An estimated 51.3 per cent of men over the age of 30 suffer from some degree of erectile dysfunction (ED) in Singapore, according to a local study published in the Singapore Medical Journal.

Defined as persistent difficulty in having or keeping an erection, ED may develop due to a number of reasons – from physical and neurological causes, to lifestyle and nutrition.

Dr Jonathan Teo, consultant urologist at UroHealth Medical Clinic, says: “Lack of exercise, an unhealthy diet, smoking and consumption of alcohol can affect vascular health and the body’s network of blood vessels. Erectile dysfunction can result when blood flow to the penis is disrupted.”

He points out that many of his ED patients are young professionals who lead minimally active lifestyles and are not conscious about their diet.

While ED on its own can be challenging, Dr Teo adds that the condition may also signal other underlying health problems: “It is estimated that 50 per cent of men with diabetes have ED, and the figure is higher if they also have hypertension and ischaemic heart disease – decreased blood flow and oxygen to the heart.

“These conditions point to or are themselves vascular health conditions, and ED is increasingly viewed as a vascular disorder. Hence, patients who develop ED should also pay more attention to their heart health.”

Not just a health-risk – erectile dysfunction can also affect you emotionally

Beyond physical health and lifestyle, Dr Teo also emphasises the need to understand an individual’s emotional state when faced with ED.

Couples trying to conceive often face performance anxiety, while men who believe they cannot deliver a satisfying sexual experience tend to feel disheartened. These challenges can lead to misunderstandings and strained relationships, intensifying the mental and emotional factors associated with ED.

Stress from work or life events, along with mental health issues such as depression, can also contribute to or worsen ED.

Such glimpses into patients’ lives, in addition to self-reports of symptoms like difficulty initiating or maintaining an erection, are what Dr Teo looks out for when conducting a comprehensive evaluation at his clinic.

Medical questionnaires such as the Erection Hardness Score and International Index of Erection are also used to diagnose the severity of each case. Having a holistic understanding of his patients helps him uncover the root cause and recommend the right treatment plan.

If he suspects that a patient’s ED is related to a psychological condition, Dr Teo says he may conduct a psychological examination to ensure that the patient gets the necessary support.

However, as ED is still a sensitive topic, not all patients are ready to come forward. Some prefer teleconsultation and having medication delivered to their home. However, this comes with its drawbacks.

“A thorough physical examination and investigations like blood tests cannot be performed through these means,” cautions Dr Teo. “Cross-checking of a patient’s existing conditions and the medications they are consuming may also not be as robust. This can result in harm to patients if significant drug interactions are missed.”

Tailored treatments for erectile dysfunction to improve quality of life

According to Dr Teo, ED can be treated with oral medication and this is suitable for the majority of cases.

“Medication under the phosphodiesterase-5 inhibitor class of drugs, such as  tadalafil, avanafil and sildenafil, helps to relax muscles and arteries inside the penis, thereby improving blood circulation,” says Dr Teo.

“The combination of relaxation and increased blood flow results in a firmer erection. However, for such medication to be effective, the individual still needs to be aroused after consuming it, which means this treatment is more useful for those facing performance anxiety or low confidence.”

Another option is low-intensity extracorporeal shockwave therapy (Li-ESWT) – a treatment in which non-invasive low-intensity sound waves are passed through erectile tissue. This treatment is suitable for those with mild to moderate erectile dysfunction.

"It stimulates the growth of new blood vessels and can potentially stimulate stem cell production to help with erectile dysfunction,"notes Dr Teo.

A course of treatment typically involves six to 12 sessions. Patients usually see an improvement in their erectile function after four to six sessions, says Dr Teo.

“Some patients may require a second course of treatment after a year if their erectile function were to deteriorate again,” he adds.

“Patients may experience a slight discomfort during the treatment but can resume normal activities immediately after without any downtime,” says Dr Teo.

Surgery, such as penile prosthesis insertion, is also available but rarely recommended as it can be invasive and patients need to be extensively counselled before undergoing it, adds Dr Teo. “Instead, lifestyle changes are something I explore with all ED patients.”

Dr Teo advocates staying active as it improves heart health and reduces the negative effects of stress, plus a Mediterranean-style diet rich in vegetables, fruits, whole grains and healthy fats with a moderate intake of red meat and dairy products.

Regardless of the treatment option, Dr Teo believes in providing dedicated care for an often overlooked aspect of men’s health, adding: “Men already tend to find seeking help difficult due to societal norms. For such a topic which they may feel embarrassed to talk about, it’s important that there is a specialist to provide professional advice without judgment.

“ED is a very treatable condition and early intervention, along with lifestyle changes, can make a significant impact on patients’ quality of life.”

For more information, visit UroHealth Medical Clinic.