Erectile Dysfunction nothing to be embarrassed about

Affecting 51.3 per cent of men here aged 30 years and above, erectile dysfunction (ED) is much more common than we think.

According to a local study done in 2003, ED prevalence and severity go up significantly among men aged 50 and older, said Dr John Cheng, head of primary care at Healthway Medical Group.

Defined as the persistent inability to achieve or maintain an erection sufficient for satisfactory sexual performance, ED affects men emotionally as well.

A global health study last year that looked at sexual habits of men on ED medication found that 71 per cent plan their sexual intercourse several hours in advance.

Men on ED medication also engage in sex a median of six times a month, the study found.

These results proved that sexual well-being is an important aspect of general health and good relationships, said Dr Cheng.

"As a part of holistic care, brief sexual history should be included as a routine part of medical history, especially for patients at risk," he said.

"As family physicians, our role is to educate patients and promote public awareness that it is not uncommon for men to have problems with erections. Appropriate treatment can improve health and quality of life."

Is ED under-diagnosed here?

ED is definitely under-diagnosed all over the world. Difficulties in diagnosis can be looked at from different perspectives.

Patients feel shame and embarrassment. They believe that the problem is part of ageing or an illness and are unaware of treatment options. They are also reluctant to talk about their sexual concerns.

Physicians may have little knowledge about certain sexual issues, lack time or find it a social taboo. They do not want to hurt the patient's ego or infringe on his privacy.

Who is at risk of ED?

Various risk factors can contribute to ED, including:

• Lifestyle factors such as physical inactivity, obesity, use of tobacco, alcohol or certain prescribed or recreational medication;
• Psychological factors, such as performance anxiety, depression and relationship issues;
• Medical conditions such as diabetes mellitus, cardiovascular diseases such as hypertension or hyperlipidaemia (high levels of lipids in the blood) and previous trauma.

How is an ED patient's mental health affected?

There is a bi-directional relationship between psychological well-being and ED. Depression can lead to ED and vice versa.

To complicate things, both can be related to other psycho-social problems such as relationships and past experience.

ED can also lead to other emotional stresses and burdens such as low self-esteem, performance anxiety, frustration and anger.

As a family physician, managing ED is more than just about medication. A patient's psychological or emotional health and history must be explored and addressed. When needed, patients may be referred to counsellors or for behaviour therapy.

What are some ways to treat ED?

Identify and treat potential reversible causes. Lifestyle modification should be continuous.

First-line oral therapies such as sildenafil, tadalafil and vardenafil target the penis through phosphodiesterase type 5 (PDE5) inhibition. These inhibitors help to increase blood flow to the area. Sexual stimulation will be required to produce an erection.

All are effective within about an hour of dosing and are typically used as needed.

Second-line therapies include intrapenile injections, vacuum devices and surgical implants.