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Debunking Myths on Erectile Dysfunction

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Men’s health is like an OB-Gyne that focuses on taking care of everything including men’s sexual health such as erectile dysfunction, premature ejaculation, circumcision, fertility problem, and even prostate issues.

In this article, Dr Tan Kok Kuan focuses on answering some questions regarding men’s health, most specifically about erectile dysfunction, which many men may be shy about asking themselves. 

What is Erectile Dysfunction?

Erectile Dysfunction is the inability to achieve or maintain a normally rigid erection. If your penis erection is like a cucumber, it is good, you do not have any issues. But if it is like tofu, you need to consult your doctor for there is probably something bad. But if it is in between, like that of a banana, it is also good to get medical attention right away Erectile Dysfunction is a symptom, not a cause.

Does old age have something to do with Erectile Dysfunction?

Erectile Dysfunction is a symptom, not a cause. When doctors want to determine the cause, age gives them a clue about it. So, if we see young men with erectile dysfunction, it is more of a genital or mechanical problem or an acute psychiatric problem. In addition, the chemicals found in over-the-counter medicines for blocked noses constrict the blood vessels and in turn, cause erectile dysfunction as a side effect.

Is it normal to have Erectile Dysfunction on a sexual debut? 

Erectile Dysfunction on sexual debut is so common. It is seen by doctors all the time. A lot of times, this is because they have not ejected the foreskin. They are not circumcised and do not tear the foreskin.

The heat is very sensitive. Imagine, if you never walked bare feet and the skin in your sole is so sensitive, when you first start to walk bare feet, it would be very painful. This is the same with the penis. If it is covered by the foreskin for a very long time, the first time it touches something, it will be very painful, and very sensitive. Because of its obnoxious stimuli, it cannot maintain an erection. 

What are its causes in older men?

For older guys, it is more on the aspects of hormonal deficiencies and blood vessel blockage issue that is mostly associated with chronic diseases such as diabetes, high blood pressure, and high cholesterol. If the prostate enlarges, that too can be a cause of erectile dysfunction.

How common is erectile dysfunction?

The prevalence of erectile dysfunction above equates the age. It is an upward slope, with around 80% of men in their 60s and 70s. 

Is Benign Prostatic Hyperplasia (BPH) related to erectile dysfunction?

The prevalence of BPH also increases with age. So, for men in their 60s and 70s, there is a prevalence of 30-50%. If it is combined, the prevalence of older men in their 60s and 70s suffering from both erectile dysfunction and BPH is around 50%. 

What is the association of erectile dysfunction with BPH?

Every man has a prostate. As a man gets older, the prostate enlarges. This is something completely unavoidable. And as the prostate enlarges, it causes many symptoms such as poor urine stream that results in urinating multiple times. One of the symptoms and causes is erectile dysfunction. 

BPH or enlarged prostate are the underlying cause of mostly older men who see a doctor for erectile dysfunction. The problem is before a lot of treatments used to treat BPH cause or worsen erectile dysfunction. But luckily now, there’s a treatment, a pill that must be taken once a day, to treat both erectile dysfunction and BPH. 

Does cycling cause erectile dysfunction?

Yes, there is an association between cycling and erectile dysfunction because it has been shown that pressure on the bicycle seat reduces blood flow to the pelvis. Studies show that blood reduction is up to 80%. Reduced blood flow to the pelvis plus reduced blood flow to the penis will result in erectile dysfunction. Men who cycle for a long distance suffer from this. 

But there are some simple things that they can do to improve the mechanics of their bicycles. Men can have special bicycle seats that take the pressure away from the blood vessels in the pelvis. 

Does using a laptop placed on your lap cause erectile dysfunction?

No. There is no evidence to support this. However, the heat from the laptop usually makes the temperature in the scrotum rise which is bad for sperm production. So, using a laptop placed on your lap will not be good for fertility but will not cause erectile dysfunction.

Does watching pornography and excessive masturbation cause erectile dysfunction?

According to the paper about pornography causing erectile dysfunction written by a professor named Bryan Park, yes it does psychologically. Pornography provides supernormal stimuli, which is very unusual. Because of the neuroplasticity of the brain, it adapts to this stimulus, and you need a constantly high stimulus to achieve an erection. In this way, pornography causes erectile dysfunction. 

On the other hand, excessive masturbation does not cause erectile dysfunction. Masturbation does not cause any harmful effects. Rather, it gives more benefits such as it reduces stress and the risk of prostate cancer. In a nutshell, yes pornography cause erectile dysfunction, but excessive masturbation does not.

Can erectile dysfunction be cured?

The answer to this question is another question, ‘What is the cause of erectile dysfunction?’. So, if the cause is benign such as acute psychological stress or a side effect from a medication, then yes, doctors can still cure it for they just need to take away those factors. 

For the high majority of patients with erectile dysfunction, the reported cause is the reduction of the blood vessel flow to the penis that is caused by chronic illnesses such as high blood pressure, diabetes, and high cholesterol. And since these chronic illnesses cannot be cured, then the erectile dysfunction will also not be cured. 

