BEHÇET'S SYNDROME; AN UNUSUAL CASE OF ERECTILE DYSFUNCTION
It is a well known fact that the health-seeking behavior of the average male in Nigeria is nothing compared to that of the average female. In Nigeria, perhaps because males are expected to be strong, and show no weakness it is unusual to see a non critically-ill young man in the hospital. This is the reason there are more women in the OPD [Out Patient Department], but more men in critical care. The only time the Nigerian man doesn't play with his health, and is willing to do anything, is when it involves his sexual health.
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ERECTILE DYSFUNCTION (ED)
Erectile dysfunction is the inability to attain or sustain erection long enough to achieve sexual pleasure is often viewed from the perspective of sexual health alone. Hence it is not uncommon to see a patient who thinks running tests is unnecessary, and just wants to be given this performance enhancer. However, truth is that erectile dysfunction, in a good number of cases, may be a pointer to an underlying systemic illness. Apart from psychological causes, drugs, and hormonal issues, for instance, most other risk factors/causes of ED are actually the same risk factors for serious cardiovascular events, such as stroke, mini strokes, and heart disease.
Also, ED may be part of systemic illnesses like diabetes, peripheral neuropathies, and vasculitides. This is the reason why ED is more than just inability to attain or sustain erection; reason why you must look beyond the transient euphoria of wellbeing and dig deep to uncover the root cause. Simply put, there's no gain, for instance, in achieving and sustaining a turgid hard-on from taking a performance enhancer, only to collapse from a heart attack while at work.
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FROM ERECTILE DYSFUNCTION TO BEHÇET'S DISEASE
Erection is usually an interaction of the following four: emotions [the brain], hormones, nerves, and blood vessels. An optimal level of Testosterone, which controls libido, is often needed. A working system of nerves is needed to send sensory stimulus to the appropriate brain centers, and to send effector signals back to the vessels of the penis. A patent system of vessels is also necessary, so that blood can effortlessly rush into the erectile tissues of the penis, swell it up, and make it turgid, hence bringing about an erection. So, a thorough evaluation for ED should take all these into consideration.
Contrary to what the man in the street thinks, that sexually transmitted infections are the major cause of impotence, STIs are rarely, if not never, a direct cause of ED.
POSSIBLE CAUSES OF ED IN BEHÇET'S SYNDROME
Behçet's syndrome is a multi-systemic illness, meaning it could affect virtually every system in the body. It is a vasculitis, a disease that arises due to inflammation of blood vessels, which we all know are ubiquitous.
Of all vasculitides, BD is unique in two ways:
- It affects all caliber of vessels: small, medium, and large.
- It affects both veins and arteries.
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POSSIBLE CAUSES OF (ED) IN (BD) ARE AS FOLLOWS
- Vasculopathy
Affecting blood vessels primarily, BD could interfere with the process of erection, by impeding blood flow in the erectile tissues of the penis, in much the same way as atherosclerosis. - Peripheral Neuropathy
Vasculitis involving the vaso nevorum-- blood vessels supplying nerves-- can lead to impaired nerve function, and hence ED, especially if the affected nerves are autonomic nerves involved in erection. - Neuro Behçet's Disease
This if affectation of the white matter of the brain, and/or spinal cord, and is different from, and more common than, the peripheral neuropathy described above.
CONCLUSION
Erectile dysfunction is more than just inability to attain, or sustain erection. For the fact that it shares similar risk factors with potentially life-threatening cardiovascular diseases, and may also be a manifestation of systemic illness, attention should not only be paid to "getting the penis to work again;" a thorough evaluation should be routine in the management of ED
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