Erectile Dysfunction (ED), 2 letters that strike fear in many men.
Defined as the inability to achieve or sustain an erection adequate enough to engage in satisfactory sexual intercourse, this condition affects more than 40% of men over the age of 40 in Singapore. And this rises to almost 80% in men in their 60’s. Younger men are also not spared. The same study found that men in their 30’s already being to experience ED. In my clinic, we see men from their 20’s to 70’s suffering from ED.
ED is different from PE (Premature Ejaculation) but is commonly confused. While ED is the inability to sustain an erection, PE is the inability to control the ejaculation. Although these 2 distinct symptoms may be biologically related. Click here for my article on Premature Ejaculation (PE).
How do you know I have ED?
Essentially if you have any trouble achieving or maintaining an erection, you have ED.
Doctors often use what is known the IIEF-5 Questionaire. Try it out.
IIEF-5 Questionaire
Over the past 6 months:
- How do you rate your confidence that you could get and keep an erection?
- When you had erections with sexual stimulation, how often were your erections hard enough for penetration?
- During sexual intercourse, how often were you able to maintain your erection after you had penetrated your partner?
- During sexual intercourse, how difficult was it to maintain your erection to completion of intercourse.
- When you attempted sexual intercourse, how often was it satisfactory for you?
Very low – 1 point
Low – 2 points
Moderate – 3 points
High – 4 points
Very High – 5 points
For each of the 5 questions, give yourself a score according to the list on the right. Now total up the scores. Ready to see how you did?
Total Score 22 – 25
No ED. Great! Continue to keep yourself in good health!
Total Score 17 – 21
Mild ED. It would be a good idea to see your Doctor. It is always better to catch it early if it is anything at all.
Total Score 12 – 16
Mild – Moderate ED. This would be a great time to get some simple treatments in order to prevent the ED from getting worse. Also to rule out any underlying health problems.
Total Score 8 – 11
Moderate ED. Definitely see your Doctor. You must be screened for underling medical problems and start on treatment.
Total Score 1 – 7
Severe ED. You will likely need a combination of therapies for your ED. And there is very likely other underlying medical problems.
But what causes ED? Is it all just in my head?
While the definition provides doctors with useful parameters to diagnose the problem and commence treatment, it does little in assuaging the anxiety of most patients experiencing the symptoms of ED.
Understanding what is happening to you and why is not only useful for managing the fear that comes with not being able to perform but also helps you plan a path towards getting proper treatment.
In reality, because ED is a multifactorial problem, the symptoms can present at different timepoints in a patients’ life and to varying degrees depending on the underlying factor driving the pathology.
I like to think of these factors as 4 large categories that overlap each other like a Venn Diagram. These factors are Hormones, Blood Flow, Nerves and Psychology.
Hormones
Hormones – the 2 main hormones to consider in most men suffering from ED are Thyroid and Testosterone. These hormones have an overlapping function in terms of regulating your metabolism (overall energy levels) hence, when either of these hormones are deficient, the common symptoms of low mood, easy fatigability and ED are usually present.
A simple blood test is able to differentiate the 2 and determining which hormone is most affecting your ED symptoms gives a direct path to remedy the issue and save you from going down the path of medicating the problem with pills and potions.
Human Growth Hormone (HGH) deficiency also may play a role in ED and aging.
Blood Flow
Blood flow – Blood flow into the penis is essential in producing an erection. The main blood vessel to the penis is the Internal Pudendal Artery which is approximately the same size as the main blood vessel of the heart – Left Anterior Descending Artery. Consequently, if you have a history of atherosclerosis of the heart vessels from high cholesterol there is a good chance the flow of the penile blood vessels are also compromised.
Peyronie’s Disease which is a curved penis can also affect blood flow and cause ED.
Nerves
Nerves – Nerves regulate the size of the blood vessels. In situations such as diabetes or repetitive strain to the area – long hours cycling, safety harnesses, can cause the nerves to be dulled.
Psychology
Psychology – Beyond the physical aspects of an erection, psychology plays an equal role in creating an erections. Stressors such as new positions, different partners, new objectives – trying to conceive can put a significant amount of pressure on your psyche and in turn affect the likelihood of having good quality erections.
In conclusion....
In summary, understanding the situation is an important first step in the treatment journey. Do see my next series of posts on ED where I discuss the different treatments available such as
- Medication like Viagra, Levitra, Cialis and Spedra/Stendra
- PRP injections
- ESWT (Electro Shock Wave Therapy)
- Penile Injections
and more!
Have a question? Please put it in the comments section below.