All about erectile dysfunction (ED)

Erectile dysfunction (ED) is the inability to achieve or sustain an erection sufficient for sexual activity such as intercourse. Also known as impotence, it can be an embarrassing problem that male sufferers have to grapple with behind closed doors.

In Singapore, ED is quite common. SGH’s Centre for Assisted Reproduction (CARE), for instance, sees an average of one to two cases of ED every week at its fertility clinic.

“However, the problem may be under-reported as men are reluctant to seek help for such a sensitive issue,” observes Dr Hemashree Rajesh, Consultant at the Department of Obstetrics & Gynaecology, Singapore General Hospital (SGH), a member of the SingHealth group. “Or, they may be unsure as to whom to seek help from.”

What causes erectile dysfunction?

As the male sexual arousal is a complex process, ED can be caused by a variety of physical and psychological factors.

One of the major causes of ED is ageing. “Whilst the condition affects 1 in 20 men in their 40s, it can be as many as 1 in 5 men in their late 60s,” says Dr Rajesh.

Other physical causes include:

  • Diabetes
  • Obesity
  • Heart disease
  • High cholesterol
  • High blood pressure
  • Smoking
  • Low testosterone
  • Spinal cord trauma
  • Neurological disorders
  • Certain abdominal surgeries

With the brain performing a key role in male arousal, psychological factors like depression, stress and relationship problems also play a part.

“Performance anxiety is one of the most common causes of erectile dysfunction,” says Dr Rajesh. “Often, such cases of ED are sudden in onset. The man may have erections at night, yet is unable to perform during sex.”

How is ED diagnosed?

ED can disrupt the sexual intimacy between a man and his partner. Left untreated, it can lead to sexual frustration for both, and cause marital stress, especially if the partner takes it personally. It can also prevent a couple from naturally conceiving a child.

That’s why it is so important for men with ED to seek medical help. First, the doctor will ask questions to obtain a detailed medical history. He or she may also ask about cardiovascular or neurological symptoms that may point to the cause. Later, a physical examination of the penis and testicles may be necessary.

Most men only need a consultation and physical exam to get a diagnosis of ED, says Dr Rajesh. But at times, further tests may be necessary. These additional tests include:

  • Blood tests: These can be ordered and sent to a lab to check for signs of heart disease, diabetes, low testosterone levels and other health issues.


  • Urine tests: These are used to look for signs of diabetes and other underlying health conditions.
  • Ultrasound: This is a test to check blood flow to the penis. But it is rarely needed.

​​Read on to learn about treatments and nutritional supplements for erectile dysfunction.