Erectile dysfunction (ED) is a troubling and common condition affecting as many as one in two sexually active men. It is typically considered an old man's issue because one of the most common causes is low testosterone, which occurs with ageing. In andropause, or male menopause, there is a gradual drop in testosterone levels from the age of 40. By the time men reach their 60s, the percentage of those afflicted by ED is estimated to reach a figure of about 80 per cent.
High cholesterol, heart disease, diabetes, obesity, tobacco use, alcoholism, sleep disorders and prostate issues are also some of the physical causes of ED. Dr Benjamin Loh of Dr Ben Medical, a health clinic for men, says that, apart from lower levels of testosterone, "as a man gets older, the likelihood of him developing prostate and lifestyle diseases increases."
More recently, Dr Loh has seen a rising number of younger men in their 30s suffering from ED. He says this is largely due to the high levels of stress they face at work or in their personal lives. Psychological causes such as these account for about 20 per cent of ED cases.
"The brain plays a significant role in initiating a series of physical events that lead to an erection. And a number of factors can interfere with sexual feelings and worsen or cause ED," says Dr Loh. "And in most cases, psychological problems such as anxiety, cause ED in younger men."
However, there is treatment for ED. Besides the conventional sildenafil medication, doctors are also using Extracorporeal Shockwave Therapy (ESWT), "a non-invasive procedure which has been shown to have promising results", says Dr Loh.
While pills can help do the job and are the most common form of treatment for ED, they cannot change the existing physiological processes associated with the condition. Sildenafil helps the arteries and the muscles in the penis to relax, which allows more blood to enter to achieve an erection. But they are usually taken on demand and only work when there is a stimulus.
Dr Loh says these pills may have side effects too - the common ones being heartburn, nasal congestion, headache, facial flushing, back pain, and sometimes, temporarily impaired colour vision. "In rare cases, you can experience a painful erection that refuses to go away. The medical term for it is 'priapism'. Patients with certain health conditions should refrain from using [such pills]," Dr Loh cautions.
How ESWT works
ESWT has been in use since the 1970s but mostly to treat kidney stones. It has only been in the last 10 years that doctors started using it to treat ED.
ESWT involves the use of a handheld device which emits gentle pulses to repair and strengthen blood vessels to improve blood flow, as that is essential to achieving an erection. The procedure, undertaken without anesthesia, takes around 20 minutes.
Dr Loh explains, "It is effective in most patients who embark on the treatment plan. It not only improves the associated ED symptoms, but can potentially reduce the reliance on ED drugs. And it is generally a painless procedure, although very few patients may experience mild discomfort."
Patients might need a couple of treatment sessions, depending on their symptoms, Dr Loh adds, "In my experience, it particularly helps patients with vasculogenic ED." Vasculogenic ED is ED caused by a problem with the blood vessels.
Getting to the root of the problem
While more men are seeking professional help to treat their ED, Dr Loh believes that there are still many who do not. Normally, it is only when their ED has become serious and has started to severely impact their quality of life that they consult a doctor, he shares.
The reasons are varied. Some men are embarrassed to talk to anyone about their problems while others lack knowledge or are fearful. While ED itself is not life-threatening, it could be an early indication of an underlying medical condition that should be addressed, so Dr Loh urges those with ED to not suffer in silence.
"It is extremely important that you seek help and find out what is causing your erectile dysfunction. You need to know whether it is linked to chronic medical conditions like obstructive sleep apnea, low testosterone and diabetes, or rare conditions such as a brain tumour."
For instance, if the cause of the ED is diabetes, apart from treating the ED symptoms, the patient's blood sugar needs to be strictly monitored and controlled.
Dr Loh reiterates: "While the effects of erectile dysfunction don't always pose serious health concerns, the potential underlying causes of ED could be injurious." He shares a rare case of one of his patients who had come to see him for his ED and low energy levels. Blood tests and scans later revealed that the cause was a benign brain tumour.
Dr Loh assures sufferers that most cases of ED can be reversed, and even when a permanent cure for ED is not possible, the right treatment can minimise symptoms. "Patients are often comforted when they experience tangible progress; and as a doctor, it is always rewarding when your patients get better," he says.
For more information on erectile dysfunction, visit drbenmedical.sg/extracorporeal-shockwave-therapy-singapore.
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