Commonly referred to as diabetes, diabetes mellitus was first identified as a disease associated with “sweet urine,” and excessive muscle loss in the ancient world. Elevated levels of blood glucose (hyperglycaemia) lead to spillage of glucose into the urine; hence the term sweet urine.

According to Dr Anthonia Ogbera, an associate professor of medicine, Lagos State University Teaching Hospital (LASUTH), Ikeja, Lagos, it may take many years for complications of diabetes to show up. In Nigeria, these complications occur at the time of diagnosis of the disease in 25 per cent of patients.

In a literature review on AlphaBetic, an anti-diabetes drug marketed by PharmacyPlus Limited, a diabetes expert remarked that “Nigeria like most developing countries is experiencing a rapid epidemiological transition with the burden of NCDs (non-communicable diseases) especially diabetes and hypertension which are threatening to overwhelm the health care system that is already overburdened by HIV/AIDS, TB and malaria.”

Similarly, a workshop on “Strategies for Improving Diabetes Care in Nigeria”, recently held in Ibadan, concluded that the rising pervasiveness of diabetes in Nigeria was due to the poor lifestyle of individuals. The medical experts, who counselled that individuals should regularly screen their wellbeing through restorative examination, also expressed shock that the level of attention given to the malady in Nigeria was still low.

Babatope Kolawole, a consultant at Obafemi Awolowo University, Ile-Ife, said that decision of sustenance had been recognised as a typical reason for diabetes. “Consuming nourishments that are unfortunate for human utilisation may irritate the propensity of being diabetic,” he said, adding that “These days in our general public, particularly in the urban groups, most individuals rely on fast food. Most individuals work out their pancreas. They take dairy milk, consume a lot of greasy nourishment, unreasonable oil use, which incline individuals to diabetes and other serious infections.”

How serious is diabetes?

Diabetes mellitus is a group of metabolic diseases characterised by high blood sugar (glucose) levels that result from defects in insulin secretion, or its action, or both. According to Prof. Alebiosu Olutayo, coordinator of Journalists Action against Diabetes (JAAD), no fewer than three million Nigerians are living with diabetes in the society today.

“Many people are living with the condition unaware of the seriousness of the disease and its consequences as those diagnosed are often poorly managed due to lack of resources or because the health care professionals who care for them have poor knowledge about diabetes and how to provide good care, “ he said.

He warned that with the rate at which diabetes is spreading, it might overtake those suffering tuberculosis, malaria, HIV/AIDS, and other terminal diseases by the year 2030 if adequate attention is not given to public enlightenment.

Normally, blood glucose levels are tightly controlled by insulin, a hormone produced by the pancreas. Insulin lowers the blood glucose level. When the blood glucose elevates (for example, after eating food), insulin is released from the pancreas to normalise the glucose level. In patients with diabetes, the absence or insufficient production of insulin causes hyperglycaemia. Diabetes is a chronic medical condition, meaning that although it can be controlled, it lasts a lifetime.

What are the effects of diabetes?

Over time, diabetes can lead to blindness, kidney failure, and nerve damage. These types of damage are the result of damage to small vessels, referred to as microvascular disease. Diabetes is also an important factor in accelerating the hardening and narrowing of the arteries (atherosclerosis), leading to strokes, coronary heart disease, and other large blood vessel diseases. This is referred to as macrovascular disease.

From an economic perspective, medical expenses for people with diabetes are over two times higher than those for people who do not have diabetes.

What causes diabetes?

Insufficient production of insulin (either absolutely or relative to the body’s needs), production of defective insulin (which is uncommon), or the inability of cells to use insulin properly and efficiently leads to hyperglycaemia and diabetes.

This latter condition affects mostly the cells of muscle and fat tissues, and results in a condition known as insulin resistance. This is the primary problem in type 2 diabetes. The absolute lack of insulin, usually secondary to a destructive process affecting the insulin-producing beta cells in the pancreas, is the main disorder in type 1 diabetes.

In type 2 diabetes, there also is a steady decline of beta cells that adds to the process of elevated blood sugars. Essentially, if someone is resistant to insulin, the body can, to some degree, increase production of insulin and overcome the level of resistance. After time, if production decreases and insulin cannot be released as vigorously, hyperglycaemia develops.

Glucose is a simple sugar found in food. Glucose is an essential nutrient that provides energy for the proper functioning of the body cells. Carbohydrates are broken down in the small intestine and the glucose in digested food is then absorbed by the intestinal cells into the bloodstream, and is carried by the bloodstream to all the cells in the body where it is utilised.

