What causes Erectile Dysfunction (ED)?

Erectile dysfunction is more common than you think. Many men of any age will experience this and it can be a worrying condition without the right help.

If you are experiencing weaker erections, don’t hesitate to seek help.

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The majority of the time there is no obvious cause and ED starts without an easily identified trigger factor. However, most who experience ED this way will probably be experiencing a degree of performance anxiety. This just means that something causes it to happen the first time (possibly stress at work/home) and then you start to worry about it happening again. And once you start to worry, it then it makes the whole cycle worse and ED is more likely to occur again.

Of course there are other causes as well such as low testosterone or chronic diseases (high blood pressure and diabetes), which require the underlying problem to be addressed for the issue to return to normal.

To help identify if you have ED, you can run through this short questionnaire and note your score:

1) How do you rate your confidence that you could keep an erection?

  • 1 = Very Low
  • 2 = Low
  • 3 = Moderate
  • 4 = High
  • 5 = Very High

2) When you had erections with sexual stimulation, how often were your erections hard enough for penetration (to enter your partner)?

  • 1 = Never or Almost Never
  • 2 = A Few Times (Less Than Half The Time)
  • 3 = Sometimes (About Half The Time)
  • 4 = Most Times (Much More Than Half The Time)
  • 5 = Almost Always

3) During sexual intercourse, how often were you able to maintain your erection after you had penetrated your partner?

  • 1 = Never or Almost Never
  • 2 = A Few Times (Less Than Half The Time)
  • 3 = Sometimes (About Half The Time)
  • 4 = Most Times (Much More Than Half The Time)
  • 5 = Almost Always

4) During sexual intercourse, how difficult was it to maintain your erection to completion of intercourse?

  • 1 = Extremely Difficult
  • 2 = Very Difficult
  • 3 = Difficult
  • 4 = Slightly Difficult
  • 5 = Not Difficult

5) When you attempted sexual intercourse, how often was it satisfactory for you?

  • 1 = Never or Almost Never
  • 2 = A Few Times (Less Than Half The Time)
  • 3 = Sometimes (About Half The Time)
  • 4 = Most Times (Much More Than Half The Time)
  • 5 = Almost Always

Score:

22-25 = No erectile dysfunction

17-21 = Mild erectile dysfunction

12-16 = Mild to moderate erectile dysfunction

8-11 = Moderate erectile dysfunction

5-7 = Severe erectile dysfunction

What can be done?

In the first instance it is best to speak to a doctor to determine the potential causes for ED. Basic treatment options would be as followed:

For Mild ED:

  • Treat with medication
  • Potentially completely reverse with ESWT

For Moderate ED:

  • Treat with medication
  • Potential improvement to mild ED with ESWT.

For Severe ED:

  • Combination of medication and ESWT for best results.

 

Medication

PDE5-I medication helps to increase blood flow to the penis resulting in stronger, longer lasting erections. A common side effect, headache, may also occur because of this but we can always alleviate through side effect medication.

An example of medication available would be The Blue Pill.

Other forms of medication can be seen here. The normal usage is to take 1 tablet approximately 1 hour before sexual activity and use no more than 1 tablet per 24 hours.

We have many options available in clinic including original, branded medication as well as the more affordable (but considered equally effective) generic brands as well. We can discuss management well suited to your budget.

ESWT

Another, newer option, is to use Extracorporeal Shock Wave Therapy (ESWT). This process involves a device passing kinetic energy into the body of the penis to improve blood vessel growth with the aim of producing stronger erections.

The process does require several sessions to show full potential but this option is safe, effective and non-invasive/pain-free, which is ideal for those that do not want to take medication or for those were medication may not be safe.

However, it is important to note that ESWT can be used together with medication or separately. Both are viable options.

How will I know if it is working?

Medication will work from the very first tablet if the cause is simply performance anxiety. Most men notice an improvement immediately and can choose to continue the medication as long as they wish.

Should the medication show no effect at all, ESWT would the next course of action. We may also begin to investigate other cause such as those listed above.

As mentioned above, ESWT often takes several sessions with maintenance over a few months to produce the best effect. The advantage of ESWT is that once a full cycle is complete the positive effects often remain long term without needing additional treatment for approximately 6 months.

Is it safe?

In general as long as we make sure your blood pressure is in check then the medication is safe. Many use it long term without issue. Of course, we recommend regular review in order to identify any potential problems.

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Since ESWT is non-invasive, it is very safe in experienced hands. It is also a good choice for those that experience severe side effects with medication or have pre-existing conditions (such as high, uncontrolled high blood pressure) that prevent the use of medication.

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Dr Justin Sim

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Dr Justin is a friendly and approachable doctor who has a special interest in men’s health, which includes erectile dysfunction. Feel free to make an appointment with him for holistic and compassionate care.

For more information please contact us or visit us in clinic.

Call us for appointments or more information. All information and correspondence is fully confidential.

Tel +65 6386 9098 or SMS 8419 1943

You can also email us and we aim to reply within the day.

Email: atlaspacificmedical@gmail.com