It is quite common, sitting in my clinic, that an average man walks into the clinic, looking anxious, often alone and carrying a heavy load of medical prescriptions. A few things are clear straight away. He does not want anyone to know about his problem, and he has been disappointed with the prescribed medical treatment so far. And then when he is asked about the purpose of his visit, he says a similar sounding phrase, “Sir, I have a sexual problem”. This man is obviously not aware of what his real problem is, and that explains the lack of satisfaction with the treatment received thus far.

Sexual problems can be anything, from a lack of libido to infertility. It is important to take a detailed history. Often, this reveals so many issues that may not be apparent on any lab test. That time given to the patient is crucial. It may help us as doctors to figure out if he needs an andrologist. In these busy times, a person stressed with earning bread and butter may lose his libido and erections.

The treatment is not medicine; it is counselling and lifestyle changes if necessary. Rarely, it may also indicate a tumour on the pituitary gland, but that’s the word, “RARELY”. PDE5 inhibitors are not the complete answer to erectile dysfunction.  Why did we have erectile dysfunction? This needs proper evaluation. Erectile dysfunction may point towards underlying cardiac dysfunction or an upcoming adverse cardiovascular or cerebrovascular event. In layman’s terms, a patient may be prone to a heart attack or stroke in the near future. Hence comes the role of a urologist/andrologist.

A perfect work-life balance is the key, accompanied by a healthy lifestyle. Clinical depression, thyroid disorder, liver dysfunction, diabetes mellitus, and certain routine medications are all culprits in causing sexual dysfunction. The treatment will be satisfactory only when the underlying causes are paid attention to. Otherwise, most medicines for varying degrees of sexual dysfunction are available over the counter to most people, but there must be an end goal to the treatment. 

Patients need to be aware of this. Medicine is the answer, but to what end? This must be clear to every doctor treating the patient. I hope I have rattled many patients and clinicians to think beyond medicine. After all, we are not treating only the organ, but the person as a whole.