However, glucose cannot enter the cells alone and needs insulin to aid in its transport into the cells. Without insulin, the cells become starved of glucose energy despite the presence of abundant glucose in the bloodstream. In certain types of diabetes, the cells’ inability to utilise glucose gives rise to the ironic situation of “starvation in the midst of plenty”. The abundant, unutilised glucose is wastefully excreted in the urine.

Insulin is a hormone that is produced by specialised cells (beta cells) of the pancreas. (The pancreas is a deep-seated organ in the abdomen located behind the stomach). In addition to helping glucose enter the cells, insulin is also important in tightly regulating the level of glucose in the blood.

After a meal, the blood glucose level rises. In response to the increased glucose level, the pancreas normally releases more insulin into the bloodstream to help glucose enter the cells and lower blood glucose levels after a meal. When the blood glucose levels are lowered, the insulin release from the pancreas is turned down.

It is important to note that even in the fasting state there is a low steady release of insulin than fluctuates a bit and helps to maintain a steady blood sugar level during fasting. In normal individuals, such a regulatory system helps to keep blood glucose levels in a tightly controlled range. As outlined above, in patients with diabetes, the insulin is either absent, relatively insufficient for the body’s needs, or not used properly by the body. All of these factors cause elevated levels of blood glucose (hyperglycaemia).

What are the different types of diabetes?

There are two major types of diabetes, called type 1 and type 2. Type 1 diabetes was also formerly called insulin dependent diabetes mellitus (IDDM), or juvenile onset diabetes mellitus. In type 1 diabetes, the pancreas undergoes an autoimmune attack by the body itself, and is rendered incapable of making insulin. Abnormal antibodies have been found in the majority of patients with type 1 diabetes. Antibodies are proteins in the blood that are part of the body’s immune system. The patient with type 1 diabetes must rely on insulin medication for survival.

In autoimmune diseases, such as type 1 diabetes, the immune system mistakenly manufactures antibodies and inflammatory cells that are directed against and cause damage to patients’ own body tissues. In persons with type 1 diabetes, the beta cells of the pancreas, which are responsible for insulin production, are attacked by the misdirected immune system. It is believed that the tendency to develop abnormal antibodies in type 1 diabetes is, in part, genetically inherited, though the details are not fully understood.

Exposure to certain viral infections (mumps and Coxsackie viruses) or other environmental toxins may serve to trigger abnormal antibody responses that cause damage to the pancreas cells where insulin is made. Some of the antibodies seen in type 1 diabetes include anti-islet cell antibodies, anti-insulin antibodies and anti-glutamic decarboxylase antibodies. These antibodies can be detected in the majority of patients, and may help determine which individuals are at risk for developing type 1 diabetes.

Type 1 diabetes tends to occur in young, lean individuals, usually before 30 years of age, however, older patients do present with this form of diabetes on occasion. This subgroup is referred to as latent autoimmune diabetes in adults (LADA). LADA is a slow, progressive form of type 1 diabetes. Of all the people with diabetes, only approximately 10 per cent have type 1 diabetes while the remaining 90 per cent have type 2 diabetes.

Type 2 diabetes was also previously referred to as non-insulin dependent diabetes mellitus (NIDDM), or adult onset diabetes mellitus (AODM). In type 2 diabetes, patients can still produce insulin, but do so relatively inadequately for their body’s needs, particularly in the face of insulin resistance as discussed above. In many cases, this actually means the pancreas produces larger than normal quantities of insulin. A major feature of type 2 diabetes is a lack of sensitivity to insulin by the cells of the body (particularly fat and muscle cells).

In addition to the problems with an increase in insulin resistance, the release of insulin by the pancreas may also be defective and suboptimal. In fact, there is a known steady decline in beta cell production of insulin in type 2 diabetes that contributes to worsening glucose control. (This is a major factor for many patients with type 2 diabetes who ultimately require insulin therapy.) Finally, the liver in these patients continues to produce glucose through a process called gluconeogenesis despite elevated glucose levels. The control of gluconeogenesis becomes compromised.

Other forms of diabetes

“Secondary” diabetes refers to elevated blood sugar levels from another medical condition. Secondary diabetes may develop when the pancreatic tissue responsible for the production of insulin is destroyed by disease, such as chronic pancreatitis (inflammation of the pancreas by toxins like excessive alcohol), trauma, or surgical removal of the pancreas.

Diabetes can also result from other hormonal disturbances, such as excessive growth hormone production (acromegaly) and Cushing’s syndrome. In acromegaly, a pituitary gland tumour at the base of the brain causes excessive production of growth hormone, leading to hyperglycaemia. In Cushing’s syndrome, the adrenal glands produce an excess of cortisol, which promotes blood sugar elevation.

