Erectile Dysfunction (ED) in Men

What Is Erectile Dysfunction?

Erectile dysfunction (ED) is defined as the inability to get or keep an erection long enough to allow for satisfactory sexual intercourse. It is a type of penile disorder.

ED, also known as impotence, is very common and normally affects men aged 40 years and above. ED can be a short-term or long-term problem, and it may also be an indication of a more serious medical condition such as heart disease.

What Are the Types of Erectile Dysfunction?

The types of ED include:

• Vascular erectile dysfunction: Vascular ED is the most common type of ED. It is caused by abnormalities with the blood vessels that provide blood to the tissues in the penis (to allow and maintain an erection), or the valves in the penis that normally keep blood inside.
• Hormonal erectile dysfunction: Hormonal ED is caused by testosterone deficiency or, in certain cases, thyroid disorders.
• Neurogenic erectile dysfunction: Neurogenic ED results from nerve abnormalities that restrict signals from travelling from the brain to the penis to produce an erection. This can occur as a result of trauma, pelvic surgery, radiation therapy, or neurological diseases such as stroke, spinal stenosis, and multiple sclerosis.
• Psychogenic erectile dysfunction: Psychogenic ED refers to psychological conditions (that impact the thoughts, feelings, or behaviour) that can cause ED.

What Is the Difference Between Erectile Dysfunction and Premature Ejaculation?

ED happens when you are unable to achieve or sustain an erection, while premature ejaculation occurs when you have an erection but reach orgasm and ejaculate earlier than you or your partner would prefer.

However, ED might cause premature ejaculation. This occurs when a man is aware of his inability to maintain an erection, therefore he develops the habit of ejaculating shortly after achieving an erection in order to avoid losing his erection.

What Are the Symptoms of Erectile Dysfunction?

ED symptoms include:

• Being able to obtain an erection prior to sexual intercourse only sometimes, but not every time you want to have sex.
• Having the ability to get an erection prior to sexual intercourse but failing to sustain it during sex.
• Complete inability to achieve an erection.
• Needing a lot of stimulation to keep an erection going.

What Are the Common Causes of Erectile Dysfunction?

The common causes of ED include:

• Certain diseases and conditions: Including type 2 diabetes, heart and blood vessel disease, atherosclerosis, high blood pressure, high cholesterol, chronic kidney disease, epilepsy, and multiple sclerosis.
• Medications: ED can be a side effect of medicines such as blood pressure medicines, prostate cancer drugs, antiandrogens, antidepressants, chemotherapy drugs, diuretics, tranquilisers, appetite suppressants, and ulcer medicines.
• Psychological or emotional issues: Including fear of sexual failure, anxiety, depression, guilt about sexual performance, low self-esteem, and stress.

Can Alcohol Cause Erectile Dysfunction?

Yes. Alcohol, as well as other substances that have addiction potential (for example amphetamines, cocaine, marijuana, and nicotine), may cause ED.

How Is Erectile Dysfunction Diagnosed?

Medical and sexual history

Your doctor will ask you questions about your personal and sexual history such as:

• How often your penis is firm enough for intercourse?
• How often are you able to maintain an erection during sexual intercourse?
• When did your ED symptoms start?
• Are you currently taking any medications?

Mental health and physical exam

Your doctor may ask some questions and use a questionnaire to diagnose any psychological or emotional problems that may be contributing to ED. Your doctor will also perform a physical examination where he/she will measure your blood pressure, look for blood flow issues, and examine your penis to determine the cause of ED.

Lab tests

Blood tests, complete blood count, lipid panel, liver function tests, kidney function tests, thyroid tests, testosterone test, and urine test.

Imaging tests

Penile Doppler ultrasound and magnetic resonance angiography (MRA).

Other tests

Tests that measure if the nerves in the penis respond to vibrations (penile biothesiometry), and an injection test (intracavernosal injection) whereby drugs that temporarily make your penis erect will be injected into your penis.

How Is Erectile Dysfunction Treated?

• Lifestyle changes: Stop smoking, limit alcohol consumption, and increase physical activity.
• Counselling: Talk to a sex therapist or a counsellor to help manage your psychological or emotional issues.
• Medications: Oral medications such as sildenafil and vardenafil help increase blood flow to your penis, while injectable medications such as alprostadil and papaverine help trigger an automatic erection.
• Vacuum constriction device: Also known as a penis pump, this device causes an erection by pulling blood into the penis.
• Testosterone replacement therapy: Available as a gel, injection, patches, and pellets.

How to Prevent Erectile Dysfunction?

ED can be prevented through various ways including:

• Quitting smoking.
• Lowering cholesterol level.
• Keeping a healthy weight.
• Following a healthy eating plan involving whole-grain foods, low-fat dairy foods, fruits and vegetables, and lean meats.
• Being physically active.
• Reducing alcohol consumption.
• Stopping illegal drug use.

Make an Appointment at Pantai Hospitals

ED is very common and usually, there is nothing to worry about. However, if you suspect that you have ED, make an appointment with your doctor.

A dedicated and expert team of urologists at Pantai Hospital is available for consultation to provide the best care and assistance. Get in touch with us to book an appointment today if you have any concerns or questions regarding your reproductive health.

For health screening appointments, please contact the Health Screening Centre at your nearest Pantai Hospital.

Pantai Hospital has been accredited by the Malaysian Society for Quality in Health (MSQH) for its commitment to patient safety and service quality.

This article has been medically reviewed by Urology specialist, Dr George Choo Eang Leng.