What you need to know about erectile dysfunction and other male sex issues

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If your husband is consistently having trouble in the bedroom, he could be experiencing sexual dysfunction. Dr Ronny Tan, consultant and director of andrology at the department of urology at Tan Tock Seng Hospital (TTSH) which is a member of the National Healthcare Group, tells us what the three most common male sex issues are, and what to do about them. He adds too, that depending on the severity, having a healthy lifestyle and exercising regularly can also help men overcome these problems.



1 Erectile Dysfunction

Erectile dysfunction (ED) is the inability to maintain an erection rigid enough for sexual intercourse. If your man can’t initiate an erection, or can’t sustain one until the completion of the sexual act, he has ED. Another common complaint is that the erection is not hard enough for satisfactory sex, says Dr Tan.

Studies have shown that by the age of 40, up to 40 per cent of men would have experienced an episode of ED in their lifetime and this figure increases to up to 75 per cent for men above 70. ED is also known to cause depression that can worsen the condition further. 


Causes: ED could be due to problems with blood flow or nerves in the penis. It could also be caused by medical treatment like drugs, surgery or radiotherapy. Medical conditions like hypertension, diabetes mellitus and high cholesterol are also significant risk factors for ED, as well as smoking. Dr Tan adds that men with testosterone deficiency commonly experience ED.


What to do: First, your man should go for blood tests to determine if he has deficiencies in testosterone, red blood cells or specific proteins produced in the prostate that can cause ED.

If he’s diagnosed with low testosterone, he’ll receive topical, oral or injected doses of testosterone therapy from a urologist, depending on his preferred treatment.

If there’s no issue with his testosterone levels, he should then see a cardiologist. This is crucial because ED in a man younger than 50 years can be a harbinger of heart disease, warns Dr Tan.

Treatment for ED ranges from oral medications such as Viagra to injectable therapy, where the man injects a drug directly into the side of the penis to induce an erection right before intercourse.


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Another option is penile prosthesis surgery, a day surgical procedure in which a prosthesis is fitted into the penis and scrotum. During sex, it can be manually activated with a pump, usually located in the scrotum.

Adjuncts like vacuum erectile devices, which helps to encourage blood to flow to the penis, can also be used.

According to Dr Tan, there is also a new form of treatment available at TTSH, called low-intensity shockwave therapy, which stimulates the growth of new blood vessels and may be a potential cure for ED. Patients undergo a total of six sessions lasting around 15 minutes each, where shockwaves are delivered to the penis through a hand-held device.  



2 Premature Ejaculation

Premature ejaculation (PE) is a condition where the man ejaculates too quickly after vaginal penetration without being able to control or delay ejaculation. Dr Tan says that in the Asia-Pacific region, as many as one in three men experience some form of PE. The condition can cause couples to avoid sex completely and some people have even reported it led to the breakdown of their relationship.


Causes: PE may be caused by psychological factors like anxiety or depression. It is also found in patients with ED.


What to do: A urologist can prescribe topical medications that numb the penis to reduce sensitivity, or oral medications to delay ejaculation.  

You can also accompany your spouse for behavioural therapy. There, therapists can teach the ‘start-stop’ technique that keeps him from getting too close to orgasm too soon. The idea is to familiarise him with the sensation of reaching orgasm so he can learn to control the urge to ejaculate. You’ll both also be taught the Masters and Johnson technique that involves squeezing the penis when he’s close to orgasm in order to delay ejaculation.  


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Dr Tan recommends that patients with PE visit the Complex ED clinic and Sexual Wellness clinic at TTSH to receive holistic care from a team of doctors, psychologists and occupational therapists.



3 Penile Curvature

Penile curvature, as the name suggests, refers to an abnormal bending of the penis during erection. It is more common in men 50 years and above. The curvature can potentially interfere with your sex life if it causes pain to either partner or in some cases, makes penetrative intercourse impossible.


Causes: If your man has had the curvature from an early age, known as congenital penile curvature, it is likely he was born with it.

If he developed it later in life, he probably has Peyronie’s disease (PD). PD is a wound-healing disorder that causes a plaque to develop over the penis and is associated with the bending of the penis. In some cases, it can cause the penis to shorten and result in erection problems.

Though the jury is still out on what causes PD, it is known that some men develop the disease from repeated injury during sports, sex or because of an accident.  

Dr Tan says that as many as 48 per cent of PD patients become clinically depressed as the condition results in the loss of penile length, which affects most, if not all, men’s morale and sense of masculinity.


What to do: If the curvature is congenital, surgical correction is the only option, where the urologist straightens the penis using sutures or grafts. Dr Tan says that in some severe cases, a penile prosthesis may have to be inserted.

Otherwise, your man should consult a doctor to determine if he has PD. Patients with PD will be referred to a urologist who specialises in its management.

Treatment for PD includes oral medication, which can treat PD symptoms to prevent the condition from deteriorating, although it cannot correct the curvature. Injectable medication may also be used to soften the palpable lump or plaque on the penis, thereby allowing it to straighten.