As erectile dysfunction is a topic that’s not openly talked about in Singapore, many people have misconceptions and false understanding of the condition. Believing in something that turns out to be false can be harmful. In this article, we go in-depth to understand what erectile dysfunction is in Singapore and what causes it. 

How does an erection come about?

To understand more about erectile dysfunction, we first have to understand how an erection happens. An erection occurs from the increased blood flow to the penis. The increased blood flow is a result of stimulation by sexual thoughts or when there’s direct contact with the penis.

There are two erection chambers in the penis which are made of spongy muscle tissues. When a man is sexually excited, the muscles in the penis relax. This allows for increased blood flow to the penile arteries, which then fills the two chambers. When the penis is filled with blood, it becomes rigid. 

An erection will end when the muscles contract and the blood can flow out through the penile veins.

What is erectile dysfunction?

Erectile dysfunction is the frequent inability to obtain or sustain an erection for sexual intercourse. It’s a condition that can occur due to problems at any stage of the erection process.

Men may face erection issues every now and then, so it’s not necessarily a sign to be alarmed. 

However, if it happens constantly, it’s a sign that you’ll need to consult a doctor for professional advice and get the proper treatment.

And while it’s more common for older men to experience erectile dysfunction, the truth is that men of any age can be vulnerable to erectile dysfunction due to various reasons.

Learn more about what you might have gotten wrong about erectile dysfunction here, as we debunk misconceptions that people in Singapore have about the condition. 

What are the symptoms of erectile dysfunction?

You may have erectile dysfunction if you have the following symptoms: 

  • Inability to get an erection
  • Inability to maintain an erection during sexual activity
  • Low sexual desire

In addition, you may experience pain during erection, or have premature or delayed ejaculation. 

Seeking medical advice for erectile dysfunction in Singapore can be daunting. But with MyDoc app, you can chat directly with a doctor from Dr Tan & Partners (DTAP) clinic and get personal medical advice easily, without having to leave your home.

What causes erectile dysfunction?

Infographic on the common causes of erectile dysfunction in Singapore

Getting an erection is a complicated process that involves many functions such as the brain, hormones, emotions, nerves, muscles and blood vessels

Hence, any issues with these functions may lead to erectile dysfunction. Other causes such as psychological factors may also cause or aggravate the condition.

Let us go further in detail on the causes of erectile dysfunction.

Physical factors 

The following health issues are common causes of erectile dysfunction. 

Diabetes

Men who have diabetes, especially type 2 diabetes, are prone to experience erectile dysfunction. In fact, about 35 to 50 percent of men with diabetes experience erectile dysfunction. 

This is because one of the complications of diabetes is nerve and artery damage due to poor long-term blood sugar control. This can affect penis sensations, as well as result in impaired blood flow and lower hormone levels that are required for an erection. 

When sexually aroused, nitric oxide will be released into the bloodstream. This signals the arteries and muscles in the penis to relax to allow blood flow. 

However, for men with diabetes, the nitric oxide released is lesser when blood sugar levels are too high. This also means that there’s not enough blood flowing into the penis to sustain an erection.

Heart disease and blocked blood vessels

Chances of experiencing erectile dysfunction are higher when you have heart or vascular diseases. This is due to the presence of risk factors such as diabetes mellitus, obesity, hyperlipidaemia, hypertension, atherosclerosis and smoking.

Heart disease and blocked vessels affects not just blood flow to the heart and brain, but also to the penis. This makes it difficult to get an erection. 

In the same vein, experiencing erectile dysfunction when you aren’t diagnosed with heart disease can be a sign of an underlying heart problem. 

Be sure to go for regular health check-ups so that you can get the proper treatment early and lower your chances of getting erectile dysfunction. Learn more about the importance of regular health check-ups here. 

High blood pressure and anti-hypertensive medication

High blood pressure can also cause erection problems. This is because high blood pressure prevents the arteries from enlarging, in turn blocking the blood flow into the penis. The muscle in the penis is also unable to relax due to high blood pressure. This leads to insufficient blood flow into the penis that’s needed to cause an erection.

In addition, men with high blood pressure may have lower levels of testosterone, which plays a huge role in sexual arousal. 

On top of high blood pressure, anti-hypertensive medications may also cause erectile dysfunction. Drugs like diuretics and beta-blockers are commonly linked to erectile dysfunction

As diuretics decrease the force of blood flow, they can cause erectile dysfunction. They may also reduce the zinc levels in the body that’s required to make testosterone.

Beta-blockers decrease the response to the nerves that lead to erections. They make it more difficult for arteries in the penis to enlarge and allow blood to flow in. 

