Erectile Dysfunction

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Erectile DysfunctionErectile dysfunction (ED) is the persistent inability to sustain an erection of sufficient rigidity and duration, in order to achieve satisfactory penetration during sexual intercourse.

The incidence of ED increases with age, with up to 25% of 65 year old men experiencing ED on a long-term basis. With increased awareness of this condition, and with better medical care and increased life expectancy, the quality of erection and sexual function has become an important component of healthy aging. ED is, however, not an unavoidable consequence of aging and should not be considered normal at any age.


For an erection to occur, 3 things must be present:

1. Nerves to the penis must be functioning properly
2. Blood circulation to the penis must be adequate
3. There must be a stimulus from the brain

Anything which causes a disruption to any of these factors, can potentially cause ED. This would include psychological causes, physical causes, or a combination of the two.

Do you know your Erection Hardness Score ?


Conditions that commonly cause ED include:

Diabetes:Diabetes causes nerve and artery damage over time, potentially leading to ED. Some studies report up to 50% - 75% of men with diabetes experience ED.

Vascular disease: Vascular diseases, such as atherosclerosis (hardening of the arteries), reduce blood flow to the penis, in the case of ED. Hypertension and high cholesterol levels both contribute to the development of atherosclerosis.

Neurological diseases: An intact neurological system is essential for achieving normal erection. Thus, conditions such as strokes, spinal cord injuries, Parkinson's disease , Alzheimer's disease etc. can all result in ED.

Kidney disease: Kidney diseases can affect hormones, circulation and nerve function. These changes, together with the fatigue associated with kidney disease, may reduce libido and contribute to ED.

Prostate cancer treatment: Surgery, radiation and hormonal treatments can lead to ED.

Injury: Injuries to the penis, bladder, pelvis, spinal cord or brain can cause ED.

Hormonal Imbalances:Thyroid hormone, prolactin and testosterone imbalances can reduce libido, thereby affecting sexual function.

Smoking, alcohol and drug use: These substances result in reduced blood flow to the penis, thus causing ED.

medicationSome commonly used medication also may cause ED:

• Anti-hypertensive drugs
• Diuretics
• Anti-depressants
• Anti-anxiety drugs
• Anti-epileptic drugs
• Medication for the treatment of Parkinson's disease 


Your doctor will ask you questions regarding your ED and about possible risk factors or causes. A physical examination is then performed. You may also be referred to a urologist for further assessment.

Certain tests may be done and these may include:

Blood tests: to assess for diabetes, high cholesterol, testosterone level, kidney disease etc.

Urine tests: also to assess for diabetes and kidney disease

Duplex ultrasound: this ultrasound examination is used to evaluate venous leaks and blood flow into the penis. An injection of prostaglandin is given to induce an erection and and a duplex ultrasound is used to measure blood flow.

Nocturnal penile tumescence: It is normal for a man to have 5 to 6 erections during sleep. If such erections occur, it means that there is an intact nerve and blood supply to the penis. This nocturnal erections can be measured by a snap or strain gauge.

Bulbocavernosus reflex test: used to determine if there is an intact nerve system in the penis. When the glands penis is squeezed, there is a normal reflex contraction of the anus.

Other tests: such as penile biothesiometry, penile angiogram, corpus cavernosometry, magnetic resonance angiography etc are sometimes performed.



How ED is treated depends largely on what is causing it. Your doctor will make an assessment of the likely physical and/or psychological components contributing to the problem of ED and decide on the type of treatment most suitable for you.

Treatments (with the exception of testosterone supplementation in those who are testosterone deficient) generally work on a temporary basis, to enable an adequate erection for intercourse, but do not permanently solve the underlying problem.

Oral Medication:
PDE5 Inhibitors: These are prescription drugs which work by blocking the action of PDE5. This results in relaxation of the arteries in the penis when there is sexual stimulation, causing the corpus cavernosum of the penis shaft to fill up with blood. Drugs in this category are: sildenfil (Viagra), tadalafil (Cialis) and vardenafil (Levitra).

Psychological factors causing or contributing to ED need to be managed through counselling.

Injectable drugs, creams and penile suppositories:
These drugs are administered just before intercourse.

Vacuum Therapy:
A penis pump is used to draw blood into the penis. A tension ring is then applied at the base of the penis to maintain the erection by preventing blood from flowing out.

Prosthetic implants are sometimes inserted as a last resort if other treatment modalities have failed.

Are You At Risk?

Many men experience occasional problems achieving an erection. This may sometimes be due to fatigue, anxiety or illness. However, failure to do so more than 50% of the time may indicate that the problem requires treatment.

Find out if you are at risk by taking this simple quiz.

1. Are you overweight?

2. Do you smoke or consume alcohol?

3. Do you have any of the following conditions?
High cholesterol
• Kidney disease

4. How often do you exercise?

5. How often do you feel stressed or depressed?

6. How old are you?


1. Men who are overweight are more likely to have ED.

2. Smoking and regular consumption of alcohol damage blood vessels and reduce blood flow to the penis over time.

3. Some medical conditions such as diabetes, hypertension, high cholesterol, kidney disease and atherosclerosis are risk factors for developing ED.

4. Regular exercise reduces your risk of developing ED.

5. Stress and depression are major psychological causes of ED.

6. The incidence of ED increases significantly after the age of 50.



1. Is my ED the result of an underlying illness?

2. Could there be a psychological component resulting in my ED?

3. Could any of the medication I am taking be contributing to my ED?

4. Is there any medication I can take for my ED? Is such medication suitable for me?

5. If oral medication isn't for me, then what are my options?


The mind plays a very important role in sex. It has been said that the biggest sex organ is the brain. Psychological factors thus play a large part in erectile dysfunction. It is often said that erectile dysfunction begets erectile dysfunction, in that once you fail in bed, the stress and anxiety makes it highly likely that you will fail again. With each failed encounter, your confidence level drops and and makes further attempts more difficult.

The following feelings may predispose you to developing ED. Do recognize them, watch out for them and manage them early.

• Stress from any source eg work, family

• Performance anxiety, perhaps from a previous bad experience or episode of ED

• Relationship problems with partner


• Feeling self conscious

• Thinking that your partner is reacting negatively to you


The article above is meant to provide general information and does not replace a doctor's consultation.
Please see your doctor for professional advice.