In addition, certain medications may worsen diabetes control, or “unmask” latent diabetes. This is seen most commonly when steroid medications (such as prednisone) are taken and also with medications used in the treatment of HIV infection (AIDS).

What are diabetes symptoms?

The early symptoms of untreated diabetes are related to elevated blood sugar levels, and loss of glucose in the urine. High amounts of glucose in the urine can cause increased urine output and lead to dehydration. Dehydration causes increased thirst and water consumption.

The inability of insulin to perform normally has effects on protein, fat and carbohydrate metabolism. Insulin is an anabolic hormone, that is, one that encourages storage of fat and protein.

A relative or absolute insulin deficiency eventually leads to weight loss despite an increase in appetite. Some untreated diabetes patients also complain of fatigue, nausea and vomiting.   Patients with diabetes are prone to developing infections of the bladder, skin, and vaginal areas. Fluctuations in blood glucose levels can lead to blurred vision. Extremely elevated glucose levels can lead to lethargy and coma.

How is diabetes diagnosed?

The fasting blood glucose (sugar) test is the preferred way to diagnose diabetes. It is easy to perform and convenient. After the person has fasted overnight (at least 8 hours), a single sample of blood is drawn and sent to the laboratory for analysis. This can also be done accurately in a doctor’s office using a glucose meter.

Normal fasting plasma glucose levels are less than 100 milligrams per decilitre (mg/dl). Fasting plasma glucose levels of more than 126 mg/dl on two or more tests on different days indicate diabetes.

A random blood glucose test can also be used to diagnose diabetes. A blood glucose level of 200 mg/dl or higher indicates diabetes. When fasting blood glucose stays above 100mg/dl, but in the range of 100-126mg/dl, this is known as impaired fasting glucose (IFG). While patients with IFG do not have the diagnosis of diabetes, this condition carries with it its own risks and concerns, and is addressed elsewhere.

What are the chronic complications of diabetes?

Diabetes complications are related to blood vessel diseases and are generally classified into small vessel disease, such as those involving the eyes, kidneys and nerves (microvascular disease), and large vessel disease, involving the heart and blood vessels (macrovascular disease).

Diabetes accelerates hardening of the arteries (atherosclerosis) of the larger blood vessels, leading to coronary heart disease (angina or heart attack), strokes, and pain in the lower extremities because of lack of blood supply (claudication).

Eye complications

The major eye complication of diabetes is called diabetic retinopathy. Diabetic retinopathy occurs in patients who have had diabetes for at least five years. Diseased small blood vessels in the back of the eye cause the leakage of protein and blood in the retina. Disease in these blood vessels also causes the formation of small aneurysms (microaneurysms), and new but brittle blood vessels (neovascularisation). Spontaneous bleeding from the new and brittle blood vessels can lead to retinal scarring and retinal detachment, thus impairing vision.

To treat diabetic retinopathy a laser is used to destroy and prevent the recurrence of the development of these small aneurysms and brittle blood vessels. Approximately 50 per cent of patients with diabetes will develop some degree of diabetic retinopathy after 10 years of diabetes, and 80 per cent of diabetics have retinopathy after 15 years of the disease. Poor control of blood sugar and blood pressure further aggravates eye disease in diabetes.

Cataracts and glaucoma are also more common among diabetics. It is also important to note that since the lens of the eye lets water through, if blood sugar concentrations vary a lot, the lens of the eye will shrink and swell with fluid accordingly. As a result, blurry vision is very common in poorly controlled diabetes. Patients are usually discouraged from getting a new eyeglass prescription until their blood sugar is controlled. This allows for a more accurate assessment of what kind of glasses prescription is required.

Kidney damage

Kidney damage from diabetes is called diabetic nephropathy. The onset of kidney disease and its progression is extremely variable. Initially, diseased small blood vessels in the kidneys cause the leakage of protein in the urine. Later on, the kidneys lose their ability to cleanse and filter blood. The accumulation of toxic waste products in the blood leads to the need for dialysis. Dialysis involves using a machine that serves the function of the kidney by filtering and cleaning the blood. In patients who do not want to undergo chronic dialysis, kidney transplantation can be considered.

The progression of nephropathy in patients can be significantly slowed by controlling high blood pressure, and by aggressively treating high blood sugar levels. Angiotensin converting enzyme inhibitors (ACE inhibitors) or angiotensin receptor blockers (ARBs) used in treating high blood pressure may also benefit kidney disease in diabetic patients.

Nerve damage

Nerve damage from diabetes is called diabetic neuropathy and is also caused by disease of small blood vessels. In essence, the blood flow to the nerves is limited, leaving the nerves without blood flow, and they get damaged or die as a result (a term known as ischemia).

