An Upright Battle – Erectile Dysfunction by Dr Joe Lee

Breaking the Silence for Better Health and Relationships

Erectile dysfunction (ED) is a condition that affects millions of men worldwide, yet it remains a topic shrouded in silence and embarrassment. Many men, along with their partners, feel too ashamed to seek help or discuss the issue openly. This can lead to unnecessary
suffering, relationship strain, and a loss of confidence.

However, in this day and age, no man should endure erectile dysfunction quietly. With a range of effective treatments available, from medications to advanced surgical options, there is hope and help for every man experiencing ED, whether it is due to age-related changes or a result of other diseases, such as prostate cancer.

This article is dedicated to women who care about their husbands and boyfriends, as well as men who are struggling with ED but are hesitant to seek help. By understanding the causes, diagnosis, social impact and modern treatments for ED, it is possible to take the first step towards regaining a fulfilling and healthy sexual life.

WHAT IS ERECTILE DYSFUNCTION?

Erectile dysfunction, commonly referred to as ED, is defined as the inability to achieve or maintain an erection sufficient for satisfactory sexual intercourse. While it is common for men to experience occasional difficulty with erections, persistent ED can significantly impact a man’s self-esteem, relationships and overall quality of life.

ED becomes more prevalent with age, but it is not an inevitable part of ageing. It can affect men of all ages and is often a sign of an underlying medical condition that requires attention. Fortunately, with the right treatment, most men can regain their sexual function and performance.

LiSWT (low-intensity shockwave therapy) stimulates the development of new blood vessels on the male genital. The increased blood flow helps enhance hardness.

CAUSES

A good erection requires a sufficient amount of blood to first flow into the penis, and then stay in the penis for the duration of intercourse.

For this to happen, an interplay of good blood vessels, healthy nerves and balanced hormones is necessary.

The causes of ED are diverse and can be broadly categorised into physical and psychological factors. In many cases, ED is the result of a combination of both.

PHYSICAL CAUSES

Some of the most common physical causes of ED include:

• Blood Vessel Disease: One of the most common causes of ED is poor blood flow to the penis brought about by chronic conditions such as hypertension and high cholesterol. These conditions lead to atherosclerosis (narrowing of blood vessels) which reduces blood flow into the penis during intercourse, making it difficult to achieve or
  maintain an erection.
• Diabetes: Men with diabetes are particularly at risk for ED. Diabetes can damage both nerves and blood vessels, leading to problems with blood flow and erectile function.
• Hormonal Imbalances: Low levels of testosterone, the primary male hormone, can contribute to ED and low libido. Thyroid problems and other hormonal imbalances may also play a role.
• Neurological Conditions: Diseases such as Parkinson’s disease, multiple sclerosis and spinal cord injuries can interfere with the nerve signals between the brain and the penis, causing ED.
• Lifestyle Factors: Smoking, excessive alcohol consumption, drug use and obesity can all contribute to ED by affecting
  blood circulation and overall health.

PSYCHOLOGICAL CAUSES

Psychological factors can include:

• Anxiety and Stress: Psychological stress, whether related to work, relationships or performance anxiety, can play a significant role in the development of ED. Even men who are otherwise physically healthy can experience erectile issues due to mental stress.
• Depression: Depression can lower libido and make it difficult for men to maintain an erection. Additionally, some antidepressant medications may have side effects that contribute to ED.
• Relationship Problems: Several issues such as lack of communication, unresolved conflicts or emotional distance between partners can lead to erectile difficulties.

DIAGNOSIS

Diagnosis of ED begins with an open conversation between the patient and the healthcare provider. This can be a challenging step for many men as it is not easy to come to terms with ED when it happens. It is essential to identify the underlying cause and determine the best course of treatment. For many men, it may not be easy to differentiate between physical causes and psychological ones.

An andrologist urologist will typically start by asking questions about the man’s sexual history, medical conditions, medications and lifestyle habits. A physical examination will follow, which may include checking blood pressure, heart rate and examining the genitals. In some cases, blood tests are done to measure hormone levels, cholesterol and blood sugar as these can provide clues to the cause of ED.

Dr Joe Lee at the Asian Healthcare Specialists Clinic @ Mt Elizabeth Novena

Sometimes, more specialised tests may be conducted. These can include:

• Penile Doppler Ultrasound: This test uses ultrasound scans to assess blood flow to the penis and can help to identify vascular problems that may be contributing to ED.
• Rigiscan Test: This test objectively measures the rigidity of a man’s penis using a machine with two soft loops placed around the shaft of the penis.

