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
Risk Factors and Causes of ED
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
Laboratory tests for diagnosis of ED
There are several laboratory tests that may help in identifying clues to diagnosis of ED. These may include urine analysis, fasting blood glucose, testosterone level, serum prolactin, Luteinizing Hormone (LH), thyroid function, liver profile and Prostate-Specific Antigen (PSA). 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 eg, Head-To-Toe, since the factors causing ED is multi-faceted.