Symptoms of diabetic nerve damage include numbness, burning, and aching of the feet and lower extremities. When the nerve disease causes a complete loss of sensation in the feet, patients may not be aware of injuries to the feet, and fail to properly protect them. Shoes or other protection should be worn as much as possible. Seemingly minor skin injuries should be attended to promptly to avoid serious infections. Because of poor blood circulation, diabetic foot injuries may not heal. Sometimes, minor foot injuries can lead to serious infection, ulcers, and even gangrene, necessitating surgical amputation of toes, feet, and other infected parts.

Diabetic nerve damage can affect the nerves that are important for penile erection, causing erectile dysfunction (ED, impotence). Erectile dysfunction can also be caused by poor blood flow to the penis from diabetic blood vessel disease.

Diabetic neuropathy can also affect nerves to the stomach and intestines, causing nausea, weight loss, diarrhoea, and other symptoms of gastroparesis (delayed emptying of food contents from the stomach into the intestines, due to ineffective contraction of the stomach muscles).

The pain of diabetic nerve damage may respond to traditional treatments with certain medications such as gabapentin (Neurontin), henytoin (Dilantin), and arbamazepine (Tegretol) that are traditionally used in the treatment of seizure disorders. mitriptyline (Elavil, Endep) and desipramine (Norpraminine) are medications that are traditionally used for depression. While many of these medications are not indicated specifically for the treatment of diabetes related nerve pain, they are used by physicians commonly.

The pain of diabetic nerve damage may also improve with better blood sugar control, though unfortunately blood glucose control and the course of neuropathy do not always go hand in hand. Newer medications for nerve pain include Pregabalin (Lyrica) and duloxetine (Cymbalta).

What can be done to slow diabetes complications?

Findings from the Diabetes Control and Complications Trial (DCCT) and the United Kingdom Prospective Diabetes Study (UKPDS) have clearly shown that aggressive and intensive control of elevated levels of blood sugar in patients with type 1 and type 2 diabetes decreases the complications of nephropathy, neuropathy, retinopathy, and may reduce the occurrence and severity of large blood vessel diseases. Aggressive control with intensive therapy means achieving fasting glucose levels between 70-120 mg/dl; glucose levels of less than 160 mg/dl after meals; and a near normal haemoglobin A1c levels.

Studies in type 1 patients have shown that in intensively treated patients, diabetic eye disease decreased by 76 per cent, kidney disease decreased by 54 per cent, and nerve disease decreased by 60 per cent. More recently the EDIC trial has shown that type 1 diabetes is also associated with increased heart disease, similar to type 2 diabetes.

However, the price for aggressive blood sugar control is a two to three fold increase in the incidence of abnormally low blood sugar levels (caused by the diabetes medications). For this reason, tight control of diabetes to achieve glucose levels between 70 to 120 mg/dl is not recommended for children under 13 years of age, patients with severe recurrent hypoglycaemia, patients unaware of their hypoglycaemia, and patients with far advanced diabetes complications.

To achieve optimal glucose control without an undue risk of abnormally lowering blood sugar levels, patients with type 1 diabetes must monitor their blood glucose at least four times a day and administer insulin at least three times per day. In patients with type 2 diabetes, aggressive blood sugar control has similar beneficial effects on the eyes, kidneys, nerves and blood vessels.

How is diabetes treated?

The major goal in treating diabetes is to minimise any elevation of blood sugar (glucose) without causing abnormally low levels of blood sugar. Type 1 diabetes is treated with insulin, exercise, and a diabetic diet. Type 2 diabetes is treated first with weight reduction, a diabetic diet, and exercise. When these measures fail to control the elevated blood sugars, oral medications are used. If oral medications are still insufficient, treatment with insulin is considered.

Adherence to a diabetic diet is an important aspect of controlling elevated blood sugar in patients with diabetes. The American Diabetes Association (ADA) has provided guidelines for a diabetic diet. The ADA diet is a balanced, nutritious diet that is low in fat, cholesterol, and simple sugars. The total daily calories are evenly divided into three meals. In the past two years, the ADA has lifted the absolute ban on simple sugars. Small amounts of simple sugars are allowed when consumed with a complex meal.

Weight reduction and exercise are important treatments for diabetes. Weight reduction and exercise increase the body’s sensitivity to insulin, thus helping to control blood sugar elevations.

Medications for type 2 diabetes

First, it must be noted that the following information only applies to patients who are not pregnant or breastfeeding. At present the only recommended way of controlling diabetes in women who are pregnant or breastfeeding is by diet, exercise and insulin therapy. You should speak with your doctor if you are taking these medications and are considering becoming pregnant or if you have become pregnant while taking these medications.

