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Erectile Dysfunction Treatment

Erectile Dysfunction (ED), or impotence, is a common condition affecting men, characterised by the inability to achieve or maintain an erection sufficient for sexual activity. It can be a source of significant distress for those affected and their partners.

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Treatment Options for Erectile Dysfunction

Lifestyle Changes

Diet and Exercise: A balanced diet rich in fruits, vegetables, lean proteins, and whole grains can improve cardiovascular health. This maintains good blood flow, a key factor in achieving and maintaining an erection. Regular exercise, particularly aerobic exercise, can also improve blood flow and help manage conditions that contribute to ED, such as obesity and diabetes.

Sleep: During sleep, the body works to regulate hormone levels, including testosterone, a hormone for sexual function. Lack of sleep can disrupt these processes, potentially leading to ED. Maintaining a regular sleep schedule and ensuring you get enough rest can help manage ED.

Weight Loss: Excess weight, particularly when it leads to conditions like diabetes and heart disease, can contribute to ED. Fat cells metabolise testosterone into oestrogen, reducing the amount of testosterone in the body, which can lead to ED. Achieving and maintaining a healthy weight through a balanced diet and regular exercise can improve erectile function.

Smoking Cessation and Alcohol Reduction: Both smoking and excessive alcohol consumption can damage blood vessels, impeding blood flow to the penis and leading to ED. Smoking also interferes with the smooth muscle in the penis which can prevent it from relaxing and filling with blood. Reducing alcohol intake and quitting smoking can significantly improve ED symptoms.

Medications

Oral Medications: Oral medications for ED work by enhancing the effects of nitric oxide, a natural chemical the body produces to relax muscles in the penis and increase blood flow.

Sildenafil (Viagra): This medication is effective within 30 to 60 minutes of ingestion and its effects can last up to four hours. It should be taken on an empty stomach for optimal effectiveness.

  • Vardenafil (Levitra, Staxyn): This medication is effective within 60 minutes of ingestion and its effects can last up to five hours. It can be taken with or without food.
  • Tadalafil (Cialis): This medication is effective within 30 to 45 minutes of ingestion and its effects can last up to 36 hours. It can be taken with or without food.
  • Avanafil (Stendra): This medication is effective within 15 to 30 minutes of ingestion and its effects can last up to six hours. It can be taken with or without food.

Injectable Medications and Suppositories: Alprostadil is a medication that can be used to treat ED when oral medications are not effective or contraindicated. It works by widening blood vessels in the penis, allowing more blood to flow in and causing an erection. It can be administered in two ways:

  • Injection (Caverject, Edex): The medication is injected directly into the side of the penis. The resulting erection typically begins within 5 to 20 minutes and lasts for up to an hour.
  • Urethral Suppository (MUSE): A tiny alprostadil suppository is placed inside the penile urethra using a special applicator. The erection usually starts within 10 minutes and lasts between 30 and 60 minutes.

Psychological Treatments

  • Psychotherapy: Psychotherapy can be an effective treatment for ED when it’s caused by psychological factors. These factors can include stress, anxiety, depression, and low self-esteem. A psychotherapist can provide strategies and techniques to manage these conditions, which can in turn help alleviate ED.

Cognitive-behavioural therapy (CBT) is a common approach used, which helps individuals identify and change negative thought patterns that lead to problematic behaviours, such as performance anxiety leading to ED.

  • Sex Therapy or Couples Counselling: These therapies can help couples communicate more effectively about their sexual relationship, reduce pressure and anxiety associated with sexual performance, and address any issues of intimacy or dissatisfaction. A sex therapist can also provide education about sexual responses and techniques for better sexual functioning. Couples counselling can help partners support each other and maintain a healthy relationship during the treatment process.

Alternative Treatments

Natural Remedies: There are several natural remedies and dietary supplements that have been used to treat ED. These include:

  • Panax Ginseng: Researchers believe the red ginseng influences nitric oxide production, improving blood flow to the penis.
  • L-arginine: This is an amino acid naturally present in your body. It helps make nitric oxide, which relaxes blood vessels in the penis, allowing for successful erections.
  • DHEA (Dehydroepiandrosterone): This natural hormone is produced by your adrenal glands, and it’s been shown to help some men with ED. DHEA reportedly can cause side effects. Discuss this with your urologist before starting treatment.

Use of Vacuum Devices: Vacuum erection devices, also known as penis pumps, are non-invasive treatments for ED. They consist of a plastic tube that you place over your penis, a pump that draws air out of the tube to create a vacuum, and an elastic ring that you move to the base of your penis to maintain the erection. These devices can be effective, but they require patience and practice to use effectively.

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Surgical Treatments

Implant Devices: Penile implants are devices placed surgically within the penis to allow men to achieve an erection. There are two main types:

  • Inflatable implants, which can be pumped up to create an erection; and
  • Semi-rigid rods, which allow the penis to be manually adjusted to the desired position.

