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Erectile dysfunction

Mrs. B, my patient of 14 years, came to see me with her husband. She was anxious while the husband was quiet and appeared depressed. “Doc,” she said, “You know we have been happily married for the past 15 years, and you have delivered our two children. All along, we have always enjoyed a good sexual relationship and we have been intimate at least twice to three times a week. I am only 40 years old and he is 45.

“However, for the past few months, he has suddenly lost interest in sex. Whenever we are in the mood, he simply cannot get an erection. The more we try, the worse it is. His friend advised him to take Viagra but I felt he should you first.”

Mr. B, a sales executive, had been a smoker for the past 25 years, smoking up to 10-20 cigarettes a day. He drank socially and was slightly overweight, having a BMI of 28. He told me some of the reasons he was losing his sexual desire were the increasing level of stress at work and tiredness.

His impotence began insidiously and this was gradually making him lose confidence in having sex. His self-esteem went down and he would reject his wife’s sexual advances. This resulted in occasional conflicts.

Fortunately, they were resolved quickly and amicably. However, with time, his wife became suspicious that he might be involved in some hanky-panky. To refute this, he agreed to come for treatment.

Nowadays, couples like Mr. and Mrs. B are becoming more aware of the importance of sexual health. A commonly encountered problem appears to be erectile dysfunction.

Many Asian men still find it embarrassing to discuss this problem with their doctors or to seek treatment. Referrals usually come from their wives.

Erectile dysfunction (ED or impotence) is the inability to attain and/ or maintain an erection sufficient for intercourse. In Singapore, about 50 per cent of the male population aged 30 years and above reportedly experience some form of ED.

ED is usually due to psychological factors such as stress, tiredness, depression and performance anxiety (nervousness over the ability to perform sexually). Occasional loss of erection is relatively common. However, if ED persists, it may lead the man to question his masculinity, causing performance anxiety.

Trying to force an erection may increase the chance of failure. Anxiety will make it difficult for the man to be sexually aroused, preventing any lovemaking. The vicious circle will make ED worse with time.

Other causes of ED include diseases affecting blood flow, such as atherosclerosis (hardening of the arteries), diabetes, nerve disorders including injuries to the spine, and diseases of the urinary system or prostate gland surgery.

Chronic illness, medications like antidepressants, tranquillisers, some cholesterol-lowering drugs and a condition called Peyronie’s disease (scar tissue in the penis) can also cause erectile dysfunction.

Studies have shown that ED can precede hypertension, diabetes and high cholesterol. It is thus important to seek early treatment.

The spouse has an important role in the treatment of ED. She should avoid being critical of her husband’s sexual performance. The couple should try to resolve the problem in cooperative and non-demanding manner. It is important that ED be discussed openly between the partners so it can be recognized and addressed – as in Mr. B’s case.

Treatment for ED should be a decision by the couple so that mutual support can be given. This can keep the relationship strong and even increase the success of the treatment. An informed wife is also important in the use of oral ED agents. The pills do not automatically cause an erection. The patient must be stimulated after taking the medication in order to achieve an erection.

If the partner is aware of this, she can help him to achieve a good erection at the right time. Also, if she knows that it will take some time for the medication to work, she will be patient and wait before getting physical, or prolong foreplay until the medication becomes effective.

Mr. B examined clinically. There was nothing wrong with his nervous or urinary systems. He was tested for diabetes, cholesterol and hormones and was quite healthy. He was put on a weight reduction regime. He was also advised to quit smoking.

An oral ED agent was given to help him regain his confidence. Many people think that any heart condition makes oral ED drugs harmful or risky. Mrs. B was reassured of the safety of the medication. This made her feel more comfortable. A worried wife does not make a good lover.

A few weeks later, I received a card in which Mrs. B wrote, “Dear Doc, thanks for your encouragement and reassurance. My husband has shed 5kg. He is as fit as a fiddle. He has quit smoking as well, and he doesn’t need the drug any more. Our love life is once again rekindled.”

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