Go limply into the night...

PHOTO: Go limply into the night...

ALL men (but not many will admit it!) will have experienced erectile dysfunction or ED at one time or another in their lives - it's only when the problem becomes persistent, occurring more than 50% of the time, or becomes a source of distress for you or your partner, should you be concerned.

ED is considered one of the most commonly occurring male sexual disorders. It is defined as the inability to develop or maintain an erection of the penis sufficient for satisfactory sexual performance. It is different from premature ejaculation, where an erection can be achieved but ejaculation happens too soon.

How common is it?

Over 150 million men worldwide suffer from erectile dysfunction. The prevalence of ED is 52% in men aged 40 to 70 years and 70% in men aged 70 years and above, according to the Massachusetts Male Aging Study conducted in 2000.

In Malaysia, the prevalence of self-reported ED has been estimated to be around 41%, occurring most commonly in those aged 50 and above.

What causes it?

The causes of ED can be psychological or physical. Psychological causes are responsible for 10 to 20% of ED. In some cases, the psychological effects of ED may stem from childhood abuse or sexual trauma.

However, the most common psychological causes of ED include stress and anxiety due to a previous experience of ED, performance anxiety, low self esteem, and depression.

Depression is a common psychological cause of ED as it is a disease that affects a person psychologically and physically, and requires appropriate medical treatment. Unfortunately, some depression medications, such as selective serotonin reuptake inhibitors (SSRI), may also cause ED.

The physical causes of ED include testosterone deficiency, diabetes, coronary artery disease, and neurological disorders. In fact, there is increasing scientific evidence to indicate that ED may be a marker for silent cardiovascular disease and may precede cardiovascular events such as a heart attack or a stroke by at least two to three years. Hence, seeking medical attention for ED may not just be a lifestyle issue, it may very well be a life-saving one.

In Malaysia, ED is strongly associated with hypertension and diabetes.

The strong association between ED and cardiovascular disease is due to the fact that both conditions involve progressive blockage of arteries by artherosclerotic deposits. In the case of cardiovascular disease, the arteries of the heart are involved, while with ED, the arteries supplying the penis are involved.

Diabetes also contributes to the increasing blockage of arteries, which accounts for its association with ED.

Erectile dysfunction affects the quality of life of patients and their partners. However, many patients are reluctant to discuss ED with their physicians, and many physicians are still uncomfortable when discussing or evaluating sexual (dys)function.

A study in Belgium showed that two-thirds of men waited one year before addressing issues of ED with their physician, with the associated detrimental effects on their sexual relationships. Furthermore, most men in the study were in a stable relationship, with the partner present in one-fifth of consultations and often responsible for initiating the discussion on ED. This means that partners too have a role to play in getting their men to seek medical attention for this issue.

There is no specific test that will confirm the diagnosis of ED. A full medical history is usually obtained to distinguish between psychological and physiological causes. Blood tests are also performed to rule out diseases such as diabetes or hormonal deficiency.



The psychological causes of ED may be minimised by reducing stress and anxiety at work and at home. Counselling may also help couples overcome issues related to performance anxiety or low self esteem.

In cases of previous sexual trauma and childhood abuse, extensive psychological treatment by a trained healthcare professional is required.

Physical risk factors for ED include high cholesterol, hypertension, diabetes, smoking, obesity, and a sedentary lifestyle. So taking steps to control cholesterol and glucose levels through a healthy diet, increased exercise, and efforts to stop smoking may improve matters.

Since ED shares the same risk factors as cardiovascular disease, measures to control these risk factors will not only improve things in the bedroom, but they can also prevent cardiovascular disease from developing or progressing.

Medical treatment

PDE5 inhibitors are oral drugs that help to maintain erection. This class of drugs are not aphrodisiacs and require sexual stimulation. They act by preventing the breakdown of a chemical (produced by the body) that is involved in maintaining erection.

Oral ED treatments are usually taken between 20 minutes and one hour before sexual intercourse and its duration of action varies between three and 36 hours, depending on the individual. Examples of PDE5 inhibitor drugs include vardenafil, sildenafil, and tadalafil.

Other treatments for physical causes of ED include alprostadil, papaverine, or phentolamine, which increase arterial blood flow to the penis. They are administered via injection or the drug is inserted directly into the penis prior to intercourse and may be inconvenient or uncomfortable for the user.

A suitable time for men to address the issue of ED and other medical issues would be at their annual medical check-up. This is when thorough medical tests are usually done to exclude serious illnesses and is also an opportunity for men to bring up this issue, especially if there is associated cardiovascular disease or diabetes which may be the contributing factor to ED.

ED is actually more common a problem than many men realise. Its strong association with cardiovascular disease and diabetes warrants medical attention as it may be a precursor to a heart attack or stroke. Serious medical problems that may cause ED should be ruled out or treated.

Where serious diseases are excluded, there are effective oral treatments for this condition so that men (and their partners) do not have to suffer in silence.

This article is contributed by Dr S.Y. Chong, medical advisor with Bayer Schering Pharma. This information is provided for educational purposes only and should not be taken in place of a consultation with your doctor. Bayer Schering Pharma disclaims any and all liability for injury or other damages that could result from use of the information obtained from this article.