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| Sunday, 10 March 2002 |
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| News Business Features Editorial
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Diabetic impotence - an impaired hormonal function by ARYADASA RATNASINGHE The relationship between diabetes (Diabetes Mellitus) and impotence in men or frigidity in women, was first recognised in 1798. Since then, diabetes as a chronic, debilitating and degenerative disease, has received increased attention among the medical men, to find a permanent cure for the ailment, but so far no satisfactory improvement has been made to fight against the disease. Since diabetes is a disturbance of the endocrine function, it adversely affects sexual response, and is one of the most insidious diseases that afflict married men and women (the unmarried are not excluded) in enjoying the pleasures of conjugal harmony, though they keep it a secret and do not divulge to others. The incidence of diabetes and its adverse effects on sexuality are probably equal, if not greater than those of all other endocrine disorders combined. Changes in sexual function, which sometimes accompany old age may also be one of its sequelae, i.e., impotence, female orgasmic dysfunction (frigidity), loss of libido and infertility. Most of the research studies, regarding the effects of diabetes on sexuality, have been directed towards male diabetics, their impotence and ejaculatory incompetence, while they have received less attention on females. In the male, the onset of impotence is usually gradual, presumably from one year to three years, depending on the potency of diabetes. It begins with a gradual loss of firmness of erection. It is said that during early stages of the ailment, the man may be able to experience orgasm and to ejaculate. If the position were to continue, total failure may occur leading to mental worry and jealousy towards the partner. If libido persists, the diseased may have normal or increased sexual interest and drive, despite loss of erectile ability. Although the precise etiology of diabetic impotence is not clear, it has been postulated that four conditions are possible, viz: (i) the type of diabetic neuropathy, (ii) vascular changes and arteriosclerotic changes in penile blood vessels that impair pooling and trapping of blood to support erection in the corpora of the penis, (iii) a disruption of the hormonal balance and (iv) psychogenic factors, such as masturbation impair cohabitation. Three etiological types of sexual dysfunction have been identified, i.e., constitutional, psychogenic and organic. In the male, constitutional impotence is usually associated with weak sexual drive (libido) and responsiveness. Organic impotence develops after previous sexual ability and results from some pathological condition. Clinically, organic impotence is constant and continues unchanged, irrespective of any sexual stimulation. In contrast, psychogenic impotence is selective and transient, occurring in certain situations and at certain times. In some men, lack of libido persists when cohabiting with their wives, but the position changes during extra-marital companionship, which is purely psychological and not physical. Many wives, perhaps, may have found this weakness, although they do not divulge it to others as a moral obligation. Emotional reaction to diabetes can be severe, because anxiety and fear of disability may adversely affect sexual function. It is said that individuals whose diabetes is poorly controlled, may experience continued stressful incidents or hypo and hyperglycemia and may be very apprehensive. Difficulty in obtaining an erection by the male or the development of orgasmic dysfunction in the female diabetic, contributes to this anxiety. True to their conscious, feeling, couples contemplating marriage, in which one or both are diabetic, should think twice before their union, without embarrassing the other partner. Diabetes, if well controlled, should not disturb usual roles and relationships. However, if neuropathy or vascular or endocrine complications affect
the body system, the diabetic may have to curtail or alter sexual
activities, with subsequent threat to sexual identity. However, in most
instances, the cause of diabetic sexual dysfunction appears to be
neurogenic. There seems to be no prophylaxis or therapeutic intervention
and the prognosis is poor. Exercise and your heart by Dr. D.P. Atukorale "The chief danger of automobiles is not of accidents but of the fact that it takes people off their feet," Paul White, an American cardiologist once said. So enthusiastic was he about the value of exercise in keeping one's heart in good condition, that he rode a bicycle every day in his native Massachausettes where cars practically outnumber people. Reasonable and regular exercise keeps the heart fit and the blood vessels young. The danger arises only when the person stops exercise. The risk of heart attacks is then great. In Sri Lanka it is the biggest killer among men before retiring age and accounts for one third of all hospital deaths. Regular and steady exercise is, therefore of immense importance in averting heart attacks. An athlete's heart, for example, learns to meet the bigger demands for oxygen. Just as the muscles of the arms and legs improve in efficiently with exercise so do the muscles of the heart. With exercise each tiny muscle fibre of the heart becomes stronger and the heart is able to pump out more blood as and when necessary without undue strain or effort. A person not accustomed to regular exercise may, if he exercises in fits and starts, have a heart speed of 120-150 beats per minute and may also pant excessively unlike the one who exercises regularly and whose heart can take the same amount of exertion with only a slight quickening of the pulse - perhaps 80-100 beats per minute with no panting. Studies Wenckebach, a leading German cardiologist also wrote in 1931 "there is no doubt that exercise delays the onset of arteriosclerosis. Exercise cancels the harmful effects of a rich diet, too" Dr. G.V. Mann's experiments have proved that doubling the daily food intake didn't cause an increase in blood cholesterol if enough energy was expanded with muscular activity. In 1956, Ancel Keys, measured the blood cholesterol increase after breakfast in sedentary men and in men who took exercise. The blood cholesterol rise among the sedentary was significantly higher. In 1962 Dr. Golding, Director of Exercise and Physiology, Laboratory, Ohio, State University found that one can reduce the blood cholesterol level as much as 25 per cent in one year by exercising. A moderate amount of exercise is sufficient to normalise blood cholesterol provided calories are watched and the dietary fats are consumed in moderation. Dr. Jane Morris stated in a study based on 3,800 autopsies 'men in physically active jobs have less coronary heart disease during middle age, what disease they have is less severe but they develop it later than men in physically inactive jobs. Another protection which exercise affords against heart attacks is through the stimulation of the co-lateral circulation when there is a danger of coronary blockade. Exercise widens the narrow by-paths the back-road coronary blood in the affected section of the heart so that the blood can by-pass the obstruction. Exercise does more for the stimulation of co-lateral circulation than medicine or surgery can offer. |
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