Erectile Dysfunction

Erection dysfunction (ED), refers to the difficulty in getting or maintaining an erection that is sufficient for sexual intercourse — a condition affecting hundreds of millions of men worldwide. According to a local ED study published in Singapore Medical Journal, over 50% of men over the age of 30 in Singapore reportedly suffer from erectile dysfunction, to varying degrees.

ED Statistics in Singapore:
Mild ED – 23.2%
Moderate ED – 8.8%
Severe ED – 19.3%

In Singapore, studies have also shown the Indian ethnic group to be at higher risk of erectile dysfunction.

Symptoms of Erectile Dysfunction

• Difficulty obtaining or maintaining an erection
• Penis not being rigid enough for penetration
• Premature ejaculation
• Reduced sexual desire or libido
• The absence of spontaneous erections during sleep or in the morning

The causes of erectile dysfunction are broadly categorized as organic, psychogenic or a mixture of both.

1. Physical Causes of ED (organic)

Age
Age is the single most significant risk factor for erectile dysfunction. The prevalence of erectile dysfunction increases with age, starting from 40% for men in their forties to over 70% for men in their sixties.

Obesity
Obesity is a risk factor for erectile dysfunction. Besides lowering testosterone levels crucial for libido and erectile function, obesity can impact blood vessel health and obstruct blood flow to the penis. Studies have shown that BMI is significantly higher in men with ED compared to those without ED.

Vasculogenic conditions
Vasculogenic erectile dysfunction refers to ED caused by problems with blood flow to the penis. Majority of erectile dysfunction cases are vasculogenic in nature, accounting for approximately 70% of ED cases. In fact, vasculogenic ED often precedes vascular diseases such as stroke and cardiac arrest, acting as an early warning sign. ED often go hand in hand with conditions such as high blood pressure (hypertension), high blood cholesterol and diabetes which restricts blood flow to the penis. Reducing visceral fat and abdominal fat not only improves overall health but can also improve erectile function. Studies involving obese men with ED have shown that the participants were able to improve their ED condition through weight loss.

2. Psychogenic Causes of ED

ED can also be caused by psychological factors. These factors can include stress, performance anxiety, depression and relationship problems with partners. It is important to talk to your healthcare provider if you think that your ED symptoms may have to do with mental health issues such as depression.

3. Medications and Drugs

Finαsteride is a common medication prescribed for men with hair loss in Singapore. While effective for combating hair loss, Finαsteride’s action of lowering DHT levels in the body can come with adverse side effects such as erectile dysfunction and decreased ejaculatory volume. For men experiencing erectile problems from taking hair loss medications, Finαsteride alternatives such as hair growth lasers can be considered.

Not sure if you have erectile dysfunction? The Erection Hardness Scale provides a self-assessment guide to help you identify if ED is suspected. While occasional erection problems are common, persistent difficulties with achieving a healthy erection (more than half the time) should be further evaluated with a medical professional. A professional assessment will be performed by the doctor to assess and diagnose the degree of your erectile dysfunction.

ED is a condition that is generally treatable and manageable. In Singapore, various treatment options are available for ED patients.

PDE5 Inhibitors
PDE5 inhibitors are a class of drugs that treat ED by relaxing muscles found in the blood vessel walls. By doing so, blood vessels are relaxed and widened to allow more blood flow to the penis, facilitating penile erections. While oral medications offer positive results for ED, some individuals may experience unwanted side effects such as stomach upset, headaches or flushing. Patients with coronary artery disease, kidney, or liver problems should exercise caution when it comes to erectile dysfunction medications and consult with your healthcare provider before starting them.

Vacuum Erectile Devices
Vacuum Erection Devices, also known as vacuum pumps or penile pumps are devices that can help with getting an erection. The device typically consists of a cylinder to place over the penis and works by creating a vacuum to engorge blood vessels in the penis, causing it to become erect. Once erected, a constriction ring is then placed around the base of the penis to retain blood in the penis and help with maintaining the erection. Penile pumps are generally less expensive compared to oral medications or other ED treatments available in the market. While generally safe, those taking blood-thinning medications are advised to avoid using penis pump devices due to risks of internal bleeding. Individuals with Peyronie’s disease should also avoid using it. It is important to carefully follow the directions that come with vacuum-assisted erection devices as improper usage or too much air pressure in the tube can injure the penis and cause pain or bruising.