What are the treatment options for erectile dysfunction?

  1. Have proper diagnosis

Before checking the treatment options for erectile dysfunction, patients must first have a correct diagnosis. That is why consulting a doctor is very important to know the cause for not everything can be treated by pills. 

  1. Treat any underlying causes

For example, if there is a reduction in the level of serum testosterone, get that treated first. If there is a problem regarding obesity, you should consult a doctor for a medical weight loss program first. After these, then we can move on to treating erectile dysfunction. 

  1. Start treatment for erectile dysfunction

Some treatments available to treat erectile dysfunction are:

  • Tablets or pills
  • Penile injection
  • Surgical penile implant
  • Electroshock wave therapy 

What are the pills that can be taken for erectile dysfunction?

This type of treatment is very famous because it is easy, convenient, painless, quite effective, and reliable. There are four different kinds of pills to treat erectile dysfunction: blue pill, orange pill, pink pill, and white pill. 

All of them are slightly different. They differ in terms of:

  1. Offset effect – For some pills, you can immediately see its effect after 15 minutes, for some 30 minutes 
  2. Duration – Some pills last for eight hours; some last for 36 hours. 

Erectile dysfunction pills are different from sleeping pills. If you take sleeping pills, you will be lying down on the bed because you cannot do anything while feeling asleep. It is the same thing when you take a pill for erectile dysfunction, you will not just get an erection. You still need sexual stimulation. 

For example, you can take the pill, go for a nice dinner, and then go back home. Once you’re stimulated then you will get your erection. You must be ready for the whole duration of the pill you took. 

Do pills used for erectile dysfunction cause a heart attack?

This was a big concern when this was first launched in the 1980s. What happened was, that all these men who were a bit older already had heart problems all their lives. Suddenly, they were not empowered to live the lifestyle they want. Sometimes, they put themselves in scenarios that were overly exciting and because of these scenarios, their heart function cannot take it and that is why they got a heart attack. So, it was not the pill that caused the heart problem. It was the pills empowering the men to be in a situation that caused their heart problems. 

Will men develop addiction or dependence on erectile dysfunction tablets?

No. They will never be dependent or addicted to it. People get this wrong impression because they do not address the underlying cause. For example, a person has diabetes. He doesn’t control his diabetes so his blood vessels get more and more blocked, so erectile dysfunction can get worse. This will result in him getting a higher and higher dose of medicine to achieve an erection. This emphasizes the need to consult a doctor for any issues, see the underlying cause, and control it rather than just medicating it with some medicines.

Are “natural cures” good in treating erectile dysfunction?

All these ‘natural cures’ like pomegranate juice, garlic, onions, and Tongkat Ali, are all harmless and it is good if it works for you. But let us look at the scientific evidence behind these supplements. Let us look at Tongkat Ali since it is the most famous local supplement. It is derived from this herb called Eurycoma Longifolia. There were studies done in Malaysian Universities on animals. But there were no studies done on humans. The bottom line is, that you can take these supplements, they are harmless; and when they work on you, good, you can continue taking them. But the warning is, that there are some supplements online that may help for erectile dysfunction but can cause side effects. It may contain a prescription ingredient that can be quite dangerous if not properly controlled by a doctor. 

Are penis pumps or sex toys a treatment for erectile dysfunction?

Penis pumps are rigid plastic tubes they put over the penis that create a vacuum around it. What happens is, blood is drawn, and because of the vacuum pressure, it is drawn into the penis. What some patients will do is put a conflicting device at the base of their penis, like a tight rubber band. This prevents the blood to go back down. Therefore, blood is retained in the penis and erection is maintained. 

Some doctors prescribe penis pumps in certain situations to help. Such as using the penis pumps without the constriction ring. Any part of the body that doesn’t get fresh blood flow will become unhealthy. So, for example, put a tight rubber band at the base of your finger and leave it there. What happens is there will be no blood flow on it, and the finger will die off. The same with the penis. If the body is not pushing fresh blood with oxygen and nutrients into the penis, the tissue of the penis will start to get unhealthy. Some doctors will prescribe regular use of penis pumps just to get fresh blood and nutrients into the penis without using the constriction ring. It is like physiotherapy for the penis. 

Using a penis pump to get an erection and then using a constriction ring is also called treatment or cure. But we were given much more convenient options like taking tablets. This kind of treatment is outdated.

Is shockwave therapy painful?

The full name for shockwave therapy is low-intensity electro shockwave therapy. Because it is a low-intensity shockwave, it is completely painless. Low-intensity electro shockwave therapy is shooting painless shockwaves into the penis to open up the blood vessels and stimulate the body to create new blood vessels, the process called Vasculogenesis.  

Any advice for men who are afraid to consult a doctor regarding erectile dysfunction?

Don’t be. It is a symptom of a disease. If your throat hurts, your knee hurts, your stomach hurts, you have no problem seeing a doctor. It is not about sex. If you have erectile dysfunction and decided to not have sex anymore, that is fine. That is a choice you made for yourself. But that doesn’t mean you can ignore the symptom that could be a sign of a more serious underlying disease.

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