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20528619 Lprob 1.Pdf Men’s Health Peter H.C. Lim Editor Men’s Health Editor Peter H.C. Lim, MBBS, M Med (Surg), M. Inst. Urol (Lon) FAMS, D. Urol (Lon), FICS Gleneagles Medical Centre Singapore Department of Urology Changi General Hospital Singapore Edith Cowan University Australia H.T. Naval Medical School Indonesia ISBN 978-1-4471-4765-7 ISBN 978-1-4471-4766-4 (eBook) DOI 10.1007/978-1-4471-4766-4 Springer London Heidelberg New York Dordrecht Library of Congress Control Number: 2012956529 © Springer-Verlag London 2013 This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or part of the material is concerned, speci fi cally the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on micro fi lms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed. Exempted from this legal reservation are brief excerpts in connection with reviews or scholarly analysis or material supplied speci fi cally for the purpose of being entered and executed on a computer system, for exclusive use by the purchaser of the work. Duplication of this publication or parts thereof is permitted only under the provisions of the Copyright Law of the Publisher’s location, in its current version, and permission for use must always be obtained from Springer. Permissions for use may be obtained through RightsLink at the Copyright Clearance Center. Violations are liable to prosecution under the respective Copyright Law. The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a speci fi c statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. While the advice and information in this book are believed to be true and accurate at the date of publication, neither the authors nor the editors nor the publisher can accept any legal responsibility for any errors or omissions that may be made. The publisher makes no warranty, express or implied, with respect to the material contained herein. Printed on acid-free paper Springer is part of Springer Science+Business Media (www.springer.com) Foreword Hypogonadism : The associations most physicians have with testosterone are that this hormone only subserves reproductive and sexual functions. Even more salient is the wrongful association most physicians assume to exist between testosterone and the development of prostate pathology such as prostate cancer and benign pros- tate hyperplasia. Recent studies prove otherwise and conclude that the conceptual- ization of the role of testosterone is based on “guilt by association,” not on scienti fi c facts. On the basis of these trepidations many more speci fi cally amongst the elderly who is hypogonadal do not receive adequate androgen treatment. Over the last three decades it has become apparent that the functions of testoster- one in adult life are much wider than hitherto assumed. Testosterone plays a signi fi cant role in the development and maintenance of bone and muscle mass, on erythropoiesis, and on mental functions. The latter is not limited to libido but testos- terone has a general vitalizing function on mood and energy. More recent are the insights that testosterone is a key player in glucose homeostasis and lipid metabo- lism. Again, most physicians will associate testosterone with the sex difference in cardiovascular morbidity. Cardiovascular disease and death occur about a decade earlier in the lives of men than of women. This issue has been critically reviewed and, while the sex difference undeniably exists, it cannot be attributed to testoster- one per se . It may even be that that it is the decline of testosterone with aging that accounts for the skewed sex ratio of cardiovascular disease and death. Several stud- ies now show that low testosterone levels are a predictor of death in elderly men. For long-time clinical conditions befalling the aging male, such as cardiovascular dis- ease, diabetes mellitus type 2, and sexual dysfunction, were regarded as indepen- dent clinical entities. Over the last decade their close interrelationship could be convincingly demonstrated. Declining testosterone levels in the elderly, once regarded as an academic endocrinological question, appears to be central to the above pathologies. It is now clear that erectile dysfunction is an expression of endothelial dysfunction of the cardiovascular function. One could say that erectile dysfunction is a local expression in the penile vasculature of generalized vascular pathology with a common pathological basis. The common underlying factor is endothelial dysfunction. Endothelial dysfunction which manifests itself clinically v vi Foreword as impaired vasodilation is the hallmark of erectile dysfunction. The PDE-5 inhibitors exert their pharmacological action on the endothelium improving vasodilatation. Testosterone de fi ciency is associated with an increased incidence of cardiovascular disease and diabetes mellitus. The latter are often the sequels of the metabolic syn- drome. Visceral obesity, a pivotal characteristic of the metabolic syndrome, sup- presses the hypothalamic-pituitary-testis axis resulting in lowered testosterone production. Conversely, substantial androgen de fi ciency leads to signs and symp- toms of the metabolic syndrome. It is an omission not to include testosterone mea- surements in the workup of the cardiovascular disease, diabetes mellitus type 2, and erectile dysfunction. These conditions hinge on testosterone de fi ciency. With these recent insights, testosterone should no longer be regarded as an exotic/erotic hor- mone but a vital hormone for men, from the “womb to the tomb.” Premature Ejaculation : Sexual arousal accompanied by penile erection is the usual precursor to ejaculation, though not every arousal nor erection leads to ejacu- lation. Men typically reach orgasm 5–10 min after the start of penile-vaginal inter- course. The most signi fi cant determinant is their own sexual arousal and of their sexual partner. Most men can exercise a certain degree of control over achieving orgasm and, if they wish, may delay orgasm and ejaculation somewhat, particularly after some years of sexual experience. Premature ejaculation is the term used when ejaculation occurs before the desired time, as a rule combined with a sense of having no control over its timing. The diagnosis hinges on the history of the patient and, in the best case, supple- mented by his sexual partner. There are no laboratory tests or other diagnostic tools to verify and con fi rm the diagnosis. However, patients often do not present with premature ejaculation as their chief complaint. Therefore, their true problem will not be diagnosed unless a sexual history is taken. Sometimes patients present pre- mature ejaculation as erectile dysfunction, interpreting their resolution-phase loss of erection following ejaculation as a problem of erection. Premature ejaculation may be associated with signs and symptoms of anxiety, depression, or substance abuse, as well as with dif fi culties or changes in the patient’s relationship. The three most commonly used clinical de fi nitions of premature ejaculation have two basic components: an inability to control or delay ejaculation and resultant distress. The American Urological Association (AUA) 2004 guideline on premature ejaculation de fi nes it as ejaculation that occurs sooner than desired, either before or shortly after penetration, causing distress to either partner. The American Psychiatric Association’s DSM-IV further categorizes premature ejaculation as either lifelong (primary), in which the patient has rarely, if ever, been able to control ejaculation, or acquired (secondary), in which the patient initially had a period of good ejacula- tory control but later in life develops premature ejaculation with all or speci fi c part- ners or in speci fi c situations. Lifelong premature ejaculation is the most common form. Acquired premature ejaculation usually begins in men between the ages of 40–50 years. None of the three de fi nitions stipulates objectively a “normal” time to ejacula- tion. In research centres where the intavaginal latency time (IELT) is used it is Foreword vii noted that, men with premature ejaculation will almost always have an IELT less than 4 min. The diagnosis of premature ejaculation encompasses four aspects to be considered: • The short ejaculatory latency • The loss of a degree of voluntary control • The presence of marked distress or interpersonal disturbance • Symptoms not due to any other mental, behavioral, or physical disorder Premature ejaculation is arguably the most common form of male sexual dys- function. The prevalence of premature ejaculation is similar across countries. In the Premature Ejaculation Prevalence and Attitudes study, 23.4–25.6 % of men in Germany, Italy, and the United States had the disorder. Frequent correlation with erectile dysfunction epidemiologic studies has found a high rate of correlation between premature ejaculation and erectile dysfunction. In the GSSAB survey, 41 % of men who reported erectile dysfunction also reported premature ejaculation, and 30 % of men reporting premature ejaculation also had erectile dysfunction. Other studies indicate that about 30 % of men with premature ejaculation also have erectile problems. Although erectile dysfunction
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