ABSTRACT
Gender-based medicine – specifically recognizing the differences in the health of men and women – drew much attention in the 1990s. The US National Institutes of Health (NIH) Office of Research on Women ’ s Health was established in 1990, and in 1994 the US Food and Drug Administration (FDA) created an Office of Women ’ s Health, resulting in a dramatic increase in the quantity and quality of research devoted to examining numerous aspects of women ’ s health such that today women ’ s health research is clearly mainstream. 1
While decades of research have yielded many important findings about health and disease in men, this knowledge has not resulted in the benefits expected. Men are still less likely than women to seek medical care and are nearly half as likely as women to pursue preventive health visits or undergo screening tests. 2 Recent data indicate that 68.6 % of men aged 20 years and older are overweight, 3 and life expectancy of men in the USA continues to trail that of women by 5.3 years in 2003. 4
Men ’ s health as a concept and discipline is in a prehistoric state compared with women ’ s health. Most clinicians and the public consider men ’ s health to be a field concerned only with the prostate and sexual function. Men ’ s health has recently become a hot topic in these specific areas with large amounts of money being spent on remedies for prostate health, improved urinary flow, and enhanced
erections and a smaller amount directed to overall improved health. 5
Men do not use or react to health services in the same way as women. 6 Men are less likely to go to healthcare providers for preventative healthcare visits. 7 Men are also less likely to follow medical regimens, and are less likely to achieve control with long-term therapeutic treatments. 8,9 The Commonwealth Fund did a mass survey and found that ‘an alarming proportion of American men have only limited contact with physicians and the health care system generally. Many men fail to get routine check-ups, preventive care, or health counseling and they often ignore symptoms or delay seeking medical attention when sick or in pain.’ 10 This report concludes by noting the need for increased efforts to address the special needs of men as well as attitudes toward healthcare. Men are more likely to be motivated to visit the doctor for conditions that specifically affect men most, such as baldness, sports injuries, or erectile dysfunction (ED). The presentation of a man to the clinician ’ s office with a sexual health complaint can present an opportunity for a more complete evaluation, most notably with the complaint of erectile dysfunction. In a landmark article published in December, 2005, Thompson et al. confirmed what had been long believed: that ED is a sentinel marker and risk factor for future cardiovascular events. 11 After adjustment, incident ED occurring in the 4300 men without ED at study entry enrolled in the prostate cancer prevention
trial (PCPT) was associated with a hazard ratio of 1.25 for subsequent cardiovascular events during the 9-year study follow-up (1994-2003). For men with either incident or prevalent ED, the hazard ratio was 1.45. Thus, men with ED are at risk for developing cardiac events over the next 10 years, with ED as strong a risk factor as current smoking or premature family history of cardiac disease. Never before has the association of ED or a male sexual dysfunction been so strongly linked as a harbinger of cardiovascular clinical events in men.