Based on what is known, medications for type 2 diabetes are designed to:

     increase the insulin output by the pancreas,

     decrease the amount of glucose released from the liver,

     increase the sensitivity (response) of cells to insulin,

     decrease the absorption of carbohydrates from the intestine, and

     slow emptying of the stomach to delay the presentation of carbohydrates for digestion and absorption in the small intestine.

When selecting therapy for type 2 diabetes, consideration should be given to:

     the magnitude of change in blood sugar control that each medication will provide;

     other coexisting medical conditions (high blood pressure, high cholesterol, etc.);

     adverse effects of the therapy;

     contraindications to therapy;

     issues that may affect compliance (timing of medication, frequency of dosing); and

     cost to the patient and the health care system.

It is important to remember that if a drug can provide more than one benefit (lower blood sugar and have a beneficial effect on cholesterol, for example), it should be preferred. It’s also important to bear in mind that the cost of drug therapy is relatively small compared to the cost of managing the long-term complications associated with poorly controlled diabetes.

Varying combinations of medications also are used to correct abnormally elevated levels of blood glucose in diabetes. As the list of medications continues to expand, treatment options for type 2 diabetes can be better tailored to meet an individual’s needs. Not every patient with type 2 diabetes will benefit from every drug, and not every drug is suitable for each patient. Patients with type 2 diabetes should work closely with their physicians to achieve an approach that provides the greatest benefits while minimising risks.

Patients with diabetes should never forget the importance of diet and exercise. The control of diabetes starts with a healthy lifestyle regardless of what medications are being used.

Report compiled by Adebayo Folorunsho-Francis with additional reports from medicinenet.com/diabetes_treament and American Diabetes Association

Erectile dysfunction (ED) and infertility are two major issues generating concerns the world over, and particularly in the Sub-Sahara Africa, where the prevalence of risk factors, such as diabetes, dyslipidaemia, hypertension, is on the increase.

ED could simply be described as a condition, in which a man experiences consistent or recurrent inability to achieve and/or maintain a penile erection, sufficient for satisfactory sexual performance. This is the major sexual dysfunction that affects men.

Infertility, on the other hand, is a health condition common in both males and females. It is the inability to conceive or produce offspring, despite having regular unprotected sex. It occurs when a poor reproductive system impairs the ability of the body to perform necessary functions of reproduction.

Contrary to the misconception that ED is an age-related condition, a Consultant Urologist at the Lagos State University Teaching Hospital (LASUTH), Ikeja, recently explained that erectile dysfunction has nothing to do with old age.

Defining ED or impotency as a state where a man cannot get an erection to have sex or cannot keep an erection long enough to finish having sex, she added that it is not necessarily a symptom of old age, as older men should still be able to get an erection for sexual pleasure.

The urologist listed some of the risk factors that can cause ED to include diabetes, which is high blood sugar; hypertension, which is high blood pressure; atherosclerosis, which is the narrowing of the arteries that take blood to the male organs; excessive alcohol intake; excessive smoking; and drug abuse can lead to erectile dysfunction.

Abolarinwa, therefore advised men to keep their blood sugar and blood pressure under control to prevent erectile dysfunction.

In addition to the highlighted causes of ED, Dr Anna Cole, a clinical psychologist with Mental Health Foundation, said psychological issues and problems in relationship with a sexual partner could also cause erectile dysfunction.

Feeling nervous about sex, feeling depressed and feeling stressed, including stress from work or family situations could degenerate to ED, she noted.

Also, a new research published in Science Alert with the title, “Erectile Dysfunction and Hypertension among Adult Males in Umudike, Nigeria: A Study of Prevalence and Relationships”, found it that ED affects approximately half of men of over 40 years of age and results in an inevitable loss of quality of life of the sufferer and his partner.

As regards the link between ED and infertility, Dr Michael Roizen, Medical Director of Internal Medicine, said ED and infertility are very different terms, noting that a man may be producing perfectly good sperm, but having trouble with his erection, which is what he termed ED. On the other hand, he explained that a man may have no trouble raising the rifle, but he is shooting blank, that he called infertility.

A man’s fertility generally relies on the quantity and quality of his sperm, if the number of sperm a man ejaculates is low or if the sperm are of a poor quality, it will be difficult, and sometimes impossible, for him to cause a pregnancy. Conversely, a woman’s fertility can be measured through various means, like the regularity of the menstrual cycle, among other things.

Dr Franklin Meme, a gynaecologist with the Federal Medical Centre (FMC), Yenagoa, Bayelsa, said evaluation of women infertility could be done through blood tests, ultrasound examinations of the ovaries or an ovulation home test kit.”