There are two main forms of Rigiscan tests:

• Audiovisual Sexual Stimulation (AVSS) test uses the Rigiscan device to measure the rigidity and duration of a man’s erections in real-time, when he is subjected to sexually stimulating content. This test is carried out in the outpatient clinic setting and takes about one hour.
• Nocturnal Penile Tumescence (NPT) test is used to check whether a man experiences normal physiological erections during deep sleep. If a man has erections while sleeping but experiences ED during waking hours, this suggests that psychological factors may be at play. This test is usually done in an inpatient setting over 1-2 nights.

SOCIAL IMPACT

ED does not just affect men physically. It also has profound emotional and social consequences. Many men suffering from ED have experienced a loss of confidence and self esteem, leading to anxiety and depression. The fear of not being able to perform sexually can result in avoidance of intimacy, which can strain relationships and cause emotional distance between partners.

For women, ED can also be a source of confusion and frustration. They may feel that their partner’s loss of sexual interest is due to a lack of attraction, when in fact, it is often related to the man’s fear of failure or embarrassment about his condition. Open communication is key to overcoming this issue together. When both partners understand that ED is a medical condition and that treatment options are available,
they can work as a team to find a solution.

Dr Joe Lee at the Asian Healthcare Specialists Clinic @ Mt Alvernia Hospital

TREATMENT OPTIONS

Thanks to medical advancements, there are now a wide range of effective treatments for ED, ranging from lifestyle changes for very mild ED to advanced surgical options for very severe ED. No man should suffer quietly when help is so readily available. The type of treatment selected will depend on how severe the condition is.

Lifestyle Changes

This works when ED is very mild and at an early stage, where simple changes in lifestyle can have a positive effect on erectile function. Quitting smoking, reducing alcohol consumption, losing weight and increasing physical activity can all improve blood flow and reduce the risk of ED. A healthy diet rich in fruits, vegetables, whole grains and lean proteins also supports overall cardiovascular health, which is crucial for erectile function.

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Medications (PDE5 Inhibitors)

Oral medications such as sildenafil (Viagra), tadalafil (Cialis), and avanafil (Spedra) are often the first line of treatment for ED. These medications work by increasing blood flow to the penis during arousal, making it easier to achieve and maintain an erection. They are effective for the majority of men with mild to moderate ED but require sexual stimulation to work.

Low Intensity Shockwave Therapy

One of the newer and more promising treatments for ED is low-intensity shockwave therapy (LiSWT). This non invasive procedure uses acoustic waves to improve blood flow to the penis by stimulating the formation of new blood vessels (angiogenesis) and enhancing existing blood flow. LiSWT has been shown to be effective, particularly in men with mild to moderate ED. Unlike medications, which provide temporary relief, shockwave therapy aims to restore natural erectile function over time. It is a safe option with minimal side effects, making it an appealing alternative for men seeking a long-term solution to ED.

Vacuum Erection Devices (VED)

This non-invasive option involves using a vacuum pump to draw blood into the penis, followed by the placement of a constriction ring at the base of the penis to maintain the erection. It is a good alternative for men who cannot take oral medications or prefer a non-drug approach. It is commonly used for men with moderate to severe ED.

Penile Injections

For men who do not respond to oral medications, injectable medications such as alprostadil (Caverject) can be used. These injections are administered directly into the penis and typically produce an erection within 10-15 minutes. This type of erection is called pharmacological or artificial erection, and men with moderate to severe ED are taught how to do self-injections when using this form of therapy.

Penile Implants

For men with severe ED who seek a long term solution, penile implant surgery offers a permanent option. There are two types of
implants: semi-rigid and inflatable. Inflatable implants are the more popular choice, allowing the man to control when and how long he has an erection. Penile implants have high success and satisfaction rates for men and their partners, and are often considered the gold standard treatment for severe ED.

Psychotherapy and Counseling

For men whose ED is linked to psychological factors, therapy can be highly effective. Cognitive behavioural therapy (CBT) and couples therapy can help to address performance anxiety, relationship issues and emotional blocks that contribute to ED.

Novel Therapies

The field of ED is always progressing with various newer modalities, such as PRP (platelet rich plasma) injections and radiofrequency
therapies, still in various stages of development and experimentation.

Top-notch facilities at the Asian Healthcare Specialists Clinic

MEN: DO NOT SUFFER IN SILENCE

Many men consider erection as a reflection of their masculinity or worth. Today, with multiple treatment options available, no man should feel embarrassed or ashamed to seek help. Whether the cause of ED is physical or psychological, there is a solution that can restore both sexual function and confidence. For women, being supportive and encouraging their partners to seek medical advice is the first step towards healing.

By breaking the silence surrounding ED, men can regain their health, relationships can flourish, and both partners can enjoy a fulfilling sexual relationship. If you or your partner is experiencing ED, consult an andrologist urologist today to explore the various treatments available.

There is no need to suffer quietly – help is here, and the future is promising.

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