Exercise to prevent and treat Erectile dysfunction (ED)

Exercise at moderate and high intensity has been shown to reduce risk of erectile dysfunction by 37 and 58 per cent respectively. Erectile dysfunction is one of the most common men’s health problems, especially among those...

WHAT IS THE RELATIONSHIP BETWEEN ERECTILE DYSFUNCTION AND HEART DISEASE?

Erectile dysfunction (ED) is the inability to attain or sustain erection of sufficient quality for or during sexual intercourse and performance.

Worldwide, it is estimated that 150 million men have some degree of erectile dysfunction. The figure is likely to double by 2025.

It is one of the most common men’s health problems, especially among those above 40.

In Malaysia, the prevalence of ED is estimated between 26.8-69 per cent in this age group. It means that, in every 10 males aged more than 40, there are about three to seven persons with ED.

Higher prevalence was shown in urban areas, where 70.1 per cent of males in urban areas in Malaysia has ED. ED increases with age. Most (65 per cent) will usually seek traditional medicine for treatment.

ED is associated with other medical conditions like hypertension, diabetes and heart disease. The causes of ED are vascular, neurological, hormonal and psychological.

The most common is vascular problem. ED shares the same risk factor as heart disease. ED is not a life-threatening condition, if it does not occur alongside heart disease.

However, most patients presented with coronary heart disease will usually have ED.

At the same time, patients presented with ED may have heart disease too. A study in Malaysia showed that 90.4 per cent of patients with ischemic heart disease have some degree of ED.

Two-thirds have moderate to severe ED. Lifestyle is the most important modifiable risk factor in ED and heart disease. The lifestyle risk factors are smoking, physical inactivity, obesity, bad diet and alcohol intake. Controlling these factors such as taking up exercise will help reduce the risk of getting ED (and heart disease too).

HOW DOES EXERCISE PREVENT ERECTILE DYSFUNCTION?

Lack of exercise is one of the important lifestyle risk factors of ED after smoking. If you are physically inactive, you have three to four times chance of getting ED than active people.

Exercise at moderate and high intensity has been shown to reduce risk of ED by 37 and 58 per cent respectively. The higher the intensity of exercise, the lower the risk of getting ED. A population study reveals that exercise of more than 18 METs-hour per week will cause better erectile function.

This is equivalent to brisk walking of 3.6 hours per week, or 30 minutes of brisk walking per day. This is similar to the recommendation of exercise by the World Health Organisation, which is more than 30 minutes of exercise per day, five times a week. The more the exercise, the more benefit you will reap.

The most common cause of erectile dysfunction is vascular problem, where there is a problem of artery supplying blood to the region, known as endothelial dysfunction.

In endothelium dysfunction, the artery is not able to produce nitric oxide, which causes occlusion and narrowing of the artery, reducing blood flow and impairing the erection process.

Exercise is able to prevent ED by ensuring availability of nitric oxide through improvement of endothelial function of the artery.

The availability of nitric oxide production by normal endothelium will ensure normal erection process.

CAN EXERCISE TREAT ERECTILE DYSFUNCTION?

Lifestyle modification is the first line of treatment for ED. Exercise is part of lifestyle modification and improvement of ED by exercise has been shown in many studies.

Erectile dysfunction is assessed using International Index of Erectile Function 5 (IIEF-5). Its range of score is between 5 and 25. A score of 22 or more is considered as normal erection function.

There is a systematic review published in Sexual Medicine Journal in 2018. The aim of the study is to provide recommendation of exercise for men with ED.

The review analysed 10 intervention studies, using physical activity to reduce ED.

The study showed that there is improvement of IIEF score between 15 per cent86 per cent in the intervention group (with exercise).

The study concludes that the recommended exercise to decrease ED is 40 minutes of aerobic exercise at moderate to vigorous intensity four times per week.

A total of 160 minutes of exercise per week for six months will decrease erectile problem in men with ED due to physical inactivity, obesity, hypertension, metabolic syndrome, and/or cardiovascular diseases

.

Lack of exercise is one of the important lifestyle risk factors of erectile dysfunction after smoking.

I’ve been taking a laxative for two years ...could it harm me?

