Erectile Dysfunction (ED) is a common problem in Malaysia affecting 16% to 47% of men. That is about 1.68 million Malaysian men above 40 years of age whom experience some degree of ED.1
ED is defined as the persistent or recurrent inability to achieve and/or maintain sufficient erection for satisfactory sexual performance, for at least 3 months duration.2
ED can be due to a range of causes, which may involve both physical and physiological factors.
Table 1: Causes and risk factors of ED
| Psychological processes | Mental disorder | Neurological disorder |
| Performance anxiety | Anxiety disorders | Trauma |
| Loss of attraction | Depression | Myelodysplasia (spinal bifida) |
| Relationship difficulties | Intervertebral disc lesions | |
| Stress | Drugs and substance abuse | Diabetes mellitus |
| Narcotics | Alcohol abuse | |
| Antihypertensives (thiazides, beta blocker, methyldopa, spironolactone) | Pelvis surgery | |
| Hormonal abnormalities | Antidepressants and transquilisers | |
| Hyperprolactinaemia | NSAID | Arterial disorder |
| Hypogonadism leading to testosterone deficiency | Miscellaneous drugs (ketoconazole, hyoscine, anticancer agents) | Hypertension |
| Hypo- or hyperthyroidism | H2 antagonists | Smoking |
| Diabetes mellitus | ||
| Hyperlipidaemia | ||
| Peripheral vascular disease |
Smoking – a good reason to stop! Adapted from CPG in erectile dysfunction (Malaysia Urological Association and MEDACT 2009)
Cigarette smoke contains about 41,000 chemicals eg, acetone, ammonia, arsenic, carbon monoxide, lead and tar. These chemicals causes damage to the blood vessels, which hinders proper blood flow to the penis.3
According to a report from the American Heart Association (data from 4,764 Chinese men with average age of 47), those who smoked more than 20 cigarettes a day had a 60% higher risk of ED, compared to those who never smoked. What was important to note from the study was the fact that as long as you smoked at some point in your life, you are 30% more likely to suffer from ED.4
Similar to smoking, drug of alcohol abuse can also reduce blood flow to the penis causing ED. A sedentary lifestyle and being overweight are other contributing factors of ED.5
There are several laboratory tests that may help in identifying clues to diagnosis of ED. These may include:
Your doctor may also recommend you to do an Ultrasound.6
While these are specific tests that could help with the diagnosis of ED, it is important to do a complete health check annually (e.g: Head-To-Toe), since the factors causing ED is multi-faceted.
If you suffer from diabetes and heart disease, treating these underlying causes may resolve ED. Talk to your doctor if you are taking any hypertensive medication. Certain medications may have the effect of restricting blood flow to the penis, thus causing ED. Alternatively, you may also consult with a qualified pharmacist for Medication Check Up service in order to identify such medications. Do not stop taking any medications without consulting your healthcare provider.
For conditions due to hormonal abnormalities (e.g: hypogonadism, androgen deficiency or hyperprolactinemia), you may consult an Urologist who will perform certain tests and suggest appropriate therapy to treat these underlying cause.2
If you are a smoker, consider quitting now! You may enrol yourself in a quit smoking program with a professional body that offers professional help, advise and support. Lovy Pharmacy Quit Smoking Program are available nationwide and managed by qualified pharmacists who can provide an intensive and comprehensive program that includes one-to-one counselling for behavioural modification using stop-smoking aids and other relevant materials.
Besides quit smoking, you may also need to:
Nutritional supplements such as the following may help to improve the symptoms of ED:
Other herbal supplements such as Asian ginseng and ginkgo biloba can improve blood circulation, thus may have the effect in inducing proper blood flow to the penis, improving conditions of ED.3
