Dr Irengbam Mohendra Singh
“Everyman thinks meanly of himself for not having been a soldier, or not having been at sea,” wrote Samuel Johnson. That was meant for Europeans. Universally, there are other aspects that demean men. A man who suffers from erectile dysfunction (ED) has a very low esteem of himself.
The discovery of Viagrahas changed prayers into reality for an estimated 150 million men who are suffering from RD in the world. Now, hard science has discovered the cause of ED, which until recently, was blamed on psychological factors. It is now mostlyphysiological causes, such as smoking (damage to small blood vessels) and excessive cycling (small nerve damage).
The most common physiological factor is ageing; men over 50 years. Not everybody though. 40% of men over 60 years suffer from it, a cause that doctors find hard to explain except low testosterone hormone level in blood. But injection of testosterone does not always relieve the symptoms, showing there are other factors.
Causes of ED are divided in to two major groups: (1) organic including the ageing process and (2) psychological, all sorts including depression.The organic causes include heart disease, high blood pressure (hypertension) anddiabetes (all causing thickening of arterial walls), prostate surgery and spinal cord injury (nerve damage).Drugs used in the treatment of heart failure and hypertension like diuretics (water pills) can cause ED as it reduces blood flow. Drugs for the treatment of psychotic illnesses and hypertensioncan cause ED. Some do illnesses like hypogonadism, Peronei’s Disease and multiple sclerosis. Stress and anxiety cause ED and vice versa.
Men, probably up to1 in four under 40,who suffer quietly with this most humiliating curse, and their wives, who mostly think their husbands have other women, have been praying to God for its cure since time in memory. But God does not always listen to people’s prayers, unlike in Baiju Bawra(Baiju the mad), a legend that made the film Baiju Bawra (1952) a classic. I remember it seeing in Bombay while in college.
Its most soul-numbing song (abbreviated): O duniyakerakhwale/sun dardbhare mere naale/ Chand kodhundepagalsuraj/shaamkodhundesabera/meibhidhunduoospritamko,hona sake jo mera/ Bjagawanbhalahotera/ nayasangatoofanbanaya/ab to neerbahale, still haunts my senses.
In English: O guardian of the world/ listen to my painful laments/ the crazy sun searches for his moon/ the evening searches for his dawn/ I’m also searching for my beloved that I can’t find/ God, all be well with you/ along with the boat you made the storm/ now at least shed some tears.
In the film, the stone statue of a god shed tears from his stone eyes as Baiju bemoaned, during hiswandering to look for his step granddaughter Meera, singing his song in high pitch.This creative thinking is psychology. It is soft science.The legend of Baiju Bawra is still preserved in Jai Vilas Mahal in Gwalior and so isTansen’smemorial tomb in Gwalior.
Science is generally considered of two types: (1) hard science and (2) soft science. Hard science, such as physics, chemistry and biology do not change the behaviour of nature eg Earth continues to move round the sun. Soft science, such as psychology, sociology, political science, deals with people and theories about people’s beliefs and behaviour that can change with time.
There are millions of men with ED, but everybody does not admit to it, as it’s a public humiliation. Men found it difficult to approach the subject even to a doctor (not anymore since the advent of
Viagra). Somany men have been suffering it quietly. I had an Indian friend (now deceased), who had developed ED after having 2 children, but he could not humiliate himself by telling his young English wife that he had become impotent (because of surgery on one kidney, done on the quiet).As his wife was not aware of it and he was failing in his marital duty, she divorced him. A few years after an acrimonious and expensive divorce, he was found deadfrom a heart attack,at his tiny flat where he lived alone, rather than in his big family house.
ED has been a scourge for men since the beginning of written history. It’s recorded in the Old Testament. King Abimelech of Gerarwas punished with it for taking Abraham’s wife, Sarah (Genesis 20:3). King David had treatment for it (First Book of Kings 1:1). In Medieval history that began with the fall of the Western Roman Empire in 5th century BC, its records were found in Egyptian tombs, and Greek cup paintings. It affects men of all races and across all social classes.