“An irregular menstrual pattern would make us suspect an ovulation problem, but it is also possible for a woman with regular periods to have an ovulation disorder,” he stressed.

He identified conditions such as polyps; adenomyosis; an abnormal uterus; fibroid; sexually transmitted diseases (STDs); as some of the major causes of infertility in women.

 Statistics on erectile dysfunction in Nigeria

Accurate statistics are lacking on how many men are affected by infertlity, but some doctors estimate that about half of men aged 40 to 70 have frequent problems achieving or maintaining an erection. The number of men with erectile dysfunction is low for those under the age of 40, but it increases with age.

 Causes of erectile dysfunction

• Circulatory problems: An erection occurs when the penis fills with blood and a valve at the base of the penis traps it. Diabetes, high blood pressure, cholesterol, clots, and atherosclerosis (hardening of the arteries) can all interfere with this process. Such circulatory problems are the number one cause of erectile dysfunction.
• Peyronie’s disease: This disease causes fibres and plaques to appear in the genitals, interrupting blood flow.
• Cancer: Cancer can interfere with nerves or arteries that are vital to erection.
• Surgery: Surgery to the pelvis, and especially prostate surgery for prostate cancer, can damage the nerves and arteries that are required to gain and maintain an erection.
• Spinal cord or pelvic injury: The nerves that stimulate erection can be cut by injury to them.
• Hormonal disorders: A lack of testosterone (male hormone or androgen) can result from testicular failure, pituitary gland problems, or certain medications.
• Depression: This condition is a common cause of erectile dysfunction. Depression is a physical disorder as well as a psychiatric one, and it can have physical effects. This may be true even if you feel comfortable in a sexual situation.
• Alcoholism: Chronic alcoholism can produce erectile dysfunction, even if there is no alcohol in the blood at the time of sex.
• Smoking: Smoking cigarettes causes constriction of blood vessels. This may decrease blood flow to the penis, causing erectile dysfunction.
• Performance anxiety: Most men have had erection problems at some point due to worrying about performing well during sexual intercourse. If this happens often, the anticipation of sex can trigger nervous reactions that prevent erection, setting up a vicious cycle.
• Situational psychological problems: Some men have problems only in certain situations or with certain people. In troubled relationships, men may be unable to achieve erection with their partner but have no problem away from home.
• Sexual aversion: Being repelled by sex is rare. It is most common in people who suffered child abuse and those who have been brought up in strict religious surroundings. Aversion can also exist in homosexual or bisexual people who attempt to lead a heterosexual life against their basic inclinations.
• Drugs: The following can cause erectile dysfunction:

1. alcohol
2. antianxiety medications
3. anticancer medications
4. cocaine
5. estrogen
6. ganglionic and adrenergic (beta) blockers
7. MAO inhibitors and tricyclic antidepressants
8.  narcotic pain relievers
9. narcotics
10. medications prescribed to control high blood pressure
11. sedatives

Symptoms and complications of erectile dysfunction

A man may sometimes have erections, (e.g., when he wakes up in the morning), but be is unable to get an erection during sex with his partner. This is often a sign of a psychological problem that may or may not have to do with that particular relationship.

If a man had regular erections in the past, but suddenly begins to have problems getting an erection, there’s a chance that it’s a nerve or hormonal problem, a circulatory problem, or the effect of alcohol, drugs, or medicine.

If a man still gets erections but they’re not as hard or long lasting as in the past, it’s quite likely that a circulatory problem is causing the dysfunction.

If surgery or injury is involved, the sufferer may already know what’s causing the erectile dysfunction. A doctor should be consulted about possible solutions.

While erectile dysfunction is inevitably going to cause some anxiety, it’s vital for sufferers to keep their relationship with their partner or spouse as regular as possible until a solution can be found. Modern medicine and therapeutic techniques can help over 90 per cent of erection problems.

 Diagnosing erectile dysfunction

To find out what’s causing erection problems, a doctor will begin by asking about other medical conditions the man might have, what medications he’s taking, when his erection problems occur, and what form they take.

Standardised questionnaires or surveys about erectile function and the satisfaction of sexual intercourse may be used to identify the nature of erectile dysfunction. Blood pressure tests and tests of hormone levels are standard.

There are tests that aim to distinguish between psychological, nervous, and circulatory causes. One is the nocturnal penile tumescence (NPT) test. A measuring device is attached to the penis to monitor erections during sleep. Men without physical disorders usually have erections during REM (rapid eye movement) sleep.

Several devices, including a Doppler radar, can track blood flow in and out of the penis and identify circulatory problems.

