ESG Virtual Wellness Series - Erectile Dysfunction

Dr. Lim Kok Bin: Next, I will go on to talk about erectile dysfunction, the second most common condition that a urologist. So what’s erectile dysfunction, it is essentially the inability for you to get an erection, or sometimes you could get an erection, but you could not maintain them hard enough to complete the entire sexual intercourse. And it’s actually quite common, essentially. I think about one in five men will have this problem, but the problem is it actually gets worse as you age. So this is a chart showing that, you know, the it means of the condition, as you get older, if you look at the blue bar, what it means is complete erectile dysfunction also increases as you get older. So in other words, as you get older, you get this problem and you get worse form of this problem.

So what are the risk factors? It is still almost the same as a prostate enlargement, where you have sedentary lifestyle and poor dieting, but other issues like smoking and medical condition, such as blood pressure, cholesterol, diabetes, or anything that involves the blood supply or blood circulation will affect the chances of getting erectile dysfunction. And we don’t forget that erectile dysfunction, there’s always an element of psychological issues. So stress from work, from family, from your wife, anyone you have will make it worse. It may not cause it by making it worse or either essentially yes, a very anxious person. And then you have a problem with this erection, the anxiety, as a result of that, the stress that comes with the fact that you are not able to perform will worsen than that. Now the treatment, first of all, is important in trying to get rid of the risk factors, such as, you know, exercising more, parking your car further away from the entrance, what would be a few more steps that will help. Eating right, eating right means, you know, cutting down all those high fat content diets.

Basically, you need to lower the risk of all the situations that might result in vascular conditions. Of course the first-line treatment will be oral medication. I do need to talk too much. You know, the blue pill, the orange pill, the yellow pill. What this pill does is that it causes nitric oxide, a very important messenger in our body, to relax the muscle of the penis. By relaxing the muscles of the penis, you allow more blood flow. That’s how it helps with the problem of improving erection. What if medicine doesn’t work? True enough, we know about 70% will benefit from the medicine, but the remaining 30%, unfortunately further help. So the second line treatment will be using a vacuum constriction device shown in this picture or the injection of a medication strip into the penis. Of course, this will be more cumbersome, a bit difficult to carry out on a daily basis, but it works better than oral medicine. Sometimes you do combination treatment. You can use a vacuum constriction device on top of the oral medicine to improve the result of the oral medicine.

What if all these fields, well, we do have surgery. Unfortunately, this is the treatment of last resort. Once you have done it you cannot reverse that. So for this operation. What we are doing is to replace the penile muscle with an implant. So what happens is that your direction essentially has become a mechanical procedure. We have a pump that’s buried inside your groin that’s activating a pump that is hidden inside your scrotum where you are supposed to fill it. And when you want to have an erection, we just need to press that. So the saline water that’s originally embedded inside the pump will flow and fill up the cylinders that flow and fill up the penile tissue. And so you have an erection. Once the job is done, you just need to reactivate the pump to let the saline water to flow back into the vascular reservoir so that the penis will soften. 

So it was a hundred percent, but essentially if you have this surgery done, there’s no turning back. So if we look at this way, there’s oral medicine, there’s a second-line treatment, there’s third line treatment, there’s nothing in between. Say for example, if I don’t want to do injections, I feel that the vacuum device is too cumbersome. I want to proceed with the implant procedure because it’s really like the last resort. So, but oral medicine doesn’t work for me or it works but not fantastic. What else are there? Well for many years, there’s not been many options to be frank, but recently we have a unique invasive treatment like endovascular approach, which will be elaborated later on by my colleague. Now this will be the end of my talk today. If you have any further questions, please do give us the (inaudible), we will answer all of these at the end of the webinar. Thank you.