The Force Awakens and Stays Awakened

I remember watching the first Star Wars movie when I was 8. George Lucas created the epic space opera franchise in 1977, which depicts the adventures of various characters “a long time ago in a galaxy far, far away”. I guess the rest is history. The first film of the series was released by 20th Century Fox and instantly gained a worldwide pop culture status. Naturally it was followed by similar success of sequels of The Empire Strikes Back and Return of Jedi, and unbelievably, the prequel trilogy continued to dominate the industry three decades later. Star Wars holds the title for the “Most successful film merchandising franchise” in the Guinness World Records with a value of US$30.7bil.

In 2012, The Walt Disney Company acquired Lucasfilm for $4.06 billion and announced another new Star Wars film trilogy. Star Wars: The Force Awakens which was released this week, is dubbed the most anticipated movie of all times by three generations of fans. So, has the force been awakened after the 38 years? I am intensely excited to relive my childhood experience with my teenage children this afternoon at the cinema.

As the year is fast drawing to a close, I am addressing a different type of phenomena for many sufferers of diabetes, confined to a distant memory of “a long time ago, in a galaxy far far away”. I am dealing with the issue of erectile function in men that may require the awakening of the force with some help of the “blue life-savers” to relive the luminous days of the “blue lightsabers”.

Dear Dr. G,

My name is David, I suffer from type I diabetes since my teenage years.

I am now 50 years old and doing well with my glucose control and daily insulin injections.

I visit my doctors regularly and have my kidneys and heart check up done twice a year. The doctors also checked my eyes and feet regularly to ensure there is no damage.

I recently had my annual check-up and the doctor asked me about my sex life. To be honest, I have been avoiding this subject in the last ten years.

My wife and I have been married for the last ten years and we have two amazing children. I began to realize the erection has been a bit compromised since my early forties, and by mid forties, the rigidity had completely vanished.

Since the children are all grown up now, I did not think the sexual relationship is important in our relationship.

Ever since the doctor asked me about the erectile dysfunction, I began to realize I really missed the sex life. My doctor asked me to try the blue pills to revive my sex life. Needless to say, I am afraid, but tempted.

I am grateful if you can tell me why am I suffering from erectile dysfunction despite meticulous sugar control?

I heard somewhere the blue pills can result in the permanent awakening of the erection and may cause long lasting damage.

Please help
David

Type I diabetes, once known as juvenile diabetes or insulin dependent diabetes, is a chronic condition in which the pancreas produces little or no insulin. With the treatment of the hormone, type I diabetic patients can expect to live a normal healthy life. In some diabetic patients, despite the stringent sugar control, the destructions of the nerves and vasculature in various parts of the body will continue, resulting in nephropathy (destruction of the kidneys), retinopathy (destructions of the eyes), neuropathy and vasculo-pathy.

The intricate function of the penis to achieve full rigidity is dependent on the functions of the blood vessels and nerves allowing blood perfusion with sexual stimulation. For diabetic patients, the narrowing of the blood supply can be temporarily reversed with the help of the blue pills. Although the medical treatments have benefited patients with diabetes induced erectile dysfunction, with efficacy rates as high as 80%, one of the feared complications of the intervention is priapism.

Priapism is named after the Greek God of fertility, Priapus, who aparrently has a disproportionately large and persistently erect penis. In medical terms, priapism is the persistent erect penis that does not return to its flaccid state, despite no physical or psychological stimulation. Although, many may think such rigidity is a blessing, on the contrary, priapism is considered a medical emergency! The persistent erection will require treatment within four to six hours, as the trapped blood in the penis can result in organ ischemia and long-term damage.

Various factors can result in priapism; these include blood disorders such as sickle cell anemia, blood clots, trauma and spinal cord injury. Certain poisonous venom from scorpions and black widow spiders are also well documented to induce priapism with the outcome being penile damage (clever creatures!).

Alcohol and illegal drugs such as marijuana or cocaine are well known to be the causes of priapism. In reality, such are rarity that may be witnessed once or twice in a career of a medical practitioner. The drugs that are associated with such complications are not just PDE5-I, such as the blue pills; the others may include antidepressants, antipsychotics and even common medications such as warfarin, widely used as the blood-thinning agent.

The true management of priapism is the recognition of the condition (I guess it is hard to miss for the patient or even the people around them, when it is ongoing for more than four hours), and prompt medical attention. Most priapism is self-limiting, but some may require the aspiration of blood or even injections of vessel constricting antidotes.

The influential Russian painter and art theorist, Wassily Kandinsky once said: “The deeper the blue becomes, the more strongly it calls man towards infinite awakening in him a desire for pure and finally supernatural”. I guess for David, after a decade to “weakened force”, the calls from the blue for the awakening is deepened. I only hope he is aware the persistent activation of the “lightsaber” is possible, but definitely not supernatural!