Treatment of erectile dysfunction

There’s a wide range of treatments for erectile dysfunction. Some are pills, and others are injections or devices that should be used just before sex. There are also treatments involving surgery.

Medications for erectile dysfunction include phosphodiesterase inhibitors, prostaglandins, and testosterone.

• Phosphodiesterase inhibitors: This class of medications includes sildenafil,* tadalafil, and vardenafil. They work by inhibiting an enzyme called phosphodiesterase type 5 (PDE-5). This enzyme normally breaks down a molecule called cGMP. Inhibiting the enzyme makes more cGMP available, which leads to relaxation of smooth muscles in the penis, allowing more blood to enter and helping to produce an erection. These medications are taken before sex and will cause an erection only when the man is sexually stimulated. The time the dose should be taken and how long the effects last depend on the medication used. The most common side effect of these medications is a headache. However, there is a potential for certain dangerous drug interactions. Anyone taking this medication must let his doctor know about any medications he’s on, and especially if he’s taking nitrates (e.g., nitroglycerin spray, nitroglycerin pills, or nitroglycerin patch) for heart problems.

• Prostaglandins (alprostadil): Alprostadil can be injected into the penis or inserted as a pellet through the urethra. It causes an erection that usually lasts about 60 minutes. The danger with this method is that too high a dose can cause priapism, an erection that won’t go away. This condition can cause serious bruising, bleeding, and pain. Once the doctor is sure of the right dose, the man can self-inject at home. Some doctors may prescribe a combination of alprostadil with additional ingredients such as phentolamine to help the medication work more effectively. This mixture is prepared by the pharmacy according to the directions of the prescribing doctor. It is injected into the penis before sex.

• Testosterone: This is only useful for people with specific disorders like hypogonadism (small testicles) that result in lower than normal amounts of testosterone in the blood stream. Testosterone increases interest in sex, as well as erections. Common non-medication ways of treating erectile dysfunction include vacuum devices and penile implants.

• Vacuum devices: This involves placing a tube over the penis, forming an airtight seal around the base. By pumping air out of the tube, blood can be drawn into the penis. Placing a ring around the base of the penis will maintain the erection.

• Penile implants: This treatment involves permanent implantation of flexible rods or similar devices into the penis. Simple versions have the disadvantage of giving the user a permanent erection. The latest (and most expensive) device consists of inflatable rods activated by a tiny pump and switch in the scrotum. Squeezing the scrotum stiffens the penis, whether the person is aroused or not. The penis itself remains flaccid, however, so the diameter and length are usually less than a natural erection, and hardness is lacking, although it’s sufficient for intercourse.

 Prevention of erectile dysfunction

There are two broad categories that the causes of erectile dysfunction (ED) fall into physical and physiological.

Physical health problems are the most likely cause of erectile dysfunction as earlier mentioned, particularly in older males. Common chronic diseases such as obesity, diabetes and high blood pressure are often associated with ED and therefore, a healthy lifestyle is the best way to avoid ED.

For younger men, ED is often related to anxiety, stress or psychological trauma due to a distressing sexual experience.

Pills such as Viagra can help a man overcome psychological obstacles and give him confidence that everything is working perfectly. However, for older men, consulting a doctor can be an important step towards uncovering and treating underlying physical causes.

 Get healthy!

The seven top tips to achieve better health, both physical and physiological, are:

• Lose weight: if you are in the overweight bracket, the excess weight may be putting your cardiovascular system under strain;
• Quit smoking: this affects blood flow and neuro-signals which normally ensure correct blood flow into the penis;
• Avoid drinking too much alcohol (no more than two drinks a day);
• Maintain a balanced diet;
• Control and monitor your blood pressure and cholesterol levels;
• Be physically active: just 30min per day can improve your blood flow, state of mind and stress levels;
• Reduce stress and get enough sleep (at least seven hours a night).

In most cases, blood vessel deterioration is the main cause of erectile dysfunction, so you want to make sure that your blood vessels are in good condition to allow normal blood flow. Depending on the state of your health, taking pills might not always prove the most effective solution.

 Beware of diabetes

Diabetes is risk factor for erectile dysfunction that is often overlooked. The damage caused to the blood vessels by abnormal blood sugar levels can, in the long run, result in ED.

Type 2 diabetes stems primarily from unhealthy diet and lack of exercise (yet another reason to maintain a healthy lifestyle to prevent ED).

 Erectile dysfunction in young men

Young men often suffer from “performance anxiety, which can result in erectile dysfunction. Being psychologically healthy does not require you to have nerves of steel. It’s simply important to be open with your feelings, and it may be beneficial to express and discuss how you feel.