These are usually considered only after other treatments have been tried.

Artery Reconstruction: In certain cases, vascular surgery to reconstruct arteries can increase blood flow to the penis. This procedure is typically reserved for younger men who have ED as a result of penile or pelvic injuries. The success of this surgery depends on the location and extent of the arterial blockage.

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Dr Lee Fang Jann image

Dr Lee is a urologist and kidney transplant surgeon with a broad-based expertise of all urological disorders

He has subspecialty focus on men’s health and male infertility, and special interest in minimally invasive prostate enlargement therapy and kidney stone treatment. Dr Lee has received numerous awards for service excellence such as the Service With A Heart Award (2006-2008, 2011) and the Singapore Health Quality Service Award (2016).

  • Bachelor of Medicine and Bachelor of Surgery (Singapore)
  • Membership of The Royal College of Surgeons (Edin)
  • Master of Medicine (Surgery) (Singapore)
  • Fellowship of the Academy of Medicine (Urology)
  • Clinical fellowship at Oxford Transplant Centre in the UK

Prior to entering private practice, Dr Lee served in the public sector for 16 years at SGH, where he initiated dedicated clinics evaluating and treating patients with complex men’s health and fertility issues. He also led the Renal Transplant Program and laparoscopic donor nephrectomy service as Surgical Director.

Apart from clinical work, Dr Lee is active in academia and believes in the importance of grooming the next generation of doctor. He was Senior Clinical Lecturer at NUS’ Yong Loo Lin School of Medicine and currently, Adjunct Assistant Professor at the Duke-NUS Medical School. Dr Lee is also regularly invited to share his experiences locally and regionally through lectures, workshops and surgical demonstrations.

Our Clinic Locations

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Farrer Park Medical Centre, #08-05
1 Farrer Park Station Rd, Singapore 217562
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Mon – Fri: 8:30am to 5:30pm
Sat: 8:30am to 12:30pm

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3 Mount Elizabeth, #11-16 Medical Centre, Singapore 228510
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Mon – Fri: 8:30am to 5:30pm
Sat: 8:30am to 12:30pm

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    Frequently Asked Questions

    What is the success rate of oral medications for Erectile Dysfunction?
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    The success rate of oral medications for Erectile Dysfunction varies depending on the specific medication and the individual’s overall health. After two years, about 30 to 60% will have returned to pre-treatment function. These rates can vary widely depending on the individual’s health and other factors.

    Are there any contraindications for the use of oral medications in treating Erectile Dysfunction?
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    Yes, there are contraindications. For example, men who take medications for angina or other heart problems and men who take alpha-blockers should not use these medications.

    How long does it take for lifestyle changes to show improvements in Erectile Dysfunction symptoms?
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    The time it takes for lifestyle changes to show improvements in Erectile Dysfunction symptoms can vary widely depending on the individual and the specific lifestyle changes made. Consistent changes in diet, exercise, sleep patterns, and other lifestyle factors can lead to noticeable improvements over a period of weeks to months.

    Can Erectile Dysfunction be completely cured or only managed?
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    Whether Erectile Dysfunction can be completely cured depends on the underlying cause. In some cases, treating the underlying cause can lead to a complete resolution of symptoms. In many cases, Erectile Dysfunction can only be managed rather than cured, requiring ongoing treatment or lifestyle changes.

    What are the long-term effects of using injectable medications and suppositories for Erectile Dysfunction?
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    The long-term effects of using injectable medications and suppositories for Erectile Dysfunction can vary depending on the specific medication used and the individual’s overall health. Discuss potential long-term effects with your urologist before starting any new medication.

    Are there any specific exercises recommended for managing Erectile Dysfunction?
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    Regular aerobic exercise can improve blood flow and help manage conditions contributing to Erectile Dysfunction. Pelvic floor exercises, or Kegel exercises, can also be beneficial in managing Erectile Dysfunction.

    Can all men with Erectile Dysfunction use vacuum devices?
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    Most men with Erectile Dysfunction can use vacuum devices, or penis pumps. They may not be suitable for men with certain blood disorders or men who are taking blood-thinning medication.

    What is the recovery time after surgical treatments for Erectile Dysfunction?
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    The recovery time after surgical treatments for Erectile Dysfunction can vary depending on the specific procedure and the individual’s overall health. For example, recovery from penile implant surgery typically involves a period of a few weeks.

    What are the potential side effects of Erectile Dysfunction medications?
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    Side effects can include headaches, body aches and pains, digestive system problems, dizziness, vision changes, flushes, and congestion or a runny nose.

    What are the risks associated with surgical treatments for Erectile Dysfunction?
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    Risks can include infection, bleeding, mechanical failure of the implanted devices, and unnatural-feeling erections.