Health Information by Dr Tan And Partners (Singapore)

Dr. Tan & Partners was established in 2005 with a vision to provide quality medical services with competency and care to our community - Health Information on Men's Health, Women's Health, Public Health and Sexual Health (HIV/STD)

Causes and treatments Erectile Dysfunction (Impotency)


Hey guys, if you're not lasting as long as you would like in bed, it could be only be due to 2 reasons:

1. You cannot get hard. Or you can get hard but it gets soft very quickly. Maybe even before you can penetrate your partner. Or you can get hard but its not as hard as you would like it to be. This is called Erectile Dysfunction.

2. You have absolutely no problems getting hard but you ejaculate much sooner than you would like to. This is called Premature Ejaculation.

Of course, these 2 issues are not mutually exclusive. You could be suffering from both at the same time. Also, one problem can lead to the other.

It is not surprising that this can lead to a lot of distress not only for you but also for your partner.

In this article, we are going to talk about certain things you can do to help with Erectile Dysfunction. We will discuss Premature Ejaculation in a separate article.

Do you have Erectile Dysfunction?

Well, this really should be rather obvious. If you cannot get hard enough to enjoy sex then you have Erectile Dysfunction. There are 2 questionnaires that attempt to semi-quantify the severity of the problem. These are the International Index of Erectile Function (IIEF) and the Erection Hardness Score. They are both rather self explanatory. Basically the lower the score you have, the bigger a problem you have.

Impotence or Erectile Dysfunction: Causes and ...

What are the possible causes?

Not being able to get an erection can just be due to stress or can be due to more serious problems. Some of the possible common causes are listed here.

1. Stress and Anxiety

I have seen many fit young men with absolutely no problems at all until their wives start stressing them about getting a baby. Then out of the blue, they cannot get an erection. Although they do not conciously feel stressed or anxious, subconciously this could be affecting their erections.

Of course Erectile Dysfunction can also be related to more serious Psychological Illness like Depression or Post-Traumatic Stress Disorder (PTSD).

2. Unhealthy Blood Vessels

Having unhealthy blood vessels can impede blood flowing into the penis. It can also lead to blood leaking out of the penis. Both of which can lead to ED. Unhealthy blood vessels can be related to Chronic Diseases like Diabetes and High Blood Pressure.

3. 'T' Deficiency

As men age, the main male hormone known as 'T' will drop. Sometimes, it drops to such a low level as to start causing problems. Being overweight and having chronic diseases like Diabetes can cause the 'T' to drop faster and further. Having a low 'T' can lead to many issues including ED.

4. Trauma or Injury

Surgery to the Prostate can injure nerves in the pelvic region leading to problems with erection. Surgery to the brain or spinal cord can also injure nerves leading to the penis.

Of course any trauma or injury to the pelvic / genital region can lead to ED issues. Even an activity as benign as cycling can injure the prostate and pelvic nerves. Some bicycle seats these days are specially designed to minimze this problem.

5. Chronic Diseases

Erectile Dysfunction could be the first sign that you have a more serious problem. Medical illnesses that are commonly associated with problems with erection are Diabetes, High Blood Pressure, High Cholesterol and Thyroid problems. So when you see a doctor for ED, he/she will usually screen you for all sorts of general heatlh issues.

6. Prostate Enlargement / Benign Prostatic Hyperplasia (BPH)

All men, as we age, our prostate gets bigger. This can lead to urinary problems like poor flow, leaking, dribbling, getting up lots of times at night to urinate etc

BPH also causes problems with erection.

7. Smoking

Smoking causes blood vessels to close up. This reduces the blood flow into the penis and can lead to erectile problems.

8. Medicines

Many types of medicine can cause Erectile Dysfunction. Common ones are:

- Medicines for High Blood Pressure

- Medicines for Gastritis and Stomach Ulcers

- Medicines for High Cholesterol

- Medicines for Male Pattern Hair Loss

- Medicines for Depression

A simple home test you can do is the so-called "Nocturnal Penile Tumescence Test".

Basically you want to know if you are getting erections while you are in REM sleep. If you can, this means your ED is more likely psychological then organic. What you do is buy a string of stamps and stick them around your penis before you go to sleep. The stamps should have perforated links. If you find the string of stamps broken apart in the morning, you probably had some erections during your sleep. Of course the other easy thing to do is to ask your partner sleeping with you if you get erections in the middle of the night.


Deciding on which treatment you need depends on what the underlying problem is.

1. Medicines

There are now many medicines available for the treatment of ED.

Collectively they are known as PDE5 inhibitors. They work by increasing a chemical called Nitric Oxide in the blood vessels of the penis. This causes the blood vessels to dilate and brings more blood into the penis leading to a stronger erection.

2. 'T' Replacement

If your 'T' is low (this is determined with a blood test), you might benefit from 'T' Replacement Treatment. This can be done with injections, gels or pills.

3. Change of Medicines

If you are on medicines that can cause ED, you can consider alternatives that will not cause ED. Of course this should not compromise the treatment of your other medivcal problem for which you were taking the medicine in the first place.

4. Electro-Shock Wave Treatment (ESWT)

Recently, there has been a lot of research into using ESWT in the treatment of ED. This treatment involves sending shockwaves into the base and shaft of the penis. This stimulates the penis to make new and healthy blood vessels thereby curing the ED.

5. Vacuum Devices

Vacuum devices work by mechanically drawing blood into the penis. The blood is then kept in the penis with a constricting device at the base, usually a rubber band.

6. Surgical Implants

Surgical implants have come a long way. One of the newest techniques involves placing silastic plastic tubes within the shaft of the penis. The reservoir is placed near the bladder and the pump is placed in the scrotum. Pressing the pump in the scrotum will create an erection.

You are welcome to visit Our Doctors at Our Clinics anytime during our opening hours.

We have 4 locations conveniently located at Robertson Walk, Bencoolen Street, Novena and Scotts (Pacific Plaza).


Robertson Walk            6238 7810

Bencoolen Street          6884 4119

Novena                           63972095

Scotts                              66942348 (Opening April 2015)

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We are now Open on Weekends.

You can also visit our free STD, HIV and Sexual Health Forum.

Read our earlier blog entry on Erectile Dysfunction.

Related Topics:

Tips, Tricks and Treatments for Premature Ejaculation

'T' Replacement Therapy

'T' and ED

More info on Medications for ED

Electro Shock Wave Treatment for ED