Shockwave Treatment
Shockwave therapy is a pain-free procedure that applies low intensity shockwaves on the penis and perineum to treat erectile dysfunction of vascular nature (accounting for majority of erectile dysfunction cases). Gentle dosing of shock wave energy stimulates blood circulation and induce the formation of new capillary blood vessels (angiogenesis) in the penis – a naturally important step in improving erectile function. The therapy also enhances the release of vascular endothelial growth factor, a protein that plays a crucial role in the development and maintenance of blood vessels.

Penile Injections
With penile injections, a small needle is used to inject medication into the base of the penis. Similar to oral medications, the injection of medications into the penis allows increased blood flow into the penis to facilitate erections, usually taking effect within 20 minutes of the injection. In Singapore, injections for ED are available and typically self-administered after initial training and supervision from your licensed doctor. Penile injections are usually prescribed for those who do not respond well to oral medications. Common side effects include pain, bruising, or penile fibrosis (scarring) in some cases. Several factors, including the type of medication injected, the frequency of injections and individual patient factors can contribute to the development of scarring of the penis.

Penile Implant Surgery
Penile implant surgery involves inserting a prosthesis into the penis. Penile implants cost between $10,000 to $20,000 in Singapore and typically last up to 20 years before replacements are required. It is important to note that once a penile implant surgery is performed, the patient will no longer be able to achieve an erection by natural means.

Due to the non-invasiveness nature of shockwave treatment, the lack of adverse side effects, and its enablement of natural, spontaneous erections, shockwave is a treatment option that is increasingly favoured by medical professionals for the treatment of ED.

Benefits of Focused Shockwave Treatment for ED

• Affordably priced
• Comfortable with no downtime and restrictions to activities following treatment
• No adverse side effects that come with ED treatments such as PDE5i medications
• No injury or scarring risks compared to treatments such as penile injections and penile vacuum pumps
• While the use of ED medications, penile pumps, injectables or inflatable penile implants requires pre-preparation 5 to 20 minutes before obtaining an erection, shockwave treatment allows for natural, spontaneous erections to occur without having to take medications or operate devices at set times before sex
• Shockwave treatment targets the underlying cause of vasculogenic erectile dysfunction by encouraging new blood vessel growth and improving blood flow in the penis. This provides long-lasting improvement and results compared to medications which produce momentary effects and requires continued reliance

It is important to recognise the key differences between shockwave therapy and radial wave therapy. Due to the difference in depth of tissue penetration, focus of energy and shape of the pressure wave, the two shockwaves produce a different effect on the target tissue. While both are used and marketed for the treatment of erectile dysfunction, there is a lack of clinical research to support the claim that radial shockwave can help with erectile dysfunction despite its growing use due to its lower cost (radial shockwave is more suited for other indications such as treating cellulite). Focused shockwave, on the other hand, has been well studied to help with ED due to its deep penetration ability to target tissues and initiate angiogenesis in the penis.

Lastly, while focused shockwave has proven to be a good treatment modality for ED, there exists differences in focused shockwave devices, such as the energy range and therapeutic depth of focus that can be chosen.

Focused Shockwave ED Treatment at Veritas

At Veritas, we adopt the sole focused shockwave technology that has been cleared by FDA for treating erectile dysfunction in the US. Validated in over 100 Pubmed publications, our shockwave treatment offered is supported by the largest number of studies in its class. With our shockwave technology, deep lying problem areas can be identified and treated with ease to its large focal zone. Unlike other focused shockwave devices where shockwaves have to be applied to both sides of the penis, our shockwave technology requires application of shockwave to only one side of the penis due to its focus depth. This means shorter treatment sessions and enhanced comfort for the patients.

In addition to treating erectile dysfunction, our focused shockwave technology has the added benefit of treating Peyronie’s disease (IPP), a condition marked by abnormal curvature of the penis and in some cases, pain. During treatment, pain points in the penis that occur due to thickened nodules (plaques) under the skin of the penis are targeted with shockwaves. This breaks down the fibrous plaques to reduce pain and improve penile curvature.