Researchers have been trying to findtreatment for ED for over 200 years. There were placebo treatments of all kinds during the ancient Greek and Roman times, such as application of balms and eating cooked testes of goat. While I was in Bombay in early ‘50s, the Chowpatty sandy beach at Marine Drive, used to have pan-wallas selling pan for 50 rupees a piece, probably containing cocaine, while the normal one was only a paisa.
It this 21st century, men have been fortunate having more effective treatment options with evidence-based results to support their use. There are vacuum and penile implantation devices, and low-intensity extracorporeal electric shock. Locally injectable Papaverine was available since early 1980s andAlprostadil(Caverjet) or in suppository form, MUSE have been marketed since 2013, but they were limited to a very small population of patients.
Now, more effective and convenient oral drugs are available. Viagra (Sildenafil) and other four chemically related drugs top the list. They are very effective with hardly any side-effect.
Viagra was first introduced in 1988 by Pfizer as treatment for hypertension. The potential for Viagra was spotted by a British chemist at Pfizer’s Research laboratories in Kent in England in 1989, by accident. It helped ED better than hypertension.
It might be of interest to some readers how scientist often use themselves as guinea pigs. The Australian doctor Barry Marshall, who discovered the cause of stomach ulcer in 1985, swallowed bacterium helicobacter pylorito confirm they caused peptic ulcer.
Paving the way for Viagra tablets, was a pioneer British physiologist Prof Giles Brindley (1926- 2017), better known for his daring public scientific demonstration of the potential of drug therapies for ED. He announced his breakthrough at the 1983 meeting of the US Urodynamic Society in Las Vegas in a lecture called Vasoactive Therapy for ED.
During the lecture, Brindley showed a series of photographs of a penis (his own) in various stages of tumescence after injections by phentolamine or papaverine (that opens up blood vessels in it) Prior to this, he had tried 33 different drugs.There was no doubt in the mind of the scientists present there, that the drugs were effective.
Further, to prove that his erect penis was not due to a prosthetic implant, he dropped the pants of his tracksuit that he was wearing especially, to his knees, and said he had injected himself with papaverine before the lecture. Then he waddled down the steps, approaching to the horror of the urologists and their partners (not wives), who were dressed in full evening regalia for the evening reception. He invited them to feel his penis to show that there was no implant.
As she approached four or five women in the front row, they threw their arms up in the air and screamed. He soon pulled up his trousers and went back to the stage. But he made the point and the History of treatment of ED has changed for ever.
Research on ED continues. Recently, in 2010, gene transfer therapy has been proposed for ED for those who do not respond to oral medications. The first human gene transfer therapy in 2006 indicated gene therapy lasts for months, and eliminates the patients’ needs for on-demand drugs. It’s still in its infancy. In this treatment, a single intravenous injection of this naked DNA in a dose of 500-1000 micrograms,produces viable solutions for ED.
The newest research (December 2018, the American Journal of Human genetics)is about the discovery of a single gene that is linked to ED. More than 6,000 men who have admitted to being impotent have allowed their Genomes to be analysed. That helped scientists to pinpoint the key gene causing ED. Scientists used data from biobanks – centres that collate genetic and health information, from Britain, Estonia and America. They could access 3.050 impotent men fromUK; 1,182 from Estonia; and 1,943 from America. They used computers to find how the DNA of men with ED differ from those without.
Their findings pointed to only one gene, “SIM1”. This gene, rather the defective version of it, is already known to be related to Type 2 diabetes, obesity and hypertension – the correlation of which has been puzzling medical scientists. Now they know they all involve the same gene.Scientists now believe that this gene SIM1 helps to ensure that hormones crucial for triggering erection, reach their target in the brain. And by targeting this genetic risk factor, ED could be cured.
Many men lost in the darkness of life are going to reach the light.
The writer is based in the UK Email: firstname.lastname@example.org Website: drimsingh.co.uk
Dr Irengbam Mohendra Singh