 I HAVE been taking a laxative for the past two years for chronic constipation. I’m worried now that long-term use might cause me damage, and it feels there’s no end in sight. Can you offer any advice?

CONSTIPATION is a common problem. The aim of laxatives is to help open the bowels with more ease. There are different types available – some, like Movicol, Laxido and lactulose, increase the amount of water in the bowels. This has the effect of softening things, so it’s easier to go. Others, such as Dulcolax (bisacodyl) and senna, stimulate the bowel muscles to get them moving.

There are also bulk-forming laxatives which contain soluble fibre – their aim is to hold on to fluid within the stool, again keeping things soft. Fybogel, which contains a fibrous seed extract called ispaghula husk, is a well-known version.

What will work for an individual depends on personal factors, such as how much water you drink and what is causing the constipation.

New constipation is always a reason to see a doctor as this is considered a change in your bowel habit and can indicate serious disease.

Laxatives are usually not recommended long-term because they can affect the balance of fluid in the body. They can also cause diarrhoea and bowel blockages known as intestinal obstruction.

It is usually recommended to come off laxatives very gradually over months to try to cut down on use. Generally they are continued long-term only for people with a medical condition that causes constipation, or if somebody is taking a medication that causes constipation.

Do not underestimate how useful non-drug measures can be for constipation. Drinking plenty of fluids and eating fruit, as well as taking plenty of exercise, are all known to help the bowels move along.

I HAVE prostate problems, and haven’t had an erection for a long time. I’ve tried Viagra, but it doesn’t work. My partner still wants sex, as she is younger than me, and this is ruining our relationship. What should I do?

SEX is a healthy and important part of a relationship, and it is distressing when it is affected by medical issues. Unfortunately, erectile dysfunction can be a complication of prostate problems – and treatment for them – but there are certainly ways to help. Firstly, do not be embarrassed to speak to a GP, as we regularly see patients about this sort of thing. With a new case of erectile dysfunction, I’d always recommend blood tests to check testosterone levels, and for diabetes. Raised blood sugar, over time, can damage small blood vessels, and a symptom of this can be problems with getting or keeping an erection.

Medications can also cause the problem – for example, some high blood pressure tablets. It is also worth thinking if any lifestyle issues, such as too much alcohol or obesity, are making matters worse.

Sildenafil, known by the brand name Viagra, is one of the commonly prescribed drugs for erectile dysfunction. It can be bought over the counter, but there are other options.

Before saying they don’t work, it is vital to trial different doses and the different drugs.

It is also crucial to understand they don’t spontaneously cause an erection: you still need to engage in normal sex and foreplay to make things work.

They also all have strict timings and some are affected by meals. Each medication should be tried for six to eight weeks before a further consultation and then trying something else.

If nothing is working from the GP, a urologist can help with other treatments such as injections and creams.

I’M asthmatic and have a terrible chesty, rattling cough that won’t go. I spoke to the GP on the phone and he prescribed antibiotics – amoxicillin – and a steroid, prednisolone. But I finished my course two weeks ago, and it’s just as bad as ever. I also feel hot. I would be grateful for any advice.

SYMPTOMS like these make me think Covid – and we are seeing a lot of this at the moment.

Covid tests will only come back positive in the first week or so of infection – so there’s little point in doing one now – but chest symptoms, in particular, do seem to take a while to resolve.

The fact that antibiotics have not helped makes me think it’s even less likely to be a chest infection, and more likely to be the effects of a virus, like Covid.

People with asthma are more at risk of symptoms like these from any infection, whether viral or bacterial, so it is important to speak to the doctor again, if problems persist.

This is especially the case if there is shortness of breath.

The doctor will need to decide whether to try another antibiotic, or if it is in fact viral, meaning antibiotics will be ineffective.

Oxygen levels and breathing need to be checked to see if further steroids are needed: prednisolone dampens inflammation, which is usually given for five days for an acute asthmatic problem.

The GP should consider altering the dose of inhalers the patient is using as well as checking to make sure they are using them properly. In some cases a chest X-ray may be useful.

If it is viral, it may take some weeks or even months to get better, but it usually does.