Time to tackle what many believe to be a taboo topic — erectile dysfunction. Better known as ED or by the local Bahasa Malaysia term mati pucuk (an umbrella phrase for impotence), this is a form of sexual dysfunction and it is a common condition among middle-aged and older men.
Sarawak’s Normah Hospital consultant urologist and renal transplant surgeon Dr. Clarence Lei Chang Moh defines ED as “the persistent inability to achieve and/or maintain an erection for satisfactory sexual activity”.
Based on the 2008 Pennsylvania State University, Behrend College’s survey of sex therapists — Canadian and American sex therapists perceptions of normal and abnormal ejaculatory latencies: how long should intercourse last? — it is implied that sexual intercourse should last between seven to 13 minutes to be considered satisfactory.
The same survey found healthy men without ED last between 9.2 to 10.1 minutes during sex but this lessens dramatically with age. ED is just one form of sexual dysfunction. Other forms include inhibited sexual desire and ejaculation problems, all of which negatively affect the patient’s quality of life.
What causes ED?
Physical conditions (age, past physical trauma), psychosomatic problems (stress, depression) and lifestyle can cause ED. Typically ED appears along with common modern day diseases such as diabetes, high blood pressure, obesity and high cholesterol.
“Management of ED should be aimed not only at treatment but also at its prevention,” says Dr Lei. Lifestyle changes which include a healthy diet, regular exercise, no smoking and reduced alcohol consumption may prevent ED and maintain a man’s overall health and well-being.
Stress management and therapy for depression may also rehabilitate the condition but ED tends to happen more and more frequently with age. This means older men naturally have fewer firm erections or can no longer have erections. They also produce less semen and have less intense ejaculations.
Sshh..it’s a taboo topic
A survey conducted in the Klang Valley back in 1998 by Dr. Ismail Tambi found that the prevalence of ED among men between the ages 40 to 70 years is about 16 percent.
“Despite the first impotence clinic opening (at Kuala Lumpur Hospital) in 1992, only 10 percent of Malaysian men with ED talked to their doctors and only 3.9 percent received some form of treatment,” Dr Lei says, pointedly. He attributes this to societal norms that are against talking about sex and sexual matters.
“It is always a taboo subject among many communities. This is probably contributed by lack of understanding, religious and cultural reasons.”
ED can seriously damage a marital or long-term romantic relationship. “ED can be frustrating for both the patient and their partners. It may create feelings of anger, embarrassment, guilt and depression, ” says Dr. Lei.
Treat me right
Sildenafil, best known by its trade name Viagra, is the most well-known cure for ED. Patients take the little blue pill before sexual intercourse to ensure an erection. Other brands currently available in the market that promise similar results are Vardenafil (brand name Levitra) and Tadalafil (Cialis). These drugs contain the compound PDE5 inhibitor, an effective treatment for ED.
“Oral tablets work only so long as there is pharmacological action in the blood stream. Therefore, the treatment is considered temporary,” says Dr. Lei. This means a man can sustain an erection only if the drug is still present in the body. Viagra works for about four hours and Cialis up to 36 hours.
The added condition is that men taking the oral tablets will only get an erection if they are sexually stimulated physically and mentally. It does not mean that an erection happens automatically once the pills are consumed.
Other treatments for ED include intrapenile injection of the vasodilator as well as vacuum suction therapy. Patients also benefit from hormone replacement therapy (HRT) through testosterone supplementation. This can be given orally or intravenously. “If all else fails, a surgical implant can be inserted into the penis,” reveals Dr. Lei.
Clinical consultation for ED is available in both public and private hospitals but medications for treatment of ED are limited. Oral medications start at about RM40 per pill while intrapenile injections cost around RM100 per session.
Don’t go traditional
Dr. Lei is strictly against traditional methods or self-treatment of ED. He believes that medications that are easily available in the market or online can be dangerous as they may contain banned ingredients that are harmful.
“Herbal therapies are not tested on double blind placebo control studies. It is best for the patient to consult a doctor as some types of self-medication can have side effects as well. For example, some of the medication can be toxic to the liver or kidneys,” stresses Dr. Lei.
7 Health Facts About ED
1. Erectile dysfunction can be a warning sign for diabetes, raised blood pressure or high cholesterol.
2. High cholesterol levels, unless treated and reduced, will not only affect the heart by narrowing the coronary arteries but will affect blood vessels in the penis, leading to impotence.
3. Two thirds of men with high blood pressure experience ED.
4. 64% of men who suffer a heart attack received a warning (up to 3 years in advance) in the form of ED.
5. If you are under 40 and otherwise fit, difficulty in getting an erection is usually caused by stress or some other psychosomatic problem. It is only rarely due to a physical cause.
6. Medication with nitrates should never be taken together with oral treatment containing PDE5 inhibitor as the combination makes the blood pressure drop to dangerously low levels. Before taking Viagra or any similar ED drugs, it is crucial to check with the doctor if any other medication consumed, contains nitrates.
7. Men aged 55 or older tend to have less firm erections, produce a smaller amount of semen and have less intense ejaculations with less need to ejaculate. They also need a longer recovery period compared to younger man.
*Information courtesy of Sexual Advice Association, UK
Warning Signs for Female Sexual Dysfunction
Women are not spared when it comes to sexual problems. The official term for this is female sexual dysfunction (FSD). According to the United Kingdom’s Sexual Advice Association, sexual problems in women are extremely common — an estimated one in two women are affected. A woman may suffer from FSD if she experiences:
- Loss of libido or sexual desire
Reasons contributing to the lack of interest in sex include depression, pregnancy, stress, hormonal changes, boredom with sexual routines and lifestyle factors.
• Loss of arousal
The lack of arousal in women during sexual activity often involves insufficient vaginal lubrication. Anxiety or insufficient stimulation could be the cause.
• Failure to orgasm
This can be divided into two categories: a woman who has never reached orgasm or one who has experienced orgasms but has stopped doing so. Reasons include fear or lack of knowledge about sex, insufficient stimulation, relationship problems, depression or stress, previous traumatic sexual experiences or certain medical conditions.
• Pain during sex
Medical conditions such as endometriosis, ovarian cysts, poor lubrication, any sexually transmitted disease or vaginismus can cause pain during sex. Vaginismus is a painful, involuntary spasm of the muscles that surround the vaginal entrance.
Don’t hesitate to speak to your gynaecologist if you suspect you have FSD.