“Dear Doctor, I am very shy to consult this with my GP. I am 34 year old male, with problems getting hard when I am with my wife. Can you advise me on what I should do?”
Erectile dysfunction is colloquially known as impotence, and refers to the inability to maintain an erection firm enough for sexual intercourse. An erection occurs when nerve impulses from the brain and local nerves cause increased arterial blood flow to the spongy tissue of the penis, and maintained by the fibrous membrane otherwise known as the tunica albuginea.
“What are the causes?”
It is increasingly common in the urbanized landscape, and there are many factors which cause ED. Some are self-resolving such as psychological stress and performance anxiety. Others are due to organic problems that need to be managed and include:
• Chronic illnesses such as diabetes mellitus, hypertension or other nerve conditions that damage the nerves and arteries to the penis.
• Poor lifestyle habits such as lack of exercise, obesity and alcohol/smoking
• Medications such as tranquilizers, flu tablets, medications for blood pressure
• Hormonal causes such as raised prolactin and hypo-testosterone state.
“What should I do?”
First recommendation: Don’t fall for scams! It is important to remember Google is not YOUR doctor. Many men look for treatment options online as it can be embarrassing to discuss ED. However, not all ideas are equal, and not all treatments are SAFE or EFFECTIVE for all men. There are many sites selling fake medications which contain other drugs which may result in low blood sugar levels leading to brain damage.
Secondly: Seek medical attention. Your doctor will take a thorough medical and sexual history to help delineate the severity and likely cause of your ED. He would then suggest a series of hormonal blood tests and may require an ultrasound assessment of the penile blood flow.
“Can ED be treated?”
ED is a treatable condition.
Generally, your doctor would usually provide oral medications which improve blood flow to the penis and help maintain an erection (Viagra, Cialis or Levitra). Options like vacuum pump or injection therapy can be discussed as well. However the above are assistive and do not treat the primary cause of ED which is inadequate blood flow.
“Can I avoid oral medication?”
There is a new treatment known as Shockwave therapy which utilizes small shocks to the penis that increases growth factor levels and lead to new blood vessel formation. To date, this is the only treatment that attempts to fix the problem at the root, and was developed by researchers in Israel. Although considered new, and is only provided at a few clinics in Singapore, this new treatment has had promising results. The shock wave therapy has been assessed as effective in 75-80% of patients, with slightly lower success in patients with vascular or diabetes-induced ED.
This treatment stretches between 3-6 weeks (2 sessions weekly for a total of 6-12 sessions- from $400 per session) and is expected to last for 2 years and upwards. This would help restore sexual spontaneity and also reduce the reliance on prescription medications.
This article is answered by Dr. Winston Lee (Expert Panel of What’s Up Doc?)
Dr Winston Lee graduated from NUS in 2005, and has completed a Masters in Public Health from NUS in 2014 and has interests in conducting small workshops on health promotion and encouraging active health screening for companies and people at large. He has experience in various Emergency Departments of the Restructured Hospitals, and recently admitted as a Member of the College of Emergency Medicine (UK).
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