If you’re looking for interesting bathroom reading, allow me to recommend Urology . The July issue is chock full of page-turners: ” Robotic Prostatectomy ,” ” Scrotal Mass with Bladder Outlet Obstruction,” “Histologic Comparison of Pubovaginal Sling Graft Materials,” “Multi-Drug-Resistant Bacteremia After Transrectal Ultrasound Guided Prostate Biopsies ,” and my favorite, “Modern Management of Adult-Acquired Buried Penis ” (it’s “a result of obesity” - don’t ask ).
Seriously, though, I want to talk about an article in the July issue. It’s called, ” Does ‘Normal’ Aging Imply Urinary, Bowel, and Erectile Dysfunction ?” Here are key excerpts from the abstract:
We assessed if urinary, bowel, and sexual dysfunction and associated bother were part of the “normal” aging process in the general male Dutch population. … Three thousand eight hundred ten (3810) men responded (81%), mean age 67 years, range 58 to 78. … Bowel dysfunction and bother were not related to age. Erectile dysfunction was reported by 19%, ranging from 12% in the youngest to 26% in the oldest group …
Conclusions: Urinary and bowel dysfunction were not part of the “normal” aging process. Erectile dysfunction was significantly more prevalent in older men.
And here’s the headline on the Reuters write-up: ” Erectile dysfunction may be ‘normal’ with age .”
The curious thing here is the word normal . It’s being used in this context to mean age-related. Most men in the sample didn’t have erectile dysfunction. But because ED’s frequency increases with age, and because we think of aging as a universal process accompanied by physical decline, ED seems normal.
Since “urinary and bowel dysfunction were not part of the ‘normal’ aging process,” the authors conclude, they “may well be related to prior treatment” in men who have been treated for prostate cancer. This appears to make them logical targets for prevention or remedy. Does the opposite implication follow for ED? Does its “normality” make it a less compelling target?
There are many plausible ways to think about normality and health. Age-dependence is one of them. To me, the authors’ framework makes sense: Medicine should focus first on maladies that strike some people unusually early in life. Maladies that accumulate with age are less unfair. They’re also less tractable, since they’re more biologically inherent.
ED, however, is a confounding example because it’s in the process of being transformed from a “normal” to a commonly treated condition. Bob Dole made his famous ad for Viagra in 1999, when he was 76 . In the last decade, 35 million men have used Viagra. Millions more have taken similar drugs such as Cialis or Levitra. Modern man has set out to conquer the ancient loss of manhood.
Which brings us back to the question posed in
Urology
: Does normal aging imply ED? The answer seems to be: It used to. And that’s not just a change in the way we think about erections. It’s a change in the way we think about aging.
