Singaporean Sean Low has no problem talking about sex with his friends. But discussions on sexual health such as premature ejaculation (PE) or erectile dysfunction (ED) — the inability to keep an erection firm enough for sex — well, that’s a different story.
“There’s a lot of taboo and stigma surrounding premature ejaculation and erectile dysfunction,” says Low via Zoom from the Australian city of Melbourne. “As an Asian man, you’re discouraged from talking about topics like that. It’s considered a sign of weakness and doesn’t fit with the macho culture.”
Low speaks from personal experience. A couple of years ago he suffered an ED scare — also referred to as impotence — and went into panic mode.
“I’d never experienced it before — or ever talked about it — so it was a really confusing time,” says the 26-year-old. “To be honest, I thought I was way too young to have that problem!” One of the most common sexual problems in men as they age is erectile dysfunction.
Low “consulted” Dr Google and was surprised to learn that all men have problems getting an erection at some stage in their lives. He was also surprised by just how complex male sexual arousal was — it’s a process that connects the brain, hormones, emotions, nerves, muscles and blood vessels.
“Only after researching ED did I discover that a lot of men can occasionally experience it because of factors such as stress or lack of sleep or after consuming too much alcohol. It wasn’t until I spoke to a doctor who told me that I didn’t have ED.
“It showed me how little us men knew about our bodies. ED in particular is one of those things that men don’t want to talk about. There’s so little conversations around men’s health because there’s so much stigma.”
While the ordeal proved frustrating, it also gave Low a light-bulb moment. In 2020 he launched Noah, a digital health clinic for men where conditions such as ED and PE are the main focus. It quickly resonated with men in Singapore, prompting Low to bring his telehealth platform to Hong Kong.
“Before we launched in Singapore and Hong Kong, we talked with a lot of GPs and got similar feedback. Many doctors said: ‘I’ve never had anyone come to me complaining of premature ejaculation.’ A lot of men don’t feel comfortable with in-person conversations about ED and PE,” Low says.
“What often happens instead is a man will visit a doctor for another reason, maybe to talk about flu symptoms or a stomach bug, and then later he would broach the subject of his ED or PE in a ‘By the way, I also have this other problem’.”
Dr Vera Chung, a Hong Kong-based specialist in urology, a branch of health care that covers the urinary tract and the male reproductive system, agrees that there are a lot of taboos around ED and PE.
“It’s also commonly associated with low self-esteem, reduced quality of life and poor partner relationships,” she says.
Chung says potential causes of ED are categorised as psychogenic or organic — or a combination of the two. “Psychogenic causes are due to a psychological disease such as depression, anxiety, stress or poor interpersonal relationship,” she says.
Organic, she says, refers to a certain disease which leads to ED. Erectile dysfunction could be a sign of a more serious underlying medical condition such as coronary heart disease, hypertension and diabetes.
“Actually, ED is one of the first signs of cardiovascular disease,” she adds.
While medications such as Viagra have long been reported as a way to treat frequent impotence, Chung says the best treatment for ongoing ED are lifestyle modifications: More exercise, a healthy diet, weight loss and cutting out cigarette smoking and the consumption of alcohol.
A surgical penile implant, she says, is also an option “as a last resort”. She also recommends psychotherapy to treat the underlying cause.
Targeted exercise can also help. According to a 2019 study published in Physiotherapy, pelvic floor muscle training (Kegel exercises) can improve erectile dysfunction and premature ejaculation.
And it seems discussions about ED are needed now more than ever: Doctors say cardiovascular and psychological problems arising from Covid-19 contribute to erectile dysfunction.
Low says Noah takes the embarrassment factor out of a visit to the doctors. “It’s a discreet, affordable, and convenient way of getting treatment.” And it’s simple.
Users fill out an online medical evaluation form and then take part in a video call with one of Noah’s registered doctors.
Consultations are free, with users paying only for the medication, which is delivered in discreet pouches within four hours.
Low believes telemedicine — the practice of medicine using technology to deliver care at a distance — is the future. And the Covid-19 pandemic has shown just how important it is, with many health centres shifting to telemedicine for convenience and infection control.
In the US, recent studies have shown that the rapid transition to online care during the pandemic also exposed some flaws in telehealth, one of the biggest being language problems. It’s something Low is aware of. “Language shouldn’t limit access to health care, and it’s on Noah’s road map to expand the languages available,” he says.
He says online consultations could also reduce the number of people who seek out pharmacies that sell under-the-counter medication, many of which are fake and potentially dangerous.
While sexual health is the main focus of Noah, it will also help with weight loss and other issues such as hair loss, and skin treatments. “We’re treating many pillars. Our ambition is to be a holistic mental health platform,” he says.
This article was first published in South China Morning Post.