Dear Dr. G,

I have been following your articles on The Star Online for a while and would like you to solve my problems of a sexual conundrum.

I am a relatively healthy (though carrying a bit of extra weight) Malaysian man, aged 49, and have been having problems sustaining an erection for the past three to four years.

It’s quite distressing that while I am able to get erect when stimulated, however I am unable to sustain it long enough to achieve penetration. This is really causing a lot of disappointment and anxiety in my life and that of my partner.

On front of self-pleasure, I am also able to masturbate till ejaculation. However, I definitely have a problem sustaining an erection beyond 30 seconds, even during masturbation.

This week, I would like to put Dr. G on the spot to find out whether such unsustainable hardness constitutes erectile dysfunction? If so, why is it happening to me?

Finally, what do you think I should do?

Thank you in advance.

The inability to achieve or sustain an erection rigid enough for penetrative intercourse till completion is defined as ED (Erectile Dysfunction). The more derogative term to describe such sexual dysfunction is impotency. ED is a common sexual disorder. It is more prevalent in men with advancing age and deteriorating health. The lack of rigidity can also affect younger and healthy men.

A 2013 study revealed one in four men seeking treatment for ED were under the age of 40. In such age groups, the sexual dysfunction often causes anxiety, distress, sexual avoidance and relationship issues in long run. The mechanism of erection is complex. Sexual arousal and tactile stimulation induces a reflex of increased of blood flowing into the penis. As the individual becomes more sexually excited, further relaxation of the blood vessels enhances copious blood flow through the arteries.

The gush of blood will quickly fill the two erectile chambers inside the penis, called corpora cavernosa. As the chambers get more engorged, more blood will be trapped in the chambers rendering further rigidity. Erectile rigidity will end as soon as the vessels contracts to reduce the influx of blood flow, or the outflow of blood from the penis is initiated.

The pathophysiology of ED and inability to sustain the rigidity can occur at various stages of the erection process. Damage to the penile arteries, due to smoking, hypertension, dyslipidemia and diabetes can reduce the blood flow into the penis. Stress and anxiety can also affect erectile firmness; as such psychological factors reduce the influx of blood into the penis to sustained erection till climax.

Having erection trouble from time to time is common and not necessarily a cause for concern. However, if the erectile dysfunction is an ongoing issue, it can affect self-confidence inside and outside the bedroom. More importantly, this can be a sign of an underlying health condition that requires treatment.

The first step of dealing with ED is to be honest with oneself and the partner. Have an open communication to discuss the issues of the pleasure and displeasure between the sheets can help to reduce the embarrassment and taboos of talking about sex. The next step of helping to resolve the sexual dysfunction is to visit a doctor to identify the causes of ED and the possibility of initiating treatment.

Treatment for ED will depend on individuals and the underlying cause. Often times, the combinations of open communication, lifestyle changes, medications, and sexual counselling are required. The lifestyle changes may include weight loss, regular exercises, quit smoking and getting adequate sleep. For most men, the medications such as the blue pills are instant magic to bring the sparkles back to the bedroom.

However, such quick fixes may not be sustainable without a healthy lifestyle in place. Finally, sexual counselling may be necessary for couples when routine sexual practice has become mundane and less exciting. Building up the courage to tell each other the likes and dislikes during sex can often times hit the spot to regain the passion in bed.

American football quarterback for the New England Patriots Tom Brady once said: “You need to think outside the box. You need to think differently if you want to sustain what, for me is my peak performance: the very best I can achieve as an athlete every day.” In many ways, sex is just like sports. We achieve our peak performance in bed while young and vibrant. However, to have a sustainable sex life with advancing age, one needs to be strategic and self-aware.

Although the medications are there to help to achieve the instant hardness, the sustainable erection is only achievable with concurrent healthy lifestyle. When Dr. G is put on the spot to resolve the issues of the forty-something with “wilting willies”, his advise is “To sustain the peak performance in bed is to be like an athlete, lose weight and keeping healthy lifestyle can ensure a home run in long run!”

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