In addition, the side effects that come from beta-blockers — such as feeling sedated and depressed — can affect sexual arousal and erection.

Obesity and metabolic syndrome

Being severely overweight puts you at risk of health issues, including erectile dysfunction. When massive weight gain is not managed well, it can affect your sexual life. 

In fact, there’s a correlation between obesity and erectile dysfunction. Research has shown that men who are obese are 2.5 times more likely to experience erectile dysfunction than other men.

This is because being obese makes you more vulnerable to cardiovascular diseases such as atherosclerosis, which is when cholesterol settles on the walls of your blood vessels, obstructing blood flow to your organs and penis. 

The correlation between heart and sexual health is also pretty strong, such that erectile dysfunction is often the first sign that an obese man is also suffering from a cardiovascular condition. Research has also found that a majority of men with coronary artery disease have experienced erectile dysfunction about two to three years before developing heart conditions. Erectile dysfunction is also linked to future heart attacks and strokes.

Besides physical health issues, being overweight can have psychological effects on you and your sexual life. Obesity can lower your testosterone level, which can cause low libido, depressed mood and low levels of energy. All these can affect your ability to get an erection and a desire to enjoy a good sexual life.

Smoking

A man smoking and drinking alcohol, which are common causes of erectile dysfunction in Singapore

Smoking can damage your blood vessels and can affect the blood flow to the penis. If you have any artery issues, smoking increases your likelihood of having erectile dysfunction.

Just like diabetes, smoking decreases levels of nitric oxide in the bloodstream, which is crucial in allowing blood to flow to the penis. 

Alcoholism and drug abuse

Similarly, alcoholism and drug abuse can lead to erectile dysfunction as they can damage your blood vessels and impede the blood flow to the penis. 

Drinking too much alcohol can also lead to high blood pressure and heart disease, which can further worsen erectile dysfunction. 

Multiple sclerosis and Parkinson’s disease

As mentioned earlier, erections are affected by the brain’s signal to the penis. They occur when there’s sexual arousal or physical stimulation of the penis. This means that nerve conditions like multiple sclerosis can result in erectile dysfunction. 

With multiple sclerosis, the nerves are damaged in a process known as demyelination. This happens when the immune system attacks and strips away the insulating membrane that protects a nerve known as the myelin sheath. 

When this happens, it affects the brain’s ability to communicate with your reproductive system, preventing you from getting an erection.

Another condition that can cause erectile dysfunction is Parkinson’s disease, due to the nerve and muscle problems associated with it. The tremors and stiffness in the body due to the disease could also make sex hard, painful and uncomfortable. 

Surgeries or injuries to the spinal cord

Surgery procedures to treat prostate and bladder cancer may also damage nerves and tissues required for an erection.  

In addition, any injury to the pelvis, bladder, spinal cord or penis can increase the likelihood of erectile dysfunction.

Psychological issues

Physical health conditions aren’t the only factors that can cause erectile dysfunction. Some psychological factors can also result in the condition. 

An erection starts with feelings of sexual excitement, whereby the brain triggers a series of physical events. This is why psychological factors can also interfere with erections, causing or even aggravating erectile dysfunction.

These are some of the psychological conditions that can lead to erectile dysfunction. 

Depression

Depression can disrupt signals that are being sent from the brain to the penis. When the brain is put under unhealthy stress due to factors such as relationship issues or work problems, it releases a hormone called cortisol.  

Cortisol narrows the blood vessels in the penis, leading to an obstruction of blood flow and subsequently the inability to achieve an erection. Over a long period of time, high cortisol levels can also lower the amount of testosterone in the body.

Due to the high levels of cortisol released, erectile dysfunction can still occur even when the man is comfortable with a sexual situation.

Depression medication can also cause erectile dysfunction. In fact, a common side effect of antidepressants is difficulty getting an erection. 

Most antidepressants are part of a family drug known as SSRIs (selective serotonin reuptake inhibitors). These drugs increase the levels of serotonin in the body, making the person feel calm and more relaxed.

This calming and anxiety-reducing effect can lower one’s libido, preventing the hormones related to sexual arousal to be sent to the brain. In other words, antidepressants can reduce the overall sex drive, making it difficult to get an erection. 

Not sure if you’re experiencing depression? Here are the warning signs to look out for. 

Anxiety

Having trouble getting an erection can also lead to anxiety and worry that it will happen again. This results in performance anxiety, which can eventually lead to erectile dysfunction.

Performance anxiety can occur when you feel stressed about body image or satisfying your partner. It’s mostly caused by negative thoughts, which can affect the signals the brain sends to the rest of the body, making it harder to get an erection.

