A heightened awareness of their sexuality and an increase in the number of people experiencing erectile dysfunction and premature ejaculation have renewed attention to men’s sexual health. Urologist Dr. Sadashiv Bhole says good sexual health also helps maintain overall well-being and general health for men. In an exclusive interview with TOI, Dr. Bhole dispels taboos and emphasizes the fundamental issues surrounding the subject.

Extracts…
Q. What are the recent improvements in men’s health?
A. Men’s health means that there are some unique issues related to their lifestyle, sexual health, and urological symptoms. These can include problems associated with the prostate, sexual health, and generally harmonic issues in an aging male population. For men’s health, problems related to the prostate begin at age 50 or sexual health declines. To solve these problems, we need a new approach and a new attitude. Urologists are closely related to these topics. While practicing urology, they also receive education and training in andrology which deals with male sexual health and male infertility.
Q. Should only middle-aged or old people pay attention to men’s health?
A. Men of all ages, once they become adults, need an assessment of their health. When people are young, they find it difficult to understand their sexuality. They have problems regarding wet dreams – ejaculation during sleep. This worries them to the extent that they cannot think straight. People come to me totally depressed thinking that dhaat (ejaculation) is some kind of disease. It is a normal physiological state of a person who becomes a man from a boy. The extra semen produced by the body is ejaculated. Since time immemorial, the popular perception has been that wet dreams would weaken you, cause blindness, mental instability, impotence, etc. Against this background, a young man loses his concentration, he cannot study or carry out his daily activities properly. .
Q. How can men cope with such problems?
A. Through counseling we teach men that it is not a disease but a normal bodily activity. Medication is needed in people who believe they will cause erectile dysfunction (ED) and impotence when they marry. It helps them and slowly they gain confidence to develop a normal sexual relationship with a regular partner and also this “dhaat” will disappear. If a person has sex daily, they ejaculate every day. If a person does not have a regular sexual partner, all the sperm produced is naturally ejaculated. So whether you use it or not, it will be produced daily.
Q. Does it cause erectile dysfunction (ED)?
A. The number of emergency patients is steadily increasing. Doctors don’t know if this is due to increased awareness from couples or from men who come to seek treatment themselves or if there is an actual increase in the disease. My personal view is that it’s both. ED is also recognized as a condition now. Initially, ED was called impotence, which is not a technical term. Premature ejaculation is having a normal erection but ejaculating within a minute of vaginal penetration. It leaves a man and a woman dissatisfied. This has a very bad repercussion on the psychology of man. Many times premature ejaculation can also cause psychogenic erectile dysfunction. Erectile dysfunction is of two types: one without anatomical problem but due to various psychological or social factors and the other organic type. People with diabetes mellitus, excessive smokers and alcoholics have a decrease in the caliber of blood vessels which is an organic phenomenon.
Q. Why are cases of erectile dysfunction increasing?
A. There are three aspects of health: physical, mental and sexual. All three are important and people have understood this too. Alcoholism has increased and is now accepted as a social norm. People started drinking from an early age. Rise in tobacco, drug use, fast food culture, high saturated fat content all add up to erectile dysfunction. Basically, if you see, there is also an increase in coronary heart disease. This means that the ED also increases. There is a curious co-relation between heart disease and organic erectile dysfunction, as both involve arteries. So if a middle-aged man has organic erectile dysfunction, we strongly recommend that he change his lifestyle, get regular cardiac evaluation and lipid profile. Penile dysfunction precedes an active heart attack or stroke by about a decade. It is an indicator.
Q. Is the younger demographic getting involved?
A. Surprisingly, young people who do not have a regular sexual partner realize that they have erectile dysfunction and seek treatment. These may not be organic but psychological as there is so much porn material available on the phone. People also have unrealistic expectations.
Q. Are couples reluctant to seek treatment?
A. There are young couples, even in town, who have been married for three or four years but who have never consummated their marriage. It was surprising that people adapted to live together. But a time came when they sought help because now women are as aware as men have problems. Women know that the problem is not always with them but with men who cannot have normal sex. Thus, couples nowadays are simple to consult. They belong to all social strata and even to villages.
Q. Does the treatment differ from case to case?
A. Most anxiety-related issues are resolved through counselling. A clinical examination, an erectile function test and an investigation are carried out. In patients with severe erectile dysfunction, we need medication or surgery if the vessel is damaged. There are some drugs with a very low dose of stimulation. On request, these drugs help in the long term. The treatment is not focused on having sex tonight. We must ensure that the patient has good erectile function throughout his active life. Sildenafil commonly known as Viagra is used for short term activity while the effect lasts for 48 hours in tadalafil. Avanafil, taken 15 minutes before sexual activity, helps couples with busy schedules. Thus, the dosage is personalized according to the needs.
Q. These pills are used for recreation especially as an aphrodisiac in betel leaves. Is it safe?
A. Sildenafil is one of the most widely abused recreational drugs. It is not recommended for a normal person. These drugs cause hypotension. People taking sorbitrate, NTG, or those with low blood pressure can face life-threatening complications with recreational drugs. Visual disturbances may occur.
Q. What is the treatment for premature ejaculation?
A. Until now, there was no specific treatment for premature ejaculation. The US FDA has approved a safe drug that prolongs ejaculation. Non-ejaculation is also another problem affecting people with neurological disorders, diabetes, people who have undergone pelvic surgeries. It is also a malfunction. It is also seen in patients coming for infertility treatment.
Q. What is the impact of hormonal dysfunction?
A. Testosterone or growth hormones are at their peak in young people. After age 40, testosterone begins to decline. It is the most important harmony to maintain vigor, muscle mass, energy, bone health and also sexual function such as desire. The 40s and 50s are the new 20s or 30s. During this time, testosterone drops and men feel tired or low on desire. We need to pay attention to a healthy and safe testosterone level in an aging population. It’s not just for sexual health, but for overall health and well-being. At the same time, these men develop symptoms of prostate cancer. Most young people today will fall into this age group within the next 10 years. We need a particular specialty to meet the needs of urological and sexual issues in this subset of patients. As we have different specialists, we need people trained in andrology. Male infertility is a unique and complex problem. It involves not only the inability to have normal sexual intercourse, proper ejaculation, and also good seminal parameters to father a child.