Erectile dysfunction (ED) refers to the inability to achieve or maintain an erection firm enough for satisfying sexual intercourse. It is one of the most common male sexual health concerns and falls under penile disorders.
ED, also known as impotence, is a common condition, particularly among men aged 40 and above. It can be temporary or persistent, and in some cases, it may signal an underlying health issue such as cardiovascular disease or diabetes.
While these conditions can occur together, they are not the same. Erectile dysfunction involves difficulty achieving or maintaining an erection, while premature ejaculation happens when a man ejaculates sooner than desired, despite having an erection.
Sometimes, ED can contribute to premature ejaculation. For example, when a man worries about losing his erection, he might ejaculate quickly to avoid losing it altogether.
You may be experiencing ED if you notice any of the following:
You can only occasionally get an erection when you want to have sex.
You can get an erection but struggle to maintain it during intercourse.
You are unable to achieve an erection at all.
You require a high level of stimulation to stay erect.
ED can result from physical, psychological, or mixed causes.
Type 2 diabetes, cardiovascular disease, atherosclerosis, high blood pressure, high cholesterol, or after major pelvic surgery such as radical prostatectomy or radiotherapy.
Spinal cord or brain injuries, Parkinson’s disease, Alzheimer’s disease, stroke, multiple sclerosis, or nerve damage from pelvic surgery or radiotherapy.
Peyronie’s disease, penile fractures, or cavernous fibrosis.
Low testosterone (hypogonadism), elevated prolactin levels, or thyroid disorders (both hyper- and hypothyroidism).
Certain antihypertensives, antiandrogens, antidepressants, antipsychotics, recreational drugs, and excessive alcohol.
Performance anxiety, past traumatic experiences, chronic stress, and mood-related disorders such as depression.
Diagnosis involves a combination of medical history, physical examination, and targeted investigations.
For medical history, your doctor will ask about:
The onset and duration of symptoms
The ability to achieve and maintain erections
Associated medical conditions
Emotional and relationship factors
A physical examination includes checking blood pressure, vascular health, and genital structure.
Laboratory tests may include:
Testosterone levels
Thyroid function
Lipid profile
Blood glucose
Liver and kidney function
Prolactin levels
Imaging and vascular studies (if indicated):
Penile Doppler ultrasound to assess blood flow
Magnetic resonance angiography (MRA) for vascular abnormalities
These are the foundation of treatment and can significantly improve symptoms.
Stop smoking
Limit alcohol intake
Maintain a healthy weight
Exercise regularly
Manage stress and get enough sleep
Control diabetes, blood pressure, and cholesterol
Stress, performance anxiety, depression, and relationship issues can affect sexual function. Management may include:
Counselling or psychotherapy
Sex therapy (individually or with your partner)
Support for mental health or stress management
Oral medications like sildenafil, tadalafil, and vardenafil increase blood flow to the penis. These are commonly prescribed and taken before sexual activity.
They require sexual stimulation to work.
Several attempts may be needed to find the right dose or timing.
They are not suitable for men taking nitrate medications for heart disease.
Your doctor will recommend the safest and most effective option based on your health.
Testosterone therapy is only effective for men with confirmed low testosterone levels. It does not enhance sexual performance in men with normal hormone levels. Blood tests are required before starting therapy. Testosterone replacement is not a first-line treatment for ED but may be used together with other therapies when appropriate.
Surgery is considered when other treatments are ineffective.
Penile implants are the main surgical option.
Inflatable implants allow the user to control when an erection occurs.
Semi-rigid implants keep the penis firm but bendable.
These procedures are safe, effective, and provide a long-term solution for selected patients.
ED is common and treatable. Most men respond well to therapy, and with the right combination of medical care, counselling, and lifestyle adjustments, normal sexual function can often be restored.
If symptoms persist, early consultation with a urologist is advisable to rule out underlying conditions and receive the most appropriate treatment.
At Prince Court Medical Centre in Kuala Lumpur, our experienced urologists and men’s health specialists provide comprehensive evaluation and treatment for erectile dysfunction and other sexual health conditions.
Book an appointment today to discuss your concerns confidentially and take the first step toward restoring confidence and well-being.
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