Erectile Dysfunction

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Erectile Dysfunction (ED) is characterised by the inability to develop and keep an erection firm enough for sexual intercourse.

It is a common problem faced by older men. If Erectile Dysfunction is an ongoing concern for you, it may affect your self-esteem, cause stress and embarrassment, and even interfere with your sex life or ability to get your partner pregnant.

Causes and Symptoms of Erectile Dysfunction

Determining the reason for ED is an important first step, as a proper diagnosis can help to identify complications which may be caused by underlying health issues.

Risk factors can consist of one or more psychological and physical disorder:

  • Increased age
  • Cardiovascular problems
  • High blood pressure, high cholesterol levels
  • Obesity
  • Stress
  • Depression
  • Medication
  • Alcohol use
  • Smoking
  • Long-term exposure to radiation at the pelvic region
  • Side effects of ongoing treatments/medications for prostate diseases
  • Blood flow problems or nerve damage in the penis
  • Peyronie’s disease – development of scar tissue in the penis

Men are considered to have Erectile Dysfunction if the below symptoms are persistent. Signs include:

  • Reduced sexual desire
  • Trouble getting an erection
  • Difficulty in maintaining an erection during sexual activities
  • Premature ejaculation


In order for your doctor to diagnose Erectile Dysfunction and come up with a treatment plan suitable for you, a physical exam will be conducted along with additional investigative tests. You may also be asked to share about your medical history, lifestyle habits or any recent incidents that may have caused you stress.

Physical check
A careful examination of the penis and testicles may be conducted to check for any swelling. A rectal exam may also be required to check the prostate.

A video image of the blood vessels in the penis will help your doctor to detect any blood flow problems.

Blood tests
Blood samples might be taken to study for signs of heart disease, diabetes, low testosterone levels and other health conditions.

Psychological exam
On top of physical examinations, your doctor might ask you some questions to screen for possible psychological causes.

Urine tests
Likewise, urine samples may be collected to look for indications of underlying health problems.

Once the cause of your condition is determined, your doctor will then be able to suggest one or more of the following treatment options:

Treating Erectile Dysfunction

Exercise & Lifestyle Changes

One of the best ways to treat ED without medication is through regular exercise. Certain exercises that improve cardiovascular status, such as running, biking, jogging or swimming, can help increase the blood flow throughout the body and in turn improve circulation problems specific to ED.

Discuss with your doctor to decide what exercises are most beneficial for you.

Oral Medication

Sildenafil (Viagra) was the first oral medicine approved to treat ED. It works by increasing the flow of blood to the penis so that a man can get an erection when he is sexually stimulated.

Other oral medications that work in a similar fashion are tadalafil (Cialis) and vardenafil (Levitra).

Raffles Specialists - oral medication: tablets and pills

Penile Injection Therapy

Injection therapy is effective in treating a wide variety of erection problems caused by blood vessel, nerve, and psychological conditions. In intracavernosal injection therapy, more commonly called penile self-injection, a man injects a small amount of medicine into the side of his penis using a tiny needle and syringe. The medicine, usually prostaglandin E1, papaverine, phentolamine, or combinations of these drugs, relaxes the blood vessels, allowing blood to flow into the penis.

The most common adverse side effects are pain and penile scarring (fibrosis).

Vacuum Constriction Device

The vacuum constriction device is a cylinder that is placed over the penis. It is operated with a hand powered or battery powered pump. When the air is pumped out of the cylinder, blood is drawn into the penis, causing an erection. The user then maintains an erection by slipping a band off the cylinder and onto the base of the penis. The band can stay in place up to 20 minutes.

However, a lack of spontaneity and the fact that using the device can be cumbersome and may cause some discomfort seem to be the biggest concerns of patients.

Extracorporeal Shock Wave Therapy (ESWT)

An erection requires a significant amount of blood flow into the penis to stay rigid. ESWT addresses this issue by utilising low-intensity shock waves to facilitate the development of blood vessels in the erectile tissues. With new and better quality blood vessels in the penis, blood flow to the area increases.

It is a non-invasive and painless treatment method. Patients generally undergo 6-12 sessions of ESWT, each lasting 15-20 minutes. During which, patients will feel a slight tapping sensation with each shock.


Surgery usually has one of three goals:

To implant a device that can cause the penis to become erect:

Implanted devices, known as prostheses, can restore erection in many men with ED. Possible problems with implants include mechanical breakdown and infection, although mechanical problems have diminished in recent years because of technological advances.

The simplest type of prosthesis consists of a pair of malleable rods surgically implanted within the corpora cavernosa. They keep the penis firm but bendable. The user manually adjusts the position of the penis and, therefore, the rods. Adjustment does not affect the width or length of the penis.

Today, many men instead choose a hydraulic, inflatable prosthesis that allows a man to have an erection whenever he chooses. The penile prosthesis is also an option for men whose erections are curved because of scarring.

To reconstruct arteries to increase flow of blood to the penis:
Surgery to repair arteries can reduce ED caused by obstructions that block the flow of blood. The best candidates for such surgery are young men with discrete blockage of an artery because of an injury to the crotch or fracture of the pelvis. The procedure is almost never successful in older men with widespread blockage.

To block off veins that allow blood to leak from the penile tissues:
Surgery to veins that allow blood to leave the penis usually involves an opposite procedure—intentional blockage. Blocking off veins (ligation) can reduce the leakage of blood that diminishes the rigidity of the penis during erection.

It must be stressed that very few men are potential candidates for vascular reconstructive surgery. In addition, extensive testing is required of men prior to undergoing this type of surgery.

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