What Is ED?

Erectile dysfunction (ED) is defined as the persistent inability to achieve or maintain a penile erection sufficient for satisfactory sexual performance.

ED can limit your intimacy, affect your self-esteem, and impact your most important relationships and cause depression.

The recent shift in the management and evaluation of ED, with primary care physicians replacing urologists in the forefront of ED diagnosis and therapy, has been a welcome and timely change.

How Common Is ED?

A Male Aging Study found that 52% of men between 40 and 70 years old reported having some form of erectile dysfunction. The reality is that ED is a natural part of ageing and that the prevalence increases with age.

In that study, they found that roughly 50% of men at 50 years old, 60% of men at 60 years old and 70% of men at 70 years old had ED. Thus, nearly all men who live long enough should develop ED.

What Contributes To ED?

Many factors can contribute to sexual dysfunction in older men, including physical and psychological conditions, comorbidities and the medications used to treat them.

The aetiology for this decline in sexual activity is multifactorial and is in part due to the fact that most of the female partners undergo menopause at 52 years of age with a significant decline in their libido and desire to engage in sexual activity.

History Snippet – ED Taken Back In Time

Impotence treatments were discussed in the oldest Chinese text, The Yellow Emperor’s Classic of Internal Medicine, which describes traditional Chinese medicine during the time of the Yellow Emperor’s rule which ended around 2600 BC. One of the treatments for impotence discussed is a potion with 22 ingredients.

Nearly 1000 years later, the Egyptian Papyrus Ebers, a medical Egyptian document dated 1600 BC, describes a cure for impotence in which baby crocodile hearts were mixed with wood oil and applied topically to the penis.

In 1973, Dr Brantley Scott from Baylor College of Medicine reported on the implantable inflatable prosthesis that urologists still use today.

The major breakthrough occurred in 1998 when sildenafil became the first oral drug to be approved to treat ED. This was followed by the use of tadalafil and vardenafil as similar phosphodiesterase-5 inhibitor oral medications for treating ED in 2003

Is ED Solely Because Of Aging?


Besides advancing age,

  • Cardiovascular disease

  • Hypertension

  • High cholesterol

  • Diabetes

  • Medication

  • BPH (Benign prostatic hypertrophy) – enlarged prostate

  • Lower back spinal or nerve injuries

  • Peyronie’s syndrome – abnormally curved penis

  • Medications

  • Smoking and alcohol abuse

  • Anxiety, performance related issues, relationship problems

  • Obesity

ED may be a harbinger of other undiagnosed conditions such as coronary artery disease (CAD), High blood pressure, high cholesterol and diabetes. Studies show that ED can predate a heart attack or significant blockages of the heart arteries by 2 years.

Men with diabetes are four times more likely to experience ED, and on average, experience ED 15 years earlier than men without diabetes.

There are hundreds of medications that have the side effect of ED and/or decreased libido. Examples of drugs implicated as a cause of ED include some high blood pressure medications.

Medications used to treat depression, particularly the SSRIs family of drugs may also contribute to ED.

Hair loss medication like Propecia can also contribute to ED.

Treatment for enlarged prostate using drugs like Dutasteride likewise also contribute to ED.

A study in 2005 suggests that ED is not only more likely among men who smoked compared with those who never did, but that in younger men with ED, cigarette smoking is very likely the cause of their impotence.

Obesity is also correlated to the development of several types of dysfunction, including a decrease in sex drive and an increase in episodes of ED.

What Are The Options Of ED Treatment?

The options for management include

  • TRT (Testosterone Replacement Therapy) – for those with proven testosterone deficiency

  • Oral Tablets (PDE5 inhibitors – Viagra, Cialis, Levitra)

  • Penile Injections – intracavernosal injection therapy

  • Vacuum Pumps – Vacuum Constriction Devices (VCDs)

  • ESWT (Extracorporeal Shock wave Therapy)

  • Surgical placement of a penile prosthesis

How Do Drugs Like Viagra Work?

These drugs are formally known as PDE-5 inhibitors. Other brands available in the market include Cialis and Levitra.

These medications do improve erectile quality for the majority of men, and they work by enhancing blood flow into the penis. These medications are generally used on demand and need to be taken about an hour before sexual intimacy.

Tadalafil (Cialis) is longer acting and does come in a daily preparation potentially eliminating the ‘on-demand’ need. The daily dosing of tadalafil (Cialis), 5mg has also been approved by the FDA for treatment of symptoms of BPH, enlarged prostates.

There is frequently a great expectation when men begin using these drugs and it is wise to temper their enthusiasm and explain they do not work immediately, and may not work every time, but also let the patient know that if these drugs do not work, there are other options.


What About The Penile Injections?

Second-line therapy is the use of Vacuum Constriction devices or penile intracavernosal injections of alprostadil.

Caverject is the alprostadil injection available in Singapore. A small needle is used to inject the medication into the side of the penis through a small, short needle.

Response is usually occurs within 10–15 min, and does not require stimulation.

ESWT Can Be Used In Those Who Don’t Respond To Drugs Like Viagra Or Cialis.

How Does It Work?

ESWT refers to Extracorporeal Shock Wave Therapy. It consists of delivery of painless low intensity shocks directly to the penis via a probe. This consists of 1500 shocks twice a week for 3-6 weeks.

The purpose is to stimulate the growth of new blood vessels into the corporal bodies of the penis. They dramatically improves blood flow into the penis – more blood equal a harder penis. The use of low-intensity shock wave lithotripsy may convert patient who are non-responders to drugs like Cialis or Viagra or Levitra to now responders.

Take A Look At The Form Below And Assess Yourself… See Where You STAND.

If the assessment suggests you might have erectile dysfunction, it is in your interest that you visit your doctor to discuss underlying problems that are contributing to your ED and offer you appropriate investigations and treatment for this.

Our Men’s Health experienced Female Doctors are ready to listen to your issues. Visit us at InSync Medical Located along East Coast Road in the heart of Katong, Singapore. We also open on Sundays to Serve you.

Book an appointment now.

Take charge of your sexual health today