The changing face of erectile dysfunction

SINGAPORE — The profile of men grappling with erectile dysfunction (ED) in Singapore is no longer what most people think. Instead of older men, a substantial proportion of these patients are under the age of 40, said doctors TODAY spoke to.

These men are in the prime of their lives but are likely stressed because of work or from trying to start a family. Some may suffer from an urban lifestyle disease, such as diabetes or high cholesterol.

Dr Ng Chee Kwan, urologist at Mount Elizabeth Novena Specialist Centre, said that one in four patients he sees for the condition is under the age of 40.

Professor Peter Lim, senior consultant urologist at the Andrology, Urology and Continence Centre at Gleneagles Hospital, Singapore, sees about 15 to 20 young ED patients who are in their 20s and 30s monthly — a figure that has more than doubled in the last decade.

“Due to better education and a modern mindset, they seek treatment the minute they find something is not right. Their partners may also push them to see a doctor earlier,” said Prof Lim.

NOT A MATTER OF AGE

ED occurs when a man is consistently unable to obtain or maintain erection for satisfactory sexual relations.

Most men are able to maintain an erection for five to seven minutes, which is the average time for ejaculation, said US-based male sexual and reproductive expert Dr John Mulhall, director of the Male Sexual and Reproductive Medicine Programme, and director of the Sexual Medicine Research Laboratory at Memorial Sloan Kettering Cancer Center in New York City. Dr Mulhall said it is a myth that ED is associated with older men.

He was in town last month for the launch of the new version of Viagra for ED treatment.

“The risk factors for ED can happen to men of different ages. For example, if you are a 22-year-old man who has a new job in a new city and works 14 hours a day, you might get ED. We need to move away from the stereotype (that ED affects only older men),” he said.

While older men often have a physical cause for their impotence, such as blocked arteries or hormonal imbalances, psychological issues are more likely to plague younger ED sufferers. These can range from work and money woes, stress because of couple issues to performance anxiety from trying to make a baby during the wife’s ovulation period, said Prof Lim.

Mr Ben Toh (not his real name) is an example of a young local patient who clocks 14-hour work days. He also has mild high blood pressure.

At the age of 30, the bank executive had trouble maintaining an erection last year and was prescribed Viagra. He takes the medication an hour before sexual intercourse.

Speaking on the condition of anonymity, Mr Toh said his inability to perform was very “stressful and ego-hurting”.

“There was also guilt from being unable to satisfy my partner and psychological stress from quarrels and the loss of intimacy. Supplements didn’t help me, so I finally saw a doctor,” said Mr Toh, who does not intend to let his partner know he is on ED medication.

Dr Mulhall pointed out that risk factors such as diabetes, high blood pressure, high cholesterol and obesity — urban lifestyle diseases previously more commonly seen in older adults — are now also affecting younger men.

One of the youngest patients Prof Lim has treated for ED is a 22-year-old diabetic, whose girlfriend had shunned him when he was unable to perform in bed.

“He was devastated, but eventually resolved his ED with counselling, treatment of his diabetes and use of medication,” said Prof Lim.

For these patients, the proper control of medical conditions can help solve ED issues.

“Once you pick up a definite physical cause and you attack that specifically, logic dictates that you have a pretty good chance to solve it,” said Prof Lim.

EARLY TREATMENT REDUCES PERFORMANCE ANXIETY

Once a physical cause is excluded, most young ED patients benefit from the early use of medication usually taken on demand as a “confidence booster”, said Dr Ng, the organising chairman of the 46th Singapore Medical Association National Medical Convention, which took place in July.

“A lot of times, they have performance anxiety. They might also have had one or two bad encounters that further perpetuate the anxiety. When they find that the medication works, they get their confidence back and may subsequently find they no longer need it.”

Dr Ng added that patients should discuss their ED issues with their partners openly, which helps reduce performance anxiety too.

The mainstay of ED treatment are oral PDE5 inhibitors to help maintain erection during sexual activity.

“These medications push blood into the penis, causing it to be erect. Without stimulation, however, it would not work. Hence, the man must still have a libido and stimulation first,” said Prof Lim.

The three versions of prescription oral PDE5 inhibitors for ED treatment are under the brand names Viagra, Levitra and Cialis, said Dr Ng.

“The former two are shorter-acting drugs with effects that last about four to six hours each. Cialis is a longer-acting drug with effects that may last for up to 36 hours,” said Dr Ng.

The newer version of Viagra, launched here last month, disintegrates when placed in the mouth and can be taken without water.

However, not everyone is suitable to take these drugs. If you are eligible, be sure to let your doctor know if you are currently taking other medications, said Dr Ng.

Prof Lim also warned against resorting to folk remedies or supplements.

He said: “Many are bogus and potentially harmful, especially if they are sold on the Internet or by roadside peddlers.

“They may contain drugs that should not be used in certain medical conditions, or cause death when they contain blood-sugar-lowering agents.”