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Doctor and Patient

Erectile Dysfunction

What is Erectile Dysfuntion?

Erectile dysfunction (ED) is the inability to get or keep a firm erection sufficient for sexual intercourse. In an erection, impulses from the brain and local nerves relaxes the muscles of the penis allowing blood to flow in and fill the spaces within the chambers. The engorged penis maintains the erection until the muscles contracts to stop the inflow of blood and open the veins for blood outflow.

Anatomy of the Penis



These include:

  • Psychological factors such as stress, anxiety, depression or fear.

  • Chronic illnesses such as diabetes, high blood pressure or heart disease 

  • Poor lifestyle such as smoking, alcohol, being overweight, and lack of fitness. 

  • Medications such as blood pressure drugs, antihistamines and antidepressants

  • Hormonal abnormalities such as low levels of testosterone.


Patient history. A person’s medical and sexual histories will help define the degree and nature of ED. Openly discuss your sexual concerns to enable the doctor to identify the problem/s with sexual desire, erection, ejaculation or orgasm. 


Physical and Psychosocial examination. A physical examination can give clues to systemic problems. The doctor can determine if it is due to an issue with nerves, hormones, your blood circulation or if it is due to drugs or underlying psychosocial issues. 


Laboratory tests. Tests for systemic diseases include blood and urine tests to take a closer look at the kidneys, liver or heart.  Measuring the male hormone testosterone can also provide information on the source of the problem.




  • Lifestyle changes such as quitting smoking, reducing alcohol consumption, losing excess weight, and increasing physical activity may help some men regain sexual function.

  • Psychotherapy. Techniques that decrease anxiety associated with intercourse can be taught together with the help of the partner.

  • Oral or locally injected drugs. Oral drugs taken an hour or two before sexual intercourse can relax the smooth muscles in the penis during sexual stimulation and allows increased blood flow in the penis. However, men who take nitrate-based drugs such as nitroglycerin for heart problems should not use these drugs because the combination can cause a sudden drop in blood pressure. 

  • Shock Wave Therapy. Shock wave therapy can also help improve erectile function over a period of weeks. It is a simple in-office treatment and takes less than half an hour with no downtime.

  • Surgery. When all else fails, there is always the surgical approach such as Penile implants or Vascular surgery to the vessels which regulate blood flow to the Penis

source: SingHealth Erectile Dysfunction

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