What I need to know about ED


The ability to get and maintain an erection involves many different systems in the body, including psychological (brain), neurologic (nerves), endocrine (hormones) and vascular (blood circulation). To become erect, the penis first needs sexual stimulation, which will cause all these systems to work together and lead to the following:4

  • Muscle fibres on either side of the length of the penis relax to let blood fill the spaces between them.
  • Increased blood flow to the penis causes it to expand and become enlarged.
  • Following expansion, blood flow is blocked and pressure builds inside the penis.
  • Once orgasm is reached, the muscles contract and release blood flow, thereby releasing pressure to allow the penis to become flaccid again.


Contrary to popular belief, ED is quite common in men of all ages and can be attributed to the following:

Young men:
Performance anxiety is the biggest contributing factors in this age group. “Condom Collapse Syndrome” and the fear of getting a girl pregnant have also been identified as growing factors.

Middle aged men:
Common causes in this group include overwork, stress, guilt and bereavement as well as diabetes, alcohol, nicotine and obesity.

Post middle age:
ED becomes more common in this age group. As ED shares the common risk factors with heart disease, a high portion of men have a problem with the narrowing of the blood vessels that carry blood into the penis. Deteriorating arteries in the heart can also play a role.

It has been described in literature that erectile dysfunction is the manifestation of vascular disease in smaller arteries and can give a two to three year early warning of heart attack.

Older men with ED should take care to reduce their risk for a stroke and heart attack by managing their blood pressure and cholesterol, and by adopting a healthy diet and getting regular exercise. They should also, at all costs, avoid smoking.


We now know that achieving and maintaining an erection involves many different systems in the body. Many things can easily interfere with this process, like stress, fatigue, too much alcohol, or narrowing of the blood vessels.2

Psychological causes alone only account for about 10-20% of the incidence of ED, but often occur with physiological causes. You are more likely to have psychological causes if you wake with an erection in the morning, or if you can still get a good erection by masturbation.5

Common psychological causes of erection difficulties include:5

  • Nerves and anxiety.
  • Stress due to relationship issues, work stress, etc.
  • Depression.
  • Exhaustion.

Physiological causes account for about 80% of the incidence of ED, and are commonly related to risk factors for heart disease.2

Common physical causes include:5

  • Deterioration of the arteries – this is a physical change which is common in older men, including those with high blood pressure and high cholesterol.
  • Diabetes – it has been reported that up to 90% of men with diabetes have ED3, regardless of the presence of other cardiovascular risk factors.
  • Smoking – Cigarette Smoking has been shown to be an independent risk factor of ED, and may be associated with a greater probability of complete impotence in men with heart disease and high blood pressure.5
  • Excessive drinking.
  • Obesity.
  • Side-effects of certain drugs, especially ones used to treat high blood pressure and depression.
  • Effects of recreational drugs, like cocaine.
  • Major surgery in the abdomen – particularly on the prostate gland.


How is an erectile dysfunction diagnosis made?
As there are a number of factors that can cause ED, your doctor has to evaluate a detailed medical and psychological history to diagnose you. Going through your medical history may reveal one of the many common disorders associated with ED.

As ED is often linked to other diseases (especially heart), your doctor will ask some personal questions about your lifestyle, your medical history and your sexual background to help identify or eliminate possible causes of your symptoms (i.e. psychological or physiological).
 We know it’s not the easiest thing to talk about, but be frank and open when discussing your sexual background and history with your doctor. The more information they get from you, the quicker they will be able to help you. After any medical health risks are eliminated, your doctor will look at treatment that will give you your confidence back for a more satisfying sexual experience.

Physical Exam
A physical exam will especially focus on the endocrine (hormonal), vascular (blood supply), and neurological systems. Blood pressure and heart rate should be measured if they have not been checked in the previous 3-6 months. Particular attention must be given to patients with heart disease and diabetes.

Blood tests
Depending on your complaints and risk factors, your doctor may request some blood tests. Due to the strong link to heart disease and diabetes, your doctor may also do a cholesterol test. Your doctor may also test your total testosterone levels to identify/eliminate hormonal causes.


Although ED due to physiological causes cannot be cured, it can be treated effectively.

ED is often linked to lifestyle or drug-related factors. Studies showed that improved erectile function is very closely linked to both weight loss and activity levels. 6 Changing your lifestyle and making healthy choices must be included in the treatment strategy. Lifestyle changes will not only improve erectile function, but may also benefit overall heart and physical health.

Along with these lifestyle changes, medicine may also be prescribed. The most effective pharmaceutical treatment option available is a class of drugs called the PDE5-inhibitors which basically increases arterial blood flow that leads to smooth muscle relaxation, dilation of blood vessels, and penile erection.

Effective and affordable treatments for erectile dysfunction are now available.