In this article, we will be explaining how an erection works, the causes and symptoms of erectile dysfunction, the various erectile dysfunction treatments available in Singapore, and how you can get your ED treated with prescription medication without having to leave home.
Erectile Dysfunction, also known as ED or impotence, is a common condition that affects your ability to get or maintain an erection long or firm enough for sexual intercourse.
Did you know that ED is the most common sexual dysfunction which patients visit doctors for? A recent study shows that about one third of all men globally are affected by ED (Gerbild, Larsen, Graugaard and Areskoug Josefsson, 2018). A 2003 study conducted in Singapore found that 51.3% of Singaporean males above the age of 30 experience some form of ED (Tan et al., 2003).
In a study done by the Department of Urology at the University of Wisconsin, it was found that mild and moderate ED affects approximately 10% of men per decade (i.e. 50% of men in their 50s, 60% of men in their 60s). This increasing probability has to do with the fact that illnesses, such as hypertension, diabetes and vascular diseases, tend to be more present in older men, where more arousal and stimulation is needed to get and maintain an erection. This may in part be due to their pre-existing health conditions which may require medication (Chung, 2019).
Our penis has two erection chambers that are made of spongy muscle tissues. The chambers extend from the penile head all the way into the pelvis. When we are sexually aroused, our brain sends a signal which causes a hormonal response, allowing the arteries that supply blood to our penis to open fully.
When these arteries are open, blood enters at a rate so fast that it does not have enough time to exit through the veins. Blood is then trapped in the chambers, which results in your penis becoming firm – and voila, an erection occurs.
Once you achieve an orgasm, the hormonal response stops, because your brain is no longer sending signals of sexual arousal. The arteries return to their normal state, the spongy muscle tissues contract, your erection comes down, and your penis is once again flaccid.
The symptoms of ED are quite straight-forward. They include having trouble getting an erection, not being able to keep the erection for long, or even experiencing a reduced desire for sexual activities. However, do keep in mind that it is completely normal if this happens occasionally! This is because there are certain triggers that could contribute to these symptoms. For example, we may have had one too many drinks, consumed certain drugs, feel depressed or even just exhausted from work. It is not a warning sign that you have ED, so there is no need to worry. The need to be concerned is if you are experiencing these symptoms more than half the time you have intercourse or find that it is taking a toll on your relationship or well-being.
Erectile dysfunction is, put simply, the inability to get or maintain an erection long or firm enough for sexual intercourse. It can happen at any stage of the erection process.
The cause of ED can be from physical issues or psychological reasons. In most cases, it is a mix of both.
Physical causes, also the most common cause of ED, are ones that arise from health issues such as cardiovascular diseases, diabetes, high cholesterol and high blood pressure.
Psychological causes, on the other hand, are less common as only one in ten cases of persistent ED are psychologically connected. Psychological causes are mental issues that affect your ability to achieve an erection. As we just covered the importance of our brain in sending signals to help us get an erection, any disruption to this process can cause ED. Common psychological issues include depression, stress, anxiety or even feeling nervous to perform.
Here are some common causes of ED:
- The blood flow into your penis is insufficient - health issues such as diabetes, heart disease, high blood pressure or hardened arteries reduces the blood flow into the penis which makes it difficult to get an erection.
- Damage to the spongy muscle tissue - when a man has gone through radiation treatment or surgery near the pelvis or lower abdomen (i.e prostate, bladder or colorectal cancer), it often leads to ED.
- Your brain is not sending the correct signals to your penis or the signals are not reaching your penis. This can happen due to neurological diseases, injury or surgery in the pelvic area where the nerves to the penis are harmed.
- Diabetes – if you have diabetes, it can cause small vessel disease or even nerve damage to the penis which affects your ability to achieve an erection.
Here are some of the most common ED treatments available in Singapore:
- An effective ED treatment for many men, oral medication like Viagra, Cialis or Tadalafil are often prescribed as a first line of treatment.
These medications are known as phosphodiesterase-5 inhibitors (PDE5 inhibitors).They help to restrict the enzyme PDE5 which degrades cGMP, a molecule that relaxes the muscle tissues in the body. By inhibiting PDE5, these ED medications are able to relax the muscles present in the blood vessel walls. This ultimately leads to an improved blood flow where you need it most; your penis.