Seeking help from a sexual health expert can prove very effective, especially to work through relationship issues or anxiety, both of which may result in ED. You should note that, while recreational drugs and low levels of testosterone are not directly responsible for erectile dysfunction, they may well affect a man’s sexual drive.

Old or young, remember that it is normal to experience engine failure”once in a while. Look for diversity and new experiences with your partner so that you can focus on present pleasure again rather than reviewing past failures.

Pills or emotional support?

When your confidence is at stake, taking pills such as Viagra can help you to realise that there is no problem with the engine and give you that confidence boost.

However, if you are facing bigger issues, then expert help and knowing fully what you are dealing with can help relieve your fear and anxiety.

This will help you to find out the real causes of the problem too, which will help you reach the best solution for you.

If you feel too embarrassed to raise the topic with your doctor, you can use our online services to directly contact one of our GPs. They can assess the causes of your ED and suggest a treatment that fits your needs.

 Relationship issues and erectile dysfunction

While you are working out the causes of your problem or being treated, it’s fundamental that you focus on your relationship.

Couples who have difficulties communicating on both sexual and heart matters are more likely to develop issues related to intimacy and sex. Talking about your feelings and anxieties, although this may sound difficult, is crucial: your partner needs to understand how you feel and what you need.

Just remember, if you are having problems with your impotence, your partner will be affected by this too. There is nothing to lose by talking about it; so it’s often beneficial to be pro-active by raising the issue and then working through it together. You may well find yourself addressing broader issues in your life, which can also improve your mood and relationship.

 Erectile dysfunction exercises

A recent research by the University of the West of England, Bristol, suggests that erectile dysfunction exercises may be a very effective way of improving your erections. Similar to the pelvic floor exercises recommended to women after childbirth, these exercises involve clenching the muscles you use to control urination.

Pelvic floor exercises have long been known to help patients with incontinence. The study conducted by a team of scientists in Bristol involved participants who had been suffering from erectile dysfunction for at least six months. 40 per cent of participants reported that they regained their erectile function within 3 to 6 months. A further 35 per cent reported, that they noticed a significant improvement to their condition.

The scientists from Bristol compared the effectiveness of these exercises to that of Viagra and believe regularly exercising your pelvic floor muscles may be the best way of preventing erectile dysfunction. The exercises train the muscles surrounding your penis, which improves the blood flow and improves your ability to gain and keep an erection.

Physical exercise – how sport can help

Exercising regularly is a great way to improve the state of your general health and boost your performance. A series of prolonged bad habits can damage the tissue responsible for erections over the years.

When combined with a healthier lifestyle, regular physical activity can contribute to improving your blood flow and restore your ability to get erections. All you need to do is to maintain a regular activity, even if it’s just 30 minutes a day, to improve your blood pressure, blood flow, cardio and overall health. Even walking is a good option, although it’s better to practice a sport or do some hard exercise to push yourself!

In addition, it’s important to achieve and maintain a healthy weight. This is a great long-term prevention strategy for erectile dysfunction.

However, there is one sport you may want to avoid: cycling. Long-term and long hours of outdoors cycling can damage the nerves in your pelvic area which control erections. Indoors cycling is much less hazardous as the seat is generally wider and less prone to damaging your body.

 Statistics of infertile women in Nigeria

Infertility affects nearly 25 per cent of couples in Nigeria and experts claim that 40 to 45 per cent of all consultations in gynaecological clinics are infertility-related.

 There are two types of infertility:

• Primary infertility: where a woman who has never conceived a child in the past has difficulty conceiving and;
• Secondary infertility: where a mother who has had one or more pregnancies in the past, is having difficulty conceiving again.

 Causes of infertility

There are many causes of infertility. Common causes of infertility in women include lack of regular ovulation (the monthly release of an egg), blockage of the fallopian tubes, age and endometriosis.

Treatment options for infertility

Infertility can be treated with therapies such as medication or surgery. The most common types of fertility treatments available include:

1. Medical treatment for lack of regular ovulation
2. Surgical procedures, such as treatment for endometriosis
3. Assisted conception, which may be intrauterine insemination (IUI) or in-vitro fertilisation (IVF)

There are numerous clinics and medical centres in Nigeria that can help couples having difficulty conceiving children. The cost for fertility treatments varies, with IVF treatments costing between N800,000 and N1,000,000.

Note that while some couples find it easy to get pregnant quickly, it can take longer for others. However, if you have been unable to conceive after one year of trying, it’s time to consult your doctor or medical provider.

Compiled by Temitope Obayendo with information from Science Alert; Health Bridge Limited; WebMD; The Daily Independent Newspapers.