Erectile dysfunction (ED) can be defined as persistent or recurrent inability to achieve and maintain a penile erection of sufficient rigidity to permit satisfactory sexual activity for at least 3 months. It is the most common type of male sexual dysfunction in which the penis fails to become or stay erect during sexual intercourse. Having erection trouble from time to time is not necessarily a cause for concern. However, if erectile dysfunction is an ongoing issue, it can be an early harbinger of heart disease especially in younger men. ED often cause significant physical, psychological and social distress and detrimental to one's relationship.
Risk factors including being older age, smoking, overweight and obesity, lack of exercises, excessive alcohol consumption, underlying chronic diseases (diabetes, hypertension, hyperlipidaemia), stress, psychological disorders (depression, anxiety) and taking several medications (such as SSRIs, beta-blocker and thiazide).
ED is more common in men above the age of 40 years. However, there are 1 in 4 men less than 40 years old suffer from ED. Among the cause are due to excessive pornography or so called porn-induced erectile dysfunction. Other contributing causes are high level of stress and unhealthy lifestyle habits
There are various causes of ED. The most common causes of ED is vascular or blood flow issues. In about 80% of cases, medical causes can be identified. Among causes of ED are:
- Blood flow (vasculogenic): heart disease, peripheral vascular disease, hypertension, hyperlipidaemia, diabetes, smoking
- Neurogenic: stroke, Parkinson's disease, multiple sclerosis, spinal cord disease, diabetes, post- surgery (prostatectomy)
- Anatomical: Peyronie's disease, hypospadias, micropenis
- Hormonal: hypogonadism (low testosterone), thyroid disease, hyperprolactinaemia
- Drug- induced: anti- hypertensives, anti-depressant, anabolic steroid, anti-psychotic, recreational drugs
- Trauma: penile fracture, pelvic fracture
About 10% of causes are due to psychological factors such as excessive stress, performance anxiety, depression and relationship issue (new partner, lack of communication). Most commonly, the cause of ED is a combination of medical and psychological causes.
In clinical practice, ED can be assessed by using several questionaires. Your doctor may perform several blood test to screen for hormonal disorders and presence of chronic diseases like diabetes, hypertension and high cholesterol. Treatment involves addressing the underlying causes, lifestyle modifications by quit smoking, regular exercises, weight reduction and cutting down on alcohol consumption, avoid excessive use of pornography material as well as addressing underlying psychosocial problems.
Medical treatment includes medication like PDE5- inhibitors such as Viagra, Cialis and Levitra which dilate blood vessels allowing flow to the spongy tissue to the penis. Side-effects include headache, flushing, dizziness, flushing and abnormal vision. Other treatment includes testosterone replacement therapy if evidence of low testosterone, penile injection (intracavernosal) penile implants, intraurethral medication, vacuum erection devices, PRP injection (P-shot) and shockwave therapy.
Erectile dysfunction can cause significant strain to many couple. Feeling embarrassed about sexual health problems may prevent many men from seeking the medical attention they need, which can delay diagnosis and treatment of more serious underlying conditions. It is important to recognise ED as a silent vascular disease and a risk factor for developing heart disease and early screening of cardiovascular risk factors and aggressive preventive measures are paramount to prevent this from happening.
If you have symptoms of ED or other male sexual dysfunction, you do not need to suffer in silence. Talk to our doctor today about the tests and treatment available to help your condition.