Erectile dysfunction (ED) is the inability to get and keep an erection firm enough for sex.
Having erection trouble from time to time is common and usually not a problem. But for some men, it can be an ongoing issue and this cause stress, affect their self-confidence and contribute to relationship problems.
There are many factors that contribute to ED. It is mainly divided into physical causes or psychological causes.
- Heart disease
- High cholesterol
- High blood pressure
- Certain medications
- Smoking and alcohol
- Surgeries or injuries that affect the pelvic area or spinal cord
Psychological causes includes
- Relationship problems.
The first thing your doctor will do is to screen you for any of the medical condition/s mentioned above. If you do have any of the health conditions above, the doctor would want to make sure you're getting the right treatment. Your doctor might suggest a few blood test such as cholesterol, sugar, kidney, liver function and testosterone level.
Lifestyle modification remain the first line therapy for ED
- Quit smoking if you do smoke
- Stop alcohol or drink at moderation
- Lose weight and/or maintain ideal body weight.
- Include physical activity in your daily routine.
- Work through relationship issues.
However, if the above failed or is taking ''too long'' to work, oral medication are the easiest and most effective treatment option for many men.
The medication we use to treat ED come under a group of medicine called Phosphodiesterase type 5 (PDE5) inhibitors. With more and more generic medications in the market, it is now cheaper for patient to get treatment for ED.
In Singapore, there are few different type and brand which include:
- Sildenafil (e.g. Viagra, ANDROZ, A-sildenafil, STADA)
- Tadalafil (e.g. Cialis)
- Vardenafil (e.g. Levitra)
The meds increases blood flow and allows you to get an erection in response to sexual stimulation. It is general safe with possible side effects include flushing, nasal congestion, headache, visual changes, backache and stomach upset.
However, before taking any medication for erectile dysfunction, please speak to your doctor. There are conditions where the PDE5 inhibitor might be dangerous or not suitable if you:
- If you are taking nitrate medications which are commonly prescribed for chest pain or in heart disease, you cannot take this medication as it can cause a potentially serious, even fatal, decrease in blood pressure if taken together with PDE5 inhibitor.
- Have very low blood pressure (hypotension) or uncontrolled high blood pressure.
- Have severe liver or kidney disease
There are other treatment for erectile dysfunction include:
- Self-injections. Medications are injected directly into the penis to achieve an erection. With this method, you use a fine needle to inject the medications into the base or side of your penis, pain from the injection site is usually minor. Side effects include bleeding from the injection, prolonged erection (priapism) and formation of scarring at the injection site.
- Alprostadil urethral suppository. This involves placing a tiny suppository inside your penis in the penile urethra. Side effects can include pain, minor bleeding in the urethra and formation of scar tissue inside your penis.
- Low-intensity extracorporeal shock wave therapy (LI-ESWT). This is a new '' ultrasound'' technique which initial studies does show a very good result but more studies is needed to fully evaluate this method.
- Testosterone replacement. Some men have erectile dysfunction that might be complicated by low levels of the hormone testosterone. In this case, testosterone replacement therapy might be needed.
- Penis pumps. Bruising of the penis is a possible side effect.
- Penile implants. It is usually not recommended ntil other methods have been tried first
- Psychological counselling. If your erectile dysfunction is caused by stress, anxiety, depression or relationship tension — you might benefit from this method.
If you're concerned about erectile dysfunction, do talk to your doctor now, you can fix it!
(Dr Lee Chong Han, Trucare Medical and Surgery)