Erectile dysfunction (ED) is becoming a common health problem affecting approximately 15% of men each year. Over 150 million men worldwide were estimated to have been affected by erectile dysfunction in 1995, and this is projected to rise to 320 million by 2025.
A 2020 study done in Johor, Malaysia showed an overall prevalence of self-reported erectile dysfunction at a staggering 81.5%. Another study in 2019 showed an ED prevalence of 77.8% amongst men in rural Peninsula Malaysia. Back in 2011, published data showed the prevalence of ED to be only 69.5% among Malaysian men.
Relatively, ED has been a problem for Malaysian men for a significant time and is getting worse in terms of how many people it affects. The negative effects of ED are also more prominent in this day and age.
We had the opportunity to have a discussion with Dr Kaarthig Ganesamoorthy from dtap Clinic with regard to this topic.
What is Erectile Dysfunction (ED)?
ED is the persistent inability to achieve or maintain a penile erection sufficient for satisfactory sexual performance. We typically grade this on a scale of 0 to 5 via the EHS (Erection Hardness Scale) where at level 5, the erection is a good quality erection whereas, at level 3, it is erect but not enough for penetration. At level 4, it is erect enough for penetration, but not as strong as a level 5 erection. Level 0 means no tumelescence at all.
There has been a significant negative impact on the quality of life of the affected individuals and their partners with the increasing prevalence of ED.
Causes of ED?
This is divided into four main categories. Blood flow issues – the most common cause and seen in younger population these days. The factors include unhealthy diet, poor cardiovascular strength and activity, increasing waist circumference and so on.
Penile blood flow is via an existing relatively small blood vessels. With constriction or external compression of the blood vessel, there is less nutrition to the penile muscles resulting in a lesser quality erection.
The second cause is a hormonal imbalance. With aging, poor diet or lifestyle, or systemic infections like autoimmune conditions or cancers can result in an abnormally low testosterone value or inappropriately high female hormone profile. Every person has both male and female hormones in the body. In the male, the dominant hormone profile is the testosterone variants and, in a lady, the female range of hormones is dominant over testosterone.
Next, we have neurological issues. This can happen with poor posture or abnormal stretching of the muscles or nerves following physical activity. When there is nerve damage, such as tears, there will be a lack of impulse from the body when needed. This causes a poor-quality erection.
Finally, the psychological issues. This is arguably the most definitive and plays a big part in any diagnosis of ED. A general practitioner is able to recognize the mental state upon a consultation but may require the expertise of a psychologist or psychiatrist to treat.
This is not a comprehensive list of causes of ED, but it does cover most of the common issues we see in the clinic.
Why is ED prevalent in young men?
With second-hand or increased smoking activities, lifestyles that do not permit much physical activity, stress, increased plastic exposure, poor diet and the likes, we see that ED is affecting more younger males. Previously, this was thought to be something affecting men over 50 years of age. We see young men in their 20s in the clinic quite regularly.
How do I screen for ED?
Screening ranges from blood tests, trial period of medications, or injectable medications to induce an erection for assessment. These are things typically done in the clinic setting. At home though, it’s most likely something where you’d notice that an erection is not satisfactory either in terms of hardness or duration of maintenance. This can also affect size perception in many men.
What are the treatment options?
Treatment options will depend on the causative factor of erectile dysfunction, to begin with. It is imperative to have the diagnosis confirmed by your doctor first before any treatments are administered.
Treatment options include a trial of PDE5i (medications like Viagra/Cialis/Spedra), hormonal therapy (this is usually something that is tailor-made to the individual because individual hormonal levels will vary), using PRP injections or shockwave therapy.
What is Electro Shockwave Therapy?
This is an option of treatment for people with a vascular problem causing erectile dysfunction. It will not be effective for other contributing causative factors of ED.
ESWT is administered by a machine that uses shockwaves to encourage new blood vessel growth and to promote existing blood flow in the penis. There are multiple ways to get this shockwave.
Some shockwave treatments are hydroelectrical, while some are purely electrical. The difference in shockwaves created by the different machines has a varying impact on the penis blood flow. Ideally, we’d like a curvilinear waveform that has good penetrating depth whilst still being focused waves. A slight diffusion of the incoming wave is welcomed.
ESWT is administered with a PDE5i being taken daily. Normally, six sessions of ESWT are arranged to see the improvement in erectile dysfunction. Each session is about 20 minutes and is completely painless. By the time you’re on your fourth session, you should be able to see some difference in the erection quality.
What is the relationship between testosterone and erectile dysfunction?
Testosterone is part of a list of hormones secreted by the body. There are typically four layers of impulses made by the body. The brain (pituitary gland), thyroid gland, adrenal gland, and testes. If there is a problem at any layer of the above, it will result in low testosterone or an abnormal proportion of testosterone in the body. In any situation, it is most important to identify where the deficit is.
Can ED be prevented?
Working closely with your doctor to manage non –communicable diseases (NCDs) such as diabetes, cancer, mental health conditions, stroke, and heart disease can help prevent ED. Healthy lifestyle choices, taking steps to maintain a healthy weight, regular checkups and medical screening tests are pertinent.
For further information regarding this topic or other health-related issues, please visit https://dtapclinic.com.my/