total cholesterol levels. The MMAS study had a preponderance of older men.

Vascular diseases account for nearly half of all cases of ED in men older than 50 years. Vascular diseases include atherosclerosis, peripheral vascular disease, myocardial infarction, and arterial hypertension. Vascular damage may accompany radiation therapy to the pelvis and prostate in the treatment of prostatic cancer. In this situation, both the blood vessels and the nerves to the penis may be affected. Radiation damage to the crura of the penis, which are quite susceptible to radiation damage, can induce ED. The radiation oncologist must take precautions to avoid treating this area. Data indicate that 50% of men undergoing radiation therapy lose erectile function within 5 years after completing therapy. Fortunately, these men tend to respond to one of the PDE-5 inhibitors.

Physician :

• นายแพทย์ปรีชา เตียวรุ่งเรืองสุข (Urologist)