All over the world, men lag behind women when it comes to health outcomes and life expectancy.
Many health conditions, especially chronic diseases, have higher mortalities in men, and tend to peak among the ageing population.
Even research into men's health is far behind that of women's health. The Malaysian Men's Health Initiative (MMHI) recognised the need to fill the research gap, and began studying men's health issues with the Malaysian Society of Andrology and Study of the Aging Male (MSASAM) back in 2000.
Since then, MMHI has published close to 200 pieces of research work, including several key studies looking at men's health in the Klang Valley in 2003, 2006 and 2008.
For the first time, MMHI's research findings on key men's health issues have been compiled into a book, Managing Men's Health: Improving Men's Health Through Research, which is now available from the MMHI.
This book covers four main themes in men's health, which are erectile dysfunction, prostate diseases, testosterone deficiency syndrome, and psychosocial issues among men.
The book draws attention to these key issues, because they urgently require attention among healthcare practitioners, policy makers and those involved in research.
This column will feature a series of four articles, starting this week, to give a sneak preview of the book and highlight the research findings for each of these health issues. This week's article covers the topic of erectile dysfunction (ED).
A neglected issue
ED is one of the most common sexual problems that affects men worldwide, particularly older men.
The medical fraternity increasingly recognises ED as a serious medical problem with significant associated morbidities, including metabolic syndrome and cardiovascular conditions.
However, there are many myths and misconceptions about ED, and it remains largely a taboo topic.
Some men believe that ED is simply due to old age and that sexual function is no longer important in the later years of life. Many men with ED do not talk openly about their problem with their wives or partners, much less with their doctors.
As a result, little has been known about the prevalence of ED in Malaysia, and how it affects men and their partners. The MMHI has sought to change this situation through research into the prevalence of erectile dysfunction, with follow-up qualitative research on the patients' and doctors' perspectives of ED.
How common is ED?
How common is ED?
MMHI carried out two key studies to look at the prevalence of ED in Malaysia. The first was the Klang Valley Men's Health Community Study, carried out in 2003 among 351 men from an urban population.
MMHI also led the 2005 Asian MALES (Men's Attitudes to Life Events and Sexuality) study of 10,934 men from China, Japan, Korea, Taiwan and Malaysia.
There were 3,000 Malaysian men who participated in Phase I of this regional study, and 380 who participated in Phase II.
The Klang Valley study found an alarmingly high prevalence of ED among the study participants, with up to 70 per cent found to suffer from the condition, while the Asian MALES study found that ED was more common among men between the ages of 60 and 75.
Both studies were instrumental in highlighting an important finding: ED does not occur in isolation, but often in tandem with other conditions, like lower urinary tract symptoms, metabolicy syndrome and depression.
This revelation is absolutely crucial because it tells doctors and men not to be complacent with a diagnosis of ED.
It could provide important clues to other serious and life-threatening conditions that require urgent diagnosis and management.
Very little is known about how men cope with ED, and how it affects their daily lives. Quality of life issues are important as the condition has serious impact on men's lives, including their relationship with their spouses, their family life and their working life.
The Klang Valley and the Asian MALES studies found that men with ED suffered from poorer quality of life and were generally more dissatisfied with all aspects of their life, including family, work, relationship, sex life and health.
Worse still, few men knew how to cope with ED properly. The Klang Valley study found that only one-third of the men with ED had talked to someone about their condition and sought treatment for it, while others did not seek help due to their fears and misconceptions about the issue. As a result, most of the men with ED were not receiving active treatment.
How do doctors deal with ED?
Unfortunately, some doctors are no better in addressing the topic of ED with their patients.
The greatest obstacle is in the primary care setting where many men present with other complaints or conditions, and may not know or report that they have ED.
Yet, it is within this primary care setting where ED, and other co-morbidities, have the best chance of being detected and treated early.
MMHI carried out a study that asked general practitioners in Klang Valley about their experiences in managing ED and the barriers that they faced with their patients.
The findings of this qualitative study were extremely valuable in identifying the numerous challenges faced by the GPs when approaching the subject of ED with their patients.
The 'Managing Men's Health' book provides more details about these study results, with immensely interesting insights from the GPs.
What more needs to be done
While a great deal of research has been carried out by MMHI on ED in Malaysia, there are still potentially many more research gaps to be filled.
As the 'Managing Men's Health' book explains, there are ample opportunities for research to be carried out in various aspects of ED, including the epidemiology of the disease, the application of research findings, longitudinal studies and research on the knowledge, attitudes and practices of men with ED.
For instance, it will be helpful to learn more about the major influences in men's decision-making behaviours, so that we are able to understand what makes them seek treatment, what impacts their choice of treatment, and what are the changes in their lives following treatment.
It is hoped that MMHI will be able to carry out these further studies in the near future.
Such research promises to be filled with interesting revelations and insights, perhaps providing concrete answers to more successful treatment for men in Malaysia.