Men have been advised not to resort to self medication in treating erectile dysfunction (ED), even as cases of ED are on the increase in the country.
A consultant urologist at the Lagos University Teaching Hospital (LASUTH), Ikeja, Dr. Funmilade Omisanjo gave this advice while addressing `pharmacists at the one day Pharmacy Academy programme organised by Pfizer Global Pharmaceuticals Limited for Retail Pharmacists.
He said as a clinician there is a remarkable increase in ED among Nigerian men. “The figures we have with us will suggest that at least 30 percent to 40 percent who are above the age of 40 have some degree of erectile dysfunction, some are mild form of dysfunction. By the time you look at men who are 60 years and above, at least 25 percent of them have the very severe form of erectile dysfunction.
“So what that means is that if you sit amongst a group of 50 years old you can expect one out of every two of them to have some degree of erectile dysfunction, for most of them it will be the very mild form of erectile dysfunction. Mild in the sense that the men can still have some sexual intercourse but he may find out the extent of the hardness (turgidity) of the penis is not what it used to be, because we measure erectile dysfunction not in the presence of or absence of erection, we also talk about the turgidity of the organ. So it is roughly about one in two in men above 50 years.”
According to Dr Omisanjo presence of ED could be a sign of other illnesses in the body such as diabetes, hypertension and other cardiovascular challenges.
Dr Omisanjo said, “For most people it is basically an age-related thing. As men get older one expects there will be some deteriorating in their sexual function this is likened to women who attain menopause, in men we loosely termed it Andropause. This is highly prevalent in men who are above 50 years. Age is a very important factor in ED. Also lifestyle is a very important factor.
“Obesity is related with that, just as lack of exercise. People who do sedentary work or people who don’t do any physical activity are prone to obesity. That kind of lifestyle will also predisposed people to erectile dysfunction. Things like smoking, taking a lot of alcohol, and most of these recreational drugs that people take actually have side effects of affecting erection negatively.
“Then of course you have various co-morbidities other diseases thing like diabetes mellitus, Hypothermia, which is a medical emergency that occurs when your body loses heat faster than it can produce heat, causing a dangerously low body temperature. People who have problems with high level of cholesterol in their system, high blood pressure, people who have problems with their nerves are all susceptible to ED. Then of course there are medications people take for various medical conditions that have various erectile dysfunctions as side effects. These are some of the factors that predisposed men to erectile dysfunction.”
On how best to know one is suffering from ED, and the best way out Dr Omisanjo said, “Curiously you may find out that the local things that these men take actually do work, but sometimes even when they work, the results will come at the expense of some other things in the body system. For instance, most of the local things that people take are invariably things that have been soaked in alcohol. Alcohol in itself can be a risk factor for erectile dysfunction, besides that, chronic intake of alcohol can have other side effects on the liver and all that.
“You can never tell what the concentrations of these things are. So in as much some of these do work they are not the things we prescribe routinely. We don’t encourage men to take herbal remedies for the treatment of erectile dysfunction. We always advise men to try and seek expert opinion and seek treatment at standard clinics or hospitals because we have well proven medications that do work.
“And what more is important is that erectile dysfunction can be a pointer of other problems that a man may have. So in as much as you want to treat erectile dysfunction it is important you evaluate that man fully, because some men with erectile dysfunction may have some cardiovascular diseases (blood pressure) that we would need to sort out. So it is not enough for the man to feel he has erectile dysfunction and just goes on his own and goes about taking herbal remedies which like I said, even if they work, invariably, do have some other effects. So we normally advise they see their doctors and have a very open discussion and get to be reviewed, evaluated and treated.”
Suggesting further on the professional way out, Dr Omisanjo said, “For me it will be that in as much as we like patients coming to us sometimes the pharmacists invariably are the first point of call because of the way most pharmacists stores are structured, patients sometimes find it easier to go to a pharmacy in the neighbourhood than going to a doctor that will only be available at teaching hospital setting, so the pharmacist may be the first point of call.
“The important point to stress to pharmacists is that patients who have erectile dysfunction sometimes will come under the guise of all other sort of things. I think the pharmacists should take out time and have a discussion with the patients and when you see there is some degree of erectile dysfunction; you need to encourage the patient to see an expert. Sometimes they may say they need an energy boost or some herbal supplements. I think experts should be sensitive to patients need. When people come with all this kind of loose complaints as it were, probe a little further.
“Not only is it important to obtain proper treatment, more importantly, let the patient get a thorough evaluation so that you do not miss out on anything. So the pharmacists should not only be interested in dispensing the medication but it is always good to have some discussion with the patient, because that may be the only way you may pick erectile dysfunction in some of these men. Most of these men will not want to come out to tell you what they have. That will be my main message to the pharmacists.”
On the impact of the training, Mr. Lere Bale said Pfizer Pharmacy Academy is totally about empowering pharmacists about the principles of patient management with medications and the whole objective is to enhance their knowledge, to give them tools to influence them so that they can have a change of attitude towards new medicines and see the importance of new medications, how much savings every new innovation can bring.
Mr. Bale said every time a company comes up with a new medication, for every dollar you spend on new innovation you will save as much as eight dollars on hospitalisation. Typically which is costing the US economy 300 billion on both hospitalization and associated costs of manning for those people, and they will be able to build their skills on the particular therapy area.
“They now have options or multiple options as to what they can do. It will also enhance their knowledge base on medication on the group of medication for that therapy area, which will therefore spur them into action to know that one can in a while they can pick the drug or they recommend the drug or pick a particular brand even though may be slightly higher in pricing it does not imply that it is cheaper overall. That you think a medicine is cheap does not mean the pharmacological profile, the biopharmaceutical profile of another, its creates more problem when the patient is going back to the hospital, the patient is going to be hospitalized, when the patient is taking a bed space that he shouldn’t have taken in the first instance, in a country like ours where we do not have enough bed space and so the compounding effects is more than imagined,” he said.
Mr. Bale said; “We are also going to be looking at lessons to be learnt on those who will normally substitute or those who will normally say generics are better and without establishing that it is the same thing bio-pharmaceutically or in terms of bio- availability. So when this happen we believe that we will be able to learn some lessons from the experiences they will have before and begin to say NO. If somebody needed to be given this brand but you cannot use pricing alone to determine which the best to be picked is.
“A number of people that will use pricing alone and does not have a means of protecting quality have become victims of substandard drugs; patients have had to have course perforations in typhoid. Many have been blinded on medications that they should have been able to use to manage Glaucoma. I can keep on reeling out virtually all family have been affected by failure of healthcare Practitioners to ensure and insists on people picking the right kind of medications.
“Most times pharmacists have a particular tendency to have psychological attachment or to be emotionally moved when they see the dressing or they see the pictures of the patient in front of them and the feel oh don’t think these ones can afford, they just make up their mind. The person is seeing that he can’t afford this medication as an anti- hypertensive. The pharmacists is linking, all the total cost in a month but that same guy is taking a bottle of Guinness each day or he is buying aso-ebi which is far more expensive and so people have not actually address the value of medication as an integral part. People should know when you buy in to medication you are actually prolonging your life. You are improving your quality of life. People have put in priority in favor in other things like clothing, like parties and the rest of them. What they should be spending more money on as age is actually healthcare,” he stated.
