Rapid Responses to:
|
|
Rapid Responses: Rapid Responses published:
-
![[Read Rapid Response]](/icons/misc/sectionDOWN.gif)
Mental Health and Erectile Dysfunction
- AMIN MUHAMMAD GADIT (22 October 2008)
-
Sildenafil, not simvastatin may be the best prescription
- Mark Struthers (23 October 2008)
-
Endothelial Dysfunction as the ultimate risk factor for Cardiovascular diseases
- Mohamed Salah-Eldin Noshi,MD,FACP (26 October 2008)
-
Enhancing erections: the role of statins, pde5 inhibitors and de-stressing agents.
- Mark Struthers (26 October 2008)
-
Cardiovascular risk factors and undergraduate education
- Juliette Mutuyimana, Edward JL Armstrong (29 October 2008)
-
Erectile dysfunction and undergraduate education
- Anne L. Appleton (3 November 2008)
|
|
|||
|
AMIN MUHAMMAD GADIT, Professor of Psychiatry Memorial University of Newfoundland, St. John's, A1B 3V6, Canada
Send response to journal:
|
It was interesting to note that the assessment of cardiovascular risk is important in erectile dysfuction. As mental health professionals, we, in most cases assume that this is a psychogenic factor and perhaps the problem is further augmented by prescription of psychotropic drugs. Of late, many of our colleagues do prescribe Viagra for patients suffering from depression and erectile dysfunction. As a routine, every patient is screened for medical problems in our unit but having read this article I feel more educated or rather sensitized to the issue of specific screening. Ironically, elaborative assessments in many instances do not come up with a possible etiological factor for erectile dysfunction and addressing the psychodynamic issue may lead to a blind alley. I believe we need more information from the general medical discipline about the problem of erectile dysfunction. Atleast this will open some avenues for psychiatrists who deal with a large number of such patients. Competing interests: None declared |
|||
|
|
|||
|
Mark Struthers, General Practitioner Bedfordshire mark.struthers@which.net
Send response to journal:
|
This is certainly an intriguing letter. But having identified the erectile dysfunctional at high risk of a coronary, what is the GP or cardiologist to do? Geoffrey Hackett implies that effective treatments for erectile dysfunction (normally paid for privately) may go a long way towards addressing that cardiovascular risk. I suspect that sildenafil and its ilk are likely to be life enhancing to a considerably greater extent than the statins. But what of the evidence? Competing interests: None declared |
|||
|
|
|||
|
Mohamed Salah-Eldin Noshi,MD,FACP, Head division of Internal Medicine SKMC ,Abu Dhabi Cleveland Clinic managed
Send response to journal:
|
While the risk factors for Cardiovascular, Cerebrovascular as well as peripheral arterial diseases include smoking, hypertension, diabetes..etc., it all exerts its deleterious effect through the ultimate risk factor of endothelial dysfunction. The endothelium ,being the largest endocrine , paracrine and autocrine organ in the body can produce a healthier vasodilator and anti- inflammatory mediators in responce to a healthy life style of exercise and healthy eating habits and not smoking . This healthy vasodilator effect is very well demonstrated during a healthy erection , which happens usually after higher centers stimulation leading to inhibition of the sympathetic tone with subsequent dilatation of blood vessels in corpora cavernose. This healthy reaction happens only in healthy endothelium which is capable of producing a healthy amount of Nitric oxide ,also called Endothlium derived relaxing factor, the discovery of which was the reason for winning Nobel prize in medicine or physiology. The effect of sildenafil through preferentially inhibiting Phosphodieserase 5 " most abundant in cavernosal tissue" , leads ultimately to producing higher amount of Nitric Oxide in responce to appropriate stimulation. It appears that the detection of this endothelial dysfunction can be much earlier when erectile dysfunction is diagnosed early , and ED can then be addressed as a whole body cardiovascular as well as cerebrovascular risk factor, that needs the same immediate attention like anginal pains or TIAs with the same recommendations for aggressive smoking cessation, Blood pressure and diabetic control, healthy eating including sufficient amounts of proteins, particularely arginine, nuts , fruits and vegetables , with exercise being the most pivotal part in management, since it has been documented that shear stress on endothelium within a certain range ( avoiding very weak and very vigorous stress)leads to the production of the healthy nitric oxide. The significance of Endothelial dysfunction is that it might be reversible , while atherosclerosis may not have the same outcome. In conclusion , i agree that Erectile dysfunction should be diagnosed early and taken very seruiously as an opportunity to reverse the causes leading to endothelial dysfunction. Competing interests: None declared |
|||
|
|
|||
|
Mark Struthers, GP and prison medical officer Bedfordshire, UK. mark.struthers@which.net
Send response to journal:
|
The evidence suggests that erectile dysfunction (ED) heralds the heart attack – but how and why? What causes the heart attack, what is the cause of erectile failure and what is the link between the two? Is there a simple pharmacological answer that will fix both problems? I somewhat doubt it: people are not that simple, particularly men. Geoffrey Hackett believes that ED is the manifestation of vascular disease of smaller penile arteries and is the warning sign of the heart attack to come. I simply can’t believe that life is that simple. Medical orthodoxy has it that cholesterol is lethal to the smaller penile vasculature as much as to the coronary. The statins lower cholesterol but it is simplistic in the extreme to believe that they’ll prevent that coronary or enhance that erection to any significant extent: men are not that simple. I believe that psychosocial stress links the two: stressed and depressed men droop … and they die early from coronaries. I believe that ED and heart attacks are caused by a dysfunctional Hypothalamic-Pituitary- Adrenal axis (HPA-axis) – it’s that simple. [1] PS. I love prescribing pde5 inhibitors because I simply make men happy. [1] The Great Cholesterol Con. Dr Malcolm Kendrick. John Blake Publishing Ltd. 2007 Competing interests: None declared |
|||
|
|
|||
|
Juliette Mutuyimana, Medical Student Imperial College London, Edward JL Armstrong
Send response to journal:
|
The pathophysiology of atheromatous disease is quite rightly an important topic in undergraduate education. It appears in cardiology and vascular surgery teaching. However, whilst MI, stroke and claudication risk factors are repeatedly emphasised, the topic of erectile dysfunction seems to only be taught in any depth in psychiatry. When learning to take medical histories, students should start to overcome potential embarrassment and start asking male patients if they have erectile dysfunction as well as the other 'big five' risk factors for cardiovascular disease. Competing interests: None declared |
|||
|
|
|||
|
Anne L. Appleton, Clinical Research Physician Eli Lilly & Co., Basingstoke, UK
Send response to journal:
|
Having originally stimulated this debate via BMJ.com, I'd like to add that Juliette is absolutely right: undergraduates should be taught to ask about erectile function as part of the cardiovascular work-up when performing routine clerking. This is the only way to learn to normalise and legitimise the importance of ED in the cardiovascular health of our patients, and indeed to diffuse any embarrassment associated with discussion of sexuality with our patients. Such a simple step would have a significant impact. Let us hope that subsequent generations of doctors will be more enlightened about matters of sexuality than previous, thus aiding in the recognition of risk factors for CVD and hence the fight against the burgeoning impact of this disease. Competing interests: None declared |
|||