Erectile dysfunction: what causes it, what are the signs and how is it treated?

What is erectile dysfunction?

The Ministry of Health Malaysia's Clinical Practice Guidelines (CPG) on managing erectile dysfunction (2024) define it as a persistent inability to get or keep an erection sufficient for satisfactory sexual activity.

The key word is “persistent”. Occasional difficulty, for example when very tired, stressed or after a heavy meal, is normal and not necessarily a disease. The NHS explains that problems that happen often or last for weeks are worth checking.

How many men in Malaysia have it?

More than most people think. The CPG cites a study based on the National Health and Morbidity Survey (NHMS) 2019 that found about 31.6% of men aged 18 and over had moderate to severe erectile dysfunction. Rates were higher in men aged 60 and above.

So if it happens to you, you are not alone. Many men stay silent out of embarrassment, while doctors treat it as an ordinary health problem.

What are the common causes?

An erection needs nerves, hormones, blood flow and the mind working together. A problem in any of them can have an effect. The CPG lists several key risk factors:

• Age: risk rises with age, though younger men can be affected too.
• Diabetes: in a large meta-analysis cited by the CPG, about 59% of people with diabetes had erectile dysfunction.
• High blood pressure, high cholesterol and heart disease, which affect blood vessels.
• Smoking, obesity and physical inactivity.
• Serious kidney disease and high uric acid levels.
• Depression, anxiety, stress and relationship problems.
• Recreational drugs, and problematic use of pornography.
• Some medicines, such as certain blood pressure or antidepressant drugs. Do not stop a medicine yourself; talk to your doctor first.

There is often more than one cause. That is why a doctor will ask about your health, lifestyle and mood, not just about erections.

Why can erectile dysfunction be an early sign of heart problems?

The blood vessels supplying the penis are smaller than those supplying the heart. When vessels start to be damaged by diabetes, high blood pressure, cholesterol or smoking, the effect is sometimes felt there first. The CPG describes erectile dysfunction as an early marker of blood vessel problems throughout the body and recommends a heart risk assessment.

That is the main reason not to just look for pills on your own. A doctor's visit can pick up other problems you did not know about, such as high blood sugar or blood pressure.

What signs should you look out for?

Consider seeing a doctor if you notice these happening repeatedly:

• Difficulty getting an erection even when you feel desire.
• Losing an erection too soon, before intimacy is over.
• The problem starting to affect your confidence or your relationship.
• The problem coming with other signs, such as constant thirst and frequent urination, chest pain on exertion, or lasting low mood.

When should you see a doctor or urologist?

The first step is usually a health clinic or GP. According to the CPG, the doctor will ask about your medical, psychological and relationship history, use a short questionnaire, do a physical examination and order basic blood tests such as sugar and cholesterol.

The CPG suggests referral to a urologist when the cause is unclear after the first assessment, when initial treatment does not work, or when the case is complex. The doctor may also refer you to a heart, hormone or mental health specialist if needed. Bringing your partner is encouraged if you are both comfortable.

What treatment options are there?

Treatment depends on the cause, and decisions should be made with a doctor. Options discussed in the CPG include:

• Lifestyle changes and treating underlying conditions such as diabetes and high blood pressure.
• Prescription medicines from the PDE5 group (for example sildenafil or tadalafil). These must not be taken with nitrate medicines, and the doctor will assess your heart first.
• Counselling or therapy when stress, anxiety or relationship problems play a part.
• Specialist treatments such as vacuum devices, injections or surgery in selected cases.

No treatment suits everyone, and results are not guaranteed. Avoid products that claim to “cure” or give instant results. Read how to spot fake sexual enhancement pills to understand the risks.

What lifestyle steps can you take yourself?

A healthy lifestyle does not replace a doctor's care, but studies cited in the CPG link it with lower risk:

• Stay active. Even moderate activity 1 to 2 days a week was linked with lower risk than no exercise at all.
• Stop smoking. The Ministry of Health's mQuit service can help.
• Lose excess weight and eat a balanced diet rich in vegetables, fruit and whole grains.
• Control blood sugar, blood pressure and cholesterol, and take medicines as advised.
• Sleep enough and manage stress. Talking honestly with your partner can also ease anxiety.

Other articles that may help: how to build stamina naturally and health screening for men.

Have a question you feel shy to ask?

We understand this topic is sensitive. If you have a general question, message us privately on WhatsApp. For diagnosis and treatment, please see a doctor.

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