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Erectile Dysfunction

Erectile Dysfunction

Erectile dysfunction (ED), also known as impotence, is defined as the persistent inability to sustain penile erection of sufficient rigidity (to keep the erection firm enough) and duration to achieve satisfactory penetration during intercourse. ED patients may also experience reduced sexual drive.

ED can occur at any age, but becomes more common with increasing age. Complications of ED may include:

  • Unsatisfactory sexual life
  • Stress
  • Depression
  • Loss of self-confidence
  • Relationship troubles with sexual partner

These may lead to marital crisis and the inability to have a baby.

Causes and risk factors of ED include physical and mental causes, as well as social habits and issues relating to medication.


  • Diseases affecting blood flow to the penis blood vessels such as arteriosclerosis (narrowing of heart blood vessels), heart problems and high blood pressure
  • Nerve damage due to stroke or spinal cord injury
  • Testicular or prostate cancer
  • Diabetes
  • Injuries
  • Obesity
  • Hormonal abnormalities


  • Fatigue or tiredness
  • Mental disorders such as depression or anxiety about sexual performance
  • Alzheimer’s disease
  • Hypothyroidism
  • Relationship problems with sexual partner

Social habits:

  • Cigarette smoking
  • Heavy alcohol consumption

Tests and diagnosis
The first step of ED management is to identify the underlying causes and, if possible, to reverse the underlying causes. The following are some tests to find out the underlying causes of ED.

  • Physical examination of the penis and testicles to check for normal nerve sensation
  • Blood tests– glucose, cholesterol, kidney function, liver function, hormone levels testing
  • Urine tests
  • Blood pressure measurement
  • Electrocardiogram (ECG)
  • Ultrasound (to check penile blood flow)

Treatment options

  • PDE5 inhibitors (Phosphodiasterase-5 inhibitors) such as sildenafil, tadalafil or vardenafil work by increasing blood flow to the penis through the effects of nitric oxide (NO). NO is a natural chemical in your body that helps to dilate the blood vessels, which permits an erection in response to sexual stimulation. The medication is not suitable for those who are already on nitrate-based heart medication (e.g. GTN, nitro-glycerine), blood-thinning medication or alpha-blocker class of blood pressure medication. Other precautions include a history of stroke, uncontrolled diabetes, uncontrolled high blood pressure and low blood pressure.
  • Alprostadil (an injection treatment) is also known as prostaglandin E1, which is used to stimulate the production of a neurotransmitter (a natural chemical in your body) that enhances blood flow to the penis. Unlike PDE5 inhibitors, the erection is not affected by sexual stimulation.
  • Testosterone-replacement therapy helps to restore testosterone (male hormone) levels in blood to the normal range. It is especially helpful for patients who have ED as a result of low testosterone levels.
  • Surgery involves implantation of a rod (penile prosthesis), either an inflatable rod or a semi-rigid rod into the penis. This method is used after failure of other treatment options, or for patients who are not suitable candidates for other treatment options.
  • Psychological counselling (sex therapy or couple/marriage counselling) may be helpful for ED caused by stress, depression, low self-esteem, and poor communication between partners.

Lifestyle modifications
As with other health conditions, prevention is always better than cure. Adopting lifestyle modifications is one way to reduce the risk of developing ED.

Any underlying health conditions such as diabetes or high blood pressure should be monitored and managed closely. Hence eating healthily and exercising regularly is also a good idea. You should try to exercise regularly for at least 20-30 minutes at least three times each week.

Smoking increases the risk of developing ED, so smoking cessation is encouraged. You should also limit your consumption of alcohol.

Some people may be hesitant to discuss sexual issues with their doctor. However, if you have symptoms of ED, you should seek help from your doctor as ED could be a sign of underlying health problems that require medical attention.

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