Stress

Stress due to work, money issues and marriage problems are common factors that can cause erectile dysfunction. 

When left untreated, erectile dysfunction can cause more stress and anxiety, further aggravating the condition. 

Feeling stressed lately? Here are 13 ways to release stress and feel better. 

Guilt

Erectile dysfunction could also arise from feeling guilty about being unable to satisfy your partner. It’s also commonly linked to mental issues such as depression, which is another cause of erectile dysfunction. 

Low self-esteem

Having previous episodes of erectile dysfunction can cause one to feel inadequate and have low self-esteem. This can lead to performance anxiety, which in turn leads to erectile dysfunction. 

Indifference

Age, loss of interest in sex, side effects of medications and relationship problems can also lead to indifference, resulting in a difficulting to get an erection.

How can erectile dysfunction be prevented?

It’s normal for men to experience erectile dysfunction once in a while. However, chances of experiencing erectile dysfunction can be lowered if you take proper care of yourself

So how can erectile dysfunction be prevented?

Manage health conditions like diabetes

If you happen to have conditions such as diabetes, hypertension and high cholesterol, make sure to manage and control them. Since they can be related to erectile dysfunction, it’s essential to also manage these conditions if you have them.

Those who poorly control these conditions have higher chances of experiencing sexual problems as compared to those who do

Limit alcohol and drug use

Try to limit or avoid alcohol and drugs. If you enjoy drinking alcohol, do so in moderation. 

Stop smoking 

If you’re having difficulty quitting smoking, be sure to seek help or join a smoking cessation programme, such as the Health Promotion Board’s I Quit 28-Day Countdown programme

Exercise regularly

Going for regular exercise, such as jogging, can help prevent erectile dysfunction

Make sure to include regular exercise in your daily life. Exercising can help reduce stress, lose weight and increase blood flow, all of which reduce your likelihood of getting erectile dysfunction.

In fact, men who exercise frequently have a 30 percent less risk of getting erectile dysfunction. 

You should ideally exercise for 30 to 45 minutes at least three to five days a week. 

Get enough rest 

Work and family duties can easily take up most of our time. But do remember to have sufficient rest to avoid fatigue. Doing so can also help to reduce stress. 

Seek help

Whether it’s anxiety, stress or depression, don’t be afraid to seek help. 

Do a virtual consultation with a medical professional easily through the MyDoc app anytime, anywhere. 

How can erectile dysfunction be treated in Singapore?

Treatment for erectile dysfunction in Singapore will vary depending on the cause. The table below summarises some examples of available treatments for erectile dysfunction in Singapore.

Non-invasive treatments
Lifestyle changes– Lose weight
– Exercise frequently
– Quit smoking
– Cut down on alcohol
Counselling– Therapy
– Couples counselling
Medication– Viagra
– Cialis
– Levitra
– Stendra
Devices– Penis pumps
Invasive treatmentsSurgery– Penile implant
– Vascular surgery

To treat erectile dysfunction, non-invasive treatments are usually tried first. 

Lifestyle changes

Changes to your lifestyle like losing weight, exercising frequently, quitting smoking and cutting down on alcohol can help to prevent erectile dysfunction.

Counselling

If you’re having psychological issues such as anxiety and depression, it’s good to seek treatment for these issues first. 

If erectile dysfunction has worsened your relationship with your partner, you may want to consider going for couples counselling. 

Medication

If required, the doctor may prescribe oral medication, such as Viagra, Cialis, Levitra and Stendra.

Other than oral medications, other forms of medication like the Alprostadil self-injection may be used.

On the other hand, if a certain medication is causing the erectile dysfunction, your doctor may prescribe a lower dose of that medication or prescribe a different one.

Find out more about the use of Viagra here. 

Penis pumps

If the above methods don’t work, the doctor may recommend penis pumps, which don’t involve the use of medication. 

A penis pump is a device that creates a low-pressure vacuum around the penis to cause an erection. It helps to hold the blood in the penis and keep it firm for at least 30 minutes.

However, if the non-invasive treatments listed above don’t work, the doctor may recommend surgery.

Surgery

The main surgery treatment is the insertion of a penile implant, which can make the penis be firm enough during sex. 

Another type of surgery is vascular surgery, which involves repairing of blocked blood vessels. 

While there are many causes of erectile dysfunction, it can be treated and is usually reversible. Thus, it’s recommended to consult a doctor to identify the cause and get the right treatment. 

Get in touch with doctors from DTAP clinic through MyDoc’s app to consult about erectile dysfunction and any other sexual health issues. To get started, simply download the app and register through this link. 

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