Contrary to popular belief, ED medication like Viagra, Cialis or Tadalafil won't magically increase your sex drive or cause you to get random erection after you take it. They will still need you to be aroused in order for you to get hard. Thankfully for most healthy men, taking ED medication will help make getting an erection a much easier task.
It is possible that these ED medication can cause mild side effects like:
Unfortunately, you will not be able to purchase any oral ED medication over-the-counter You will need to see a doctor for a prescription.
- If prescription ED medication is not working or unsuitable for you, there are alprostadil injections that can be administered directly into the penis. These injections work by expanding your blood vessels, which increases the blood flow to your penis.
These penile injections can quickly produce an erection, which can then last up to an hour.
It is possible that penile injections can cause side effects like prolonged erection, mild bleeding, and in rare cases, the formation of fibrous tissues at and around the injection site.
- If other ED treatments are found not to be effective, penile implants might be recommended by your doctor. This ED treatment involves surgically inserting a small tube on both sides of your penis. These tubes can then be pumped with air to help erect your penis.
- Alprostadil urethral suppository involves inserting a small alprostadil suppository into the tip of your penis. The medication gets absorbed by the urethral wall, which then produces an erection that can last up to an hour.
Alprostadil urethral suppository can cause side effects like pain, burning sensation in the penis, and minor bleeding.
- Vacuum restriction devices (also known as a penis pump) can be prescribed to treat ED. A hollow tube is placed over the penis and then connected to a pump (either operated by hand or battery).
The pumping will draw blood towards the penis due to the pressure created by the vacuum. When a tension rubber ring is placed around the base of the penis, the penis pump can produce an erection that lasts up to 30 minutes.
- While ED medication like Sildenafil Citrate or Tadalafil works to address the physiological causes of ED, they will not be able to treat your depression, anxiety or stress.
Some methods to help psychological issues, including psychological causes of ED, include cognitive behavioural therapy (CBT) which is facilitated by a therapist. If not, some relaxation methods that you can try at home include breathing exercises, meditation and guided imagery, which may help to relieve some symptoms of anxiety, stress and depression.
The first step to understanding and diagnosing your ED is to consult with a doctor. Here at Noah, our doctors are best equipped with the knowledge to help you ascertain the root cause of erectile dysfunction and determine whether it is physiological or psychological. They will be able to advise you on the best treatment suited for you, and can also prescribe you the right medication should you need it.
Looking for an ED specialist in Singapore, but not too keen on making the awkward trip to the clinic?
With Noah, a zero judgement digital health clinic for men in Singapore, you can get the ED treatment you need from the comfort of home. See a licensed doctor and have the prescribed ED medication discreetly delivered to your door within 4 hours at no additional cost.
- Some EDs can be cured but it depends on the cause. There are "reversible" causes of ED (like obesity, stress, and alcohol); this ED will be cured once the underlying cause is treated. There are also "treatable" causes of ED (like hormonal imbalances and high cholesterol); once treated, you will see your ED improve.
- ED treatment is not a one-size-fits-all. Different causes would lead to different treatments. Sometimes, the cause of ED is an underlying health issue and fixing that very issue can directly treat ED. You should first consult a doctor to diagnose the root cause of your erectile dysfunction before deciding on a treatment plan.
- If you have been prescribed ED medication, you might experience mild side effects like headaches, nausea, dizziness, flushing, and nasal congestion. These side effects will eventually subside and go away after a few hours.
If you are experiencing erectile dysfunction, it is advisable that you consult a doctor. Here at Noah, our doctors are best equipped with the knowledge to help you ascertain the root cause of your erectile dysfunction. They will be able to advise you on the best treatment suited for you, and can also prescribe you the right medication should you need it.
Gerbild, H., Larsen, C., Graugaard, C. and Areskoug Josefsson, K., 2018. Physical Activity to Improve Erectile Function: A Systematic Review of Intervention Studies. Sexual Medicine, 6(2), pp.75-89. (Link)
Chung, E., 2019. Sexuality in Ageing Male: Review of Pathophysiology and Treatment Strategies for Various Male Sexual Dysfunctions. Medical Sciences, 7(10), p.98. (Link)
Tan, J., Hong, C., Png, D., Liew, L. and Wong, M., 2003. Erectile dysfunction in Singapore: prevalence and its associated factors--a population-based study. Singapore Medical Journal, 44(1). (Link)