aLife Singapore | Impotence (Erectile Dysfunction/ED)
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07 Apr Impotence (Erectile Dysfunction/ED)

In order to understand impotence, one should know the conditions that must be present for erection to take place. These are:

  • The male sexual organs, including testes and penis must be healthy
  • Circulating hormones (substances travelling through blood and acting on specific organs) including male sex hormone and milk-producing hormone must be normal
  • Nerve supply and blood flow to the sex organs must be intact
  • There must be healthy psychological response to sexual arousal and relaxed state of mind

Many men with Erectile Dysfunction (ED) suffer in silence. They are too embarrassed to tell their doctors. Yet ED is a fairly common condition in Singapore, affecting about 50% of men aged 30 years and above.


The causes of ED are often psychological, or due to relationship and life style problems. Physical causes are less common and include those shown in the table

Psychological Causes Physical Causes
  • Performance anxiety
  • Guilt about sex
  • Fear of pregnancy or sexually transmitted diseases
  • Resentment of women’s bodies and jealousy
  • Diabetes
  • Drugs like antidepressants, tranquilisers, cholesterol-lowering medications
  • Alcohol, smoking and drug abuse
  • Diseases of nervous system including injuries to the spines
  • Diseases of the urinary system including prostate gland surgery
  • Heart diseases
  • Hormonal problems
  • Chronic illnesses
  • Depression

Loosing an erection once in a while during sexual intercourse is the experience of most men. However, ED always leads men to question their own masculinity. Difficulties with erection causes performance anxiety in men who tend to force another erection. The more he forces, the higher the chances he fails. This is because anxiety will make him lose the sensations and the sexual arousal from lovemaking. This vicious cycle will make the erectile problem recur and get worse with time.

When ED occur, the couples must work together to get to the root of the problem. They must not be critical and point fingers at each other and try to solve the problem in a cooperative and non-demanding manner.

If erection fails, it is important to stop trying for a moment and relax. This will remove tension and performance anxiety. Instead, try to indulge in other intimate activities like kissing, hugging, cuddling, touching and massaging. Once the man is sufficiently aroused again and the penis is rigid, he may be ready again for sexual intercourse. The woman could also take over an active role and try to insert the penis into her vagina, in a female-on-top position, or in any other way the couple find comfortable.

If the problem persists, the couple should seek the help of doctors dealing with sexual health. The doctor will investigate the medical, surgical and sexual history. Physical examination includes examination of the sexual organs. Blood tests, including diabetes and hormonal tests, may be taken. After the evaluation, an appropriate treatment and recommendation of sexual techniques will be given.

Treatment options:

  • Sexual counselling and therapy.
  • Oral medications. Viagra has been fairly successful in treating ED. However not everyone is suitable and there are side effects. Newer medications with longer duration of action and fewer side effects are now available. Some herbal products may also be helpful.
  • Cock rings and vacuum erection devices: These mechanical devices help to maintain an erection by keeping the blood in the penis for a longer period of time.
  • Self injection and dispensing drug (prostaglandin) into the penis or urethra (urinary passage) have been used with good results. However, most men are hesitant to inject themselves even though the needle is quite small and injection is generally painless.
  • Surgical procedure: This is usually done as a last resort as it carries surgical risks and risks of infection. Many procedures have been tried but the most popular is to implant prosthesis into the penis and surrounding region. The implant is inflatable and connects to a fluid reservoir. When the man wants to have sexual intercourse, he uses the pump (hidden in the scrotum) to fill the implant with fluid and make the penis rigid.
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