Erectile Dysfunction

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What is Erectile Dysfunction?

Erectile dysfunction (ED), also known as impotence, is a condition where a man experiences difficulty in achieving or maintaining an erection sufficient for sexual intercourse. ED is not an uncommon problem.

Occasional difficulties in getting an erection should be differentiated from ED, which is a more persistent condition. It is more prevalent with increasing age. It can also serve as an early indicator of more serious health issues like heart disease or diabetes.

Causes and Risk Factors

ED can result from a range of physical and psychological factors. 

  • Cardiovascular Diseases: Conditions like heart disease and atherosclerosis lead to reduced blood flow to the penis, making it difficult to achieve or maintain an erection.
  • Metabolic and Endocrine Disorders: Diabetes is a risk factor as it can damage the nerves and blood vessels required for an erection. Hormonal imbalances, including low testosterone levels, can also contribute to ED.
  • Neurological Disorders: Diseases like Parkinson’s and Multiple Sclerosis can affect the transmission of signals from the brain to the genital area, leading to ED.
  • Lifestyle Factors: Smoking, excessive alcohol consumption, lack of physical activity, and obesity can negatively impact vascular health and blood flow, leading to ED.
  • Medications and Treatments: Certain drugs, including those for high blood pressure or depression, can cause ED as a side effect. Treatments for prostate cancer or an enlarged prostate, as well as surgeries or injuries affecting the pelvic area or spinal cord, are also common contributors.
  • Psychological Factors: Stress, anxiety, depression, and relationship problems can play a role in the onset of ED. These factors can create a cycle where anxiety about sexual performance leads to ED, which then further increases anxiety.
  • Age-Related Factors: While not an inevitable part of ageing, the prevalence of ED does increase with age.

Symptoms and Signs

The primary symptom of ED is the consistent difficulty in getting or maintaining an erection firm enough for sexual intercourse. This can manifest in various ways:

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    Inconsistent Erection Ability

    Men may find that they can achieve erections sometimes, but not every time they wish to have sex.

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    Trouble Maintaining an Erection

    Even if an erection is achieved, it might not last long enough for the completion of sexual activity.

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    Reduced Sexual Desire

    Often accompanying the physical symptoms of ED is a noticeable decrease in sexual desire or libido.

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    Anxiety About Sexual Performance

    Many men with ED experience anxiety about their sexual performance, which can exacerbate the problem.


The process of diagnosing ED involves a thorough evaluation by a doctor, starting with a detailed medical and sexual history. Key aspects include:

  • Medical and Sexual History: This involves discussing any health conditions, medications, surgeries, and lifestyle factors that might contribute to ED. The doctor will also inquire about sexual function, relationships, and any recent changes in sexual desire or performance.
  • Physical Examination: A physical exam may include an examination of the penis and testicles, checking nerves for sensation, and assessing blood flow.
  • Laboratory Tests: Blood and urine tests can reveal underlying health issues like diabetes, heart disease, or low testosterone levels, which can contribute to ED.
  • Psychological Examination: Since psychological factors can play a role in ED, doctors may screen for depression, anxiety, and other mental health conditions.
  • Advanced Testing: In some cases, additional tests like an ultrasound of the penile blood vessels, nocturnal penile tumescence (NPT) test, or injection test might be necessary. These help evaluate blood flow, nerve function, and the response of the penis to stimulation.

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Treatment Options

Each treatment option has its considerations and suitability depending on the individual’s health, preferences, underlying causes of ED, and response to initial treatments.

Oral Medications

  • These drugs function by enhancing the effects of nitric oxide, a natural chemical the body produces that relaxes muscles in the penis, increasing blood flow. They require sexual stimulation to initiate their effects and have different durations of action.

Other Medications

  • Alprostadil can be self-injected or introduced into the urethra. While they are effective, these methods are less convenient and may have side effects like burning or pain at the injection site.

Vacuum Erection Devices (VEDs)

  • VEDs are an external method where a tube is placed over the penis, and a pump is used to create a vacuum that pulls blood into the penis, causing an erection. A tension ring is then applied to maintain the erection.

Penile Implants

  • This surgical option involves placing inflatable or malleable rods inside the penis. Implants are typically considered when other treatments have failed.

Lifestyle Changes

  • Addressing lifestyle factors like obesity, smoking, and sedentary habits can have an impact on improving erectile function and overall health.

Psychological Counseling

  • Therapy can be particularly beneficial when ED has a psychological component, such as stress, anxiety, or depression. Couples therapy may also be recommended to address relationship issues.

Alternative Medicine

  • While some herbal supplements are marketed for ED, their safety and effectiveness are not always scientifically proven, and they may interact with other medications.

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

Farrer Park Medical Centre, #08-05
1 Farrer Park Station Rd, Singapore 217562

Mon – Fri: 8:30am to 5:30pm
Sat: 8:30am to 12:30pm

3 Mount Elizabeth, #11-16 Medical Centre, Singapore 228510

Mon – Fri: 8:30am to 5:30pm
Sat: 8:30am to 12:30pm

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    Frequently Asked Questions (FAQ)

    Is ED a normal part of ageing?

    While more common in older men, ED is not an inevitable part of ageing. Many men maintain sexual function well into their senior years.

    Can lifestyle changes help with ED?

    Yes, improvements in diet, exercise, and quitting smoking can impact ED. A healthy lifestyle can improve blood flow and reduce ED symptoms.

    Are oral ED medications safe for everyone?

    These medications are generally safe but may not be suitable for men with certain heart conditions or those taking nitrates.

    Can psychological factors cause ED?

    Stress, anxiety, depression, and relationship problems can all contribute to or exacerbate ED.

    Is it necessary to see a doctor for ED?

    Yes, you should consult your doctor to diagnose underlying causes and explore appropriate treatment options.

    Can ED be a sign of other health problems?

    Yes, ED can be an early sign of cardiovascular diseases, diabetes, or other health conditions.

    Are there permanent solutions to ED?

    Penile implants offer a more permanent solution but are usually only considered when other treatments fail.