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Erectile Dysfunction

Erectile dysfunction (ED) is more common than many people realize and can significantly impact an individual’s overall health and quality of life. In Singapore, a population-based survey in 2003 revealed that 51.3% of men over the age of 30 experienced some degree of ED, with age being the most significant risk factor.

ED is not just a sexual health issue; it may also indicate underlying health conditions, such as cardiovascular disease, making it crucial to address this concern promptly.

Why You Shouldn’t Ignore ED

Erectile dysfunction can act as an early warning system for cardiovascular disease. The blood vessels supplying the penis are among the smallest in the body (1–2 mm), compared to the larger arteries supplying the heart (2–3 mm). As a result, reduced blood flow to the penis often precedes cardiovascular events by 3–5 years.

Take Action: If you experience ED, consult a specialist as soon as possible to address the issue and assess your overall health.

  1. Limited Blood Flow

Reduced blood flow to the penis is one of the most common causes of ED. Conditions that restrict blood flow include:

  • Cigarette smoking
  • Diabetes
  • High blood pressure
  • Obesity
  • Aging

Medications for high blood pressure and other chronic conditions may also interfere with blood flow, contributing to ED. 

  1. Neurological Causes

Nerve damage caused by:

  • Diabetes
  • Spinal cord injuries
  • Prostate surgery
  • Strokes

  1. Psychological Causes
  • Depression: Low libido and ED can both be symptoms of depression.
  • Performance Anxiety: A single episode of erectile failure may lead to anxiety, creating a cycle of difficulty.

  1. Medication Side Effects

Medications that affect testosterone or the nervous system can contribute to ED, including:

  • Opioids for chronic pain.
  • Blood pressure medications (e.g., beta blockers).
  • Antidepressants.

  1. Other Contributing Factors
  • Low testosterone levels: Leads to reduced libido and sexual function.
  • Smoking and alcohol: Both negatively affect blood flow and nerve function.

Medical History and Physical Exam

Your healthcare provider will ask about your sexual history, lifestyle factors, and overall health. Key areas of focus include:

  • Onset of ED: Was it sudden or gradual?
  • Morning erections: Do they still occur?
  • Erectile function during masturbation.
  • Risk factors: Smoking, obesity, diabetes, or alcohol use.

Blood Tests

Tests may include:

  • Testosterone levels.
  • Cholesterol and blood sugar levels.
  • Thyroid hormone levels.

Specialized Testing

Some cases may require advanced diagnostics, such as:

  • Ultrasound to evaluate penile blood flow.
  • Hormone testing to identify imbalances.

Yes, there are numerous effective treatments for ED, ranging from lifestyle changes to medical interventions.

  1. Lifestyle Changes
  • Diet and Exercise: Maintaining a healthy weight and active lifestyle can improve blood flow and erectile function.
  • Quit Smoking: Reduces the risk of vascular-related ED.
  • Limit Alcohol: Excessive alcohol can impair sexual performance.

  1. Phosphodiesterase-5 (PDE-5) Inhibitors

These medications improve blood flow to the penis, allowing for erections with sexual stimulation. Common options include:

  • Sildenafil (Viagra): Taken 1 hour before intercourse; effects last up to 4 hours.
  • Tadalafil (Cialis): Can last up to 36 hours and is available as a daily low-dose option.
  • Vardenafil (Levitra): Onset within 30 minutes, effects lasting up to 4 hours.
  • Avanafil (Stendra): Onset within 15 minutes, effective with food or alcohol.

Side Effects: Headaches, flushed skin, indigestion, and dizziness.
Caution: Never combine PDE-5 inhibitors with nitrates, as this can cause dangerously low blood pressure.

  1. Penile Injections

Medications such as alprostadil can be injected directly into the penis to induce an erection without sexual stimulation. While effective, injections may cause discomfort or scarring over time.

  1. Vacuum-Assisted Devices

These devices create a vacuum around the penis to draw blood into it, with a ring placed at the base to maintain the erection. Though effective for many, satisfaction rates vary.

  1. Penile Implants

Surgical options, such as inflatable penile prostheses, are reserved for severe cases where other treatments fail.

  1. Testosterone Replacement Therapy (TRT)

For men with low testosterone, TRT can improve libido and erectile function, especially when combined with PDE-5 inhibitors.

  1. Psychological Counseling

For ED caused by anxiety or depression, therapy can help address underlying issues and improve sexual function.

  • Avoid online sources for ED medications; many are counterfeit and unsafe.
  • Discuss all medications with your doctor to ensure no interactions occur.

Report any severe side effects, such as prolonged erections or vision changes, immediately.