Suspect you have erectile dysfunction and want to explore treatment using TCM? Join us in our webinar as we explore the TCM perspective on male infertility and erectile dysfunction.
Title: Consult a TCM Physician: Male Infertility and Erectile Dysfunction
Date: 9 April 2021
Register here: https://bit.ly/3sEcyPP
Ever wondered about your options for treating erectile dysfunction (ED) in Singapore?
ED is one of my favourite topics to talk about, and I'm here to break down the issue for you from a medical perspective. With a good understanding of the reasons behind erectile dysfunction, ensuring that your body works as it should can be simple.
1. What is erectile dysfunction?
Also known as impotence, erectile dysfunction simply means a state where:
- You have difficulties initiating an erection
- You cannot maintain your erection for adequate penetration
Erectile dysfunction is most commonly seen in older men, and some andrologists even suggest that from age 30 onwards:
Your age = percentage of sufferers
So if you're 35 years old, you can expect that approximately 35% of your peers suffer from ED.
2. What are the causes of erectile dysfunction?
Even though most Singaporeans tend to assume that erectile dysfunction is limited to “performance anxiety”, the causes of erectile dysfunction can really be categorised into either psychological or physical. For some Singaporeans, it's a mix of both.
3. What are the psychological causes for erectile dysfunction?
Psychological causes typically affect men in situations where there's a need to "perform". Some common stressors include:
- Wedding anniversary
- New partner/relationship
In my practice, erectile dysfunction is also frequently due to a lack of sexual interest. Causes for this are:
- Finding your main partner sexually unattractive (while sex is totally okay with other partner)
- Low testosterone (see my previous article)
- Depression or low mood
- Relationship strain with your wife or partner
4. What are the physical causes of erectile dysfunction?
If you've ever wondered why erectile dysfunction is more common in older men, it's simply because penile vessels also undergo wear and tear (like all other things in life).
Other physical causes for erectile dysfunction include:
- Diabetes mellitus - over 70% of diabetic men in Singapore suffer from erectile dysfunction
- High blood pressure
5. How is erectile dysfunction diagnosed in Singapore?
Diagnosis of erectile dysfunction requires an open conversation about sexual practices and sexual partners, as well as a thorough medical/drug history.
It's also important to differentiate erectile dysfunction from premature ejaculation (although both conditions can co-exist). The International Index of Erectile Function (IIEF-5) is widely used by doctors as a diagnostic tool for erectile dysfunction.
6. What medical investigations are done for erectile dysfunction?
I usually screen for abnormal hormone levels that can impede sex drive. This includes estradiol and prolactin levels.
Another possible investigation your doctor may request for is a vascular ultrasound of the penile shaft, which looks at the health of your penile blood vessels. I tend to send my patients to Singapore General Hospital for this investigation, which costs about $330.
The vascular ultrasound isn't a test I order routinely however, as the history usually gives me clues to the cause. For instance, a patient of mine in his 30s had never had a meaningful sexual encounter due to difficulties in erection initiation. I decided to send him for an ultrasound on the suspicion that a large blood vessel was blocked, and sure enough, this was confirmed by the report.
7. How is erectile dysfunction treated in Singapore?
The treatment modality depends on the cause. Psychological causes tend to need some form of counselling or reassurance. I have sometimes opted to send patients to sexual therapists or relationship counsellors.
The larger part of treatment involves physical aspects. It really helps to improve your lifestyle habits, such as:
- Adopting a healthy diet
- Regular exercise to upkeep your cardiovascular health
- Cut down on smoking and drinking
8. Are there anything over the counter for erectile dysfunction in Singapore?
You can buy Viagra, Cialis, and Levitra at most clinics in Singapore. All three improve blood flow during sexual arousal, and are effective in 60 to 70% of men with erectile dysfunction.
It is possible that one medicine may work better for you than another, so it's best at the start to try out which is most effective for you under your doctor's advice.
9. Which medication for erectile dysfunction should you choose?
Viagra, Cialis, and Levitra differ mainly in how long their effects last for. Your choice therefore depends on your need for sexual spontaneity and sexual frequency.
For instance, the effects of Cialis (up to 36 hours) last much longer than those of Viagra (5 hours) or Levitra (8 hours), so many Singaporeans prefer Cialis as it involves less planning.
The downside to Cialis is that any side effects last for longer too.
10. How can you buy Viagra, Cialis, or Levitra in Singapore?
All three require a doctor's prescription in Singapore - meaning that you cannot walk into a pharmacy and buy it from the pharmacist counter.
Clinics in Singapore typically allow patients to purchase "refill medication" after your first consult without having to see the doctor again. Of note, these medicines can drop your blood pressure, so do inform your doctor if you are on any heart or hypertension medications.
These medications cost about $20 - $23 per tablet. Here are some average price ranges for what you can expect to pay:
Viagra cost in Singapore: $80 - $90 for box of 4 tablets
Cialis cost in Singapore: $90 - $100 for box of 4 tablets
Levitra cost in Singapore: $80 - $90 for box of 4 tablets
11. Are there ways to treat erectile dysfunction without medication?
Shockwave therapy for the penile shaft involves the use of a machine that induces tiny injuries in the penile tissues, which lead to increased blood vessel growth. It's currently the only treatment that's targeted at the cause of the condition (reduced blood flow), as opposed to medications which only have temporary effects.
About 70 - 82% of patients see an improvement in IIEF-5 score and erectile turgor in various studies. Some centres in the US suggest that shockwave therapy also leads to improved penile tissue health through the recruitment of stem cells, but this is currently not proven.
Treatment with shockwave therapy is completely painless, and carried out twice a week for between 3 - 6 weeks, depending on the severity of your erectile dysfunction. The cost of shockwave therapy in Singapore ranges from about $400 - $600 per session.
I hope that this article has made it easier for you to understand what causes erectile dysfunction, as well as the available treatments!
Dr Winston Lee manages South Bridge Aesthetics Clinic, and has a special interest in men’s health. He enjoys the occasional cuppa, and de-stresses through gardening.