Dear Dr G,

I hope all is well with the movement control order. I assume you are still working as providing for essential services.

I am keen to put Dr G on the spot as I am facing some issues on how to rise to the occasion during the MCO.

My wife and I have been married for a while, and things go stale as we continue with our respective lives at work and raising the kids.

In the past, when I was “called for duties” in the bedroom, work and tiredness can always be the excuse for my wilting passion.

Now, I am well fed and well rested and being in the solitary confinement of home, I can no longer run away from my inability to “stand tall” and be counted on!

I think I am ready for some assistance of the blue diamonds.

I would like to put Dr G on the spot to debunk some myths about the blue pills.

I assume my erectile dysfunction is psychogenic, as I can get morning erection and good rigidity during “self-indulgence”.

Is there such thing as psychogenic ED? Are the pills suitable for me?

How do the blue pills work? Are the pills safe?

I hear while taking the pills, you get red-faced and chest pain, is that true?

Lastly, I hear there are so many versions of the pills in the market. How do I differentiate between them all?

Can you also recommend what will be the right pills for me?

Rising Richard

Psychogenic Erectile Dysfunction (ED) is where erection or penetration fails due to thoughts or feelings, instead of organic etiology such as diabetes, hypertension and dyslipidemia.

Previously, most ED was thought to be psychogenic and due to anxiety, however the overall incidence is a lot lower, involving about 10% of all cases.

Psychogenic impotence tends to occur in individuals with lower self-confidence, interpersonal factors and has a strong response to placebo treatment.

Psychological causes of ED may stem from childhood sexual trauma or upbringing. Often times, occupational stress or anxiety can perpetuate the impotency, resulted in sexual avoidance and marital conflicts.

The traditional approaches for psychogenic ED have included anxiety reduction, desensitisation intervention, cognitive-behavioral therapy, guided sexual stimulation techniques and couples’ relationship counseling.

However, in a culture where psychological intervention is not a social norm and carries stigma, the therapy itself may be counter-productive.

Sildenafil, commonly known as the blue pills, together with other similar class of medications known as Phosphodiesterase 5 Inhibitors (PDE5-I) is effective and well-tolerated for the treatment of ED, regardless of the etiology. The medication acts by blocking an enzyme that regulates the blood flow to the penis (and the lungs).

Therefore, with the help of sexual stimulation, the drug prevents the degradation of the vasodilation, keeping the penis hard and helping it stay hard.

The blue pills and its counterparts are arguably the most scrutinised drugs in history. The utilisation of the drug for sexual pleasure has hit raw nerves in most of society, including ethical dilemmas and the fear of complications.

Common side effects of the blue pills include headaches, heartburn, flushed skin and blurred vision. One of the peculiar side effects of the blue diamonds is inducing blue vision; raising the alarm the “dye” of the medication has caused “blue blindness”.

In fact, this is the result of the medication stimulating certain receptors in the retina, and the visual disturbance is a nuisance that is transient. Therefore the myth of too much sex causing blindness is still unfounded.

In 1998, a group of scientists at Pfizer was initially studying the use of the Sildenafil for hypertension and angina. The phase I clinical trial in Wales failed to control chest pain and blood pressure. However, the accidental quest for the heart had found diamonds for hard-ons.

Since its discovery, the evolution of various compounds of PDE5-I’s had emerged to serve men with different needs in erectile dysfunction.

The different shades of blue marketed in Malaysia including Sildenafil, Tadalafil, Vardenafil and Udenafil. The variations of the PDE5-I’s are predominantly due to their pharmacokinetics delivery, the speed and duration of interventions.

Typically, the blue pills reach its maximum potential around 90 minutes while Vardanafil tends to have faster onset at 30 minutes. On the other hand, Tadalafil and Udenafil have the characteristic of various degrees of prolonged effectiveness up to 36 hours.

Therefore, this shade of blue has a nickname of “le-weekend” among French couples wanting diamond moments to last the whole weekend!

Abraham Lincoln once said: “The dogmas of the quiet past are inadequate to the stormy present. The occasion is piled high with difficulty, and we must rise with the occasion”.

The fast pace of modern lifestyles can be demanding and exhausting. It is not uncommon for the initial excitement of sex for the newly wed to fade, especially after sex had served its purpose of procreation.

When the intensity of life begins to take a slower pace, many men (and women) will face the unfamiliarity of the old magic between the sheets. Often times, Dr G is put on the spot by men who claim to have ED when the slow pace of life, such as retirement (or MCO) requires them to rise to the occasion.

His advice is sex is just like riding a bicycle; the action comes second nature to most of us. As we should know everything about the manoeuvre and the action should take off where it was left off. The various shades of blues are just like “batteries for electric bikes”, for those who need a bit of nudge before rising high!

“The dogma of the quiet past sex life may seem inadequate to the stormy present, especially during the MCO. The demand sure will pile high with difficulty, and it is only natural to get any shades of blue that will help men to rise to the occasion!”

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