Movember Month Article 1: Erectile dysfunction – Getting Hard isn’t Hard

Posted on by Dr Poh

Erectile dysfunction ishe inability to get and keep an erection firm enough for sex. Up to 50 % of men at the age of 50 may experience erectile dysfunction.

This week we explore the many causes of erectile dysfunction and various methods to get around it.

What causes erectile dysfunction?

Having problems keeping an erection once in a while isn’t necessarily a cause for concern but if it is an ongoing issue, it can affect your self confidence and relationships. Problems keeping an erection can also be a sign of an underlying health condition that requires medical attention and a risk for heart disease.

Some of the common causes include:

  • Obesity
  • Smoking
  • Diabetes Mellitus
  • Obstructive Sleep apnea
  • Chronic Kidney Disease
  • Hormonal problems.
  • Psychological causes such as depression and anxiety or even performance related issues.

Some medications/prior treatment can also cause erectile dysfunction:

  • Blood pressure medications
  • Benzodiazepines
  • SSRI Antidepressants
  • Alcohol
  • Prostate Cancer Treatment

What is the best treatment for erectile dysfunction

Lifestyle modifications are considered first-line therapy can can have a significant impact in ED management. However, despite the benefits of behaviour modification, men presenting with ED may want the physician to help with measures that can have an immediate impact.

What is viagra?

Viagra is a PDE5 inhibitor which works by increasing blood flow to the penis. Viagra and other PDE5 inhibitors have been the mainstay of ED treatment since 1998. These medications are able to induce good effect within a short period of time and various medications have different duration of potency.

There are also different methods of dosing, for example to take a dose before intimacy or to take a tablet everyday. PDE5 inhibitors are considered very safe and effective but a doctor will need to review you medications to ensure there arent any interactions, especially with nitrates.

It is also important to take as what your doctor has prescribed. Overdosing can lead to irreversible side effects such as blindness. It is also important that you obtain your medication from a registered clinic/pharmacy. 80% of websites claiming to sell Viagra were in fact selling counterfeits.

Are there other medications other than Viagra?

Injections such as alprostadil can also help to induce erection. A small needle is used to inject the medication into the side of the penis through a small-gauge needle.

An intraurethral form is also available, consisting of a tiny pellet of drug inserted into the urethra.

Non-medical approaches

1. Vacuum constriction devices are clear plastic chambers placed over the penis, which directs blood into the penis. If an adequate erection occurs inside the chamber, the patient may slip a small constriction band off the end of the VCD and onto the base of the penis. An erection beyond 30 min is not recommended.

2. Low-Intensity extracorporeal shock wave therapy is a useful and noninvasive treatment for erectile dysfunction. This consists of low-intensity shock waves that are applied to different areas of the penis, stimulating new blood vessel growth and improving blood flow.

Seeking Medical Advice

If you’re concerned about erectile dysfunction, speak to your doctor. Psychosexual counselling can sometimes play a huge difference. Treating an underlying condition is enough to reverse erectile dysfunction and given how common it is, there is no need to be embarrassed to seek professional advice. Lifestyle modifications, medications or other direct treatments might be needed. This is available through our telemedicine service.

Contraceptives Awareness Month: Week 4 – Combating Side Effects

Posted on by Dr Poh

Oral contraception Side effects

A small number of women may experience side effects from taking oral contraceptives and they can range from negligible to irritating. These are but not limited to:

  1. Temporary Weight Gain
  2. Nausea
  3. Breast Tenderness
  4. Breakthrough Bleeding
  5. Mood disturbances

However most of the symptoms are temporary and often reassurance that symptoms will likely resolve within three to five months is often the only treatment required.

Continue reading Contraceptives Awareness Month: Week 4 – Combating Side Effects

Contraceptives Awareness Month: Week 2 – More than Birth Control

Posted on by Dr Poh

Non-contraceptive benefits of oral contraception

Oral contraception is a reliable method of preventing unwanted pregnancies. However, there is more to oral contraception than controlling the world’s population.

In this article, we share 4 ways oral contraception can play a bigger role than just birth control

  • Skin improvement
  • Reduced mood symptoms & breast tenderness in women with Premenstrual Dysphoric Disorder
  • Reduced bloated feeling
  • Improved period regularity and reduced spot bleeding

1. Skin improvement

Many contraceptive pills work in the prevention and treatment of acne, of the various brands, you may have heard of Yaz which is one of the three pills approved by the FDA.

By prevention of hormonal fluctuations, contraceptive pills can control androgen hormones and prevent too overproduction of testosterone. Testosterone can increase sebum production that clogs up pores and lead to acne formation. Where uncontrolled and inflammation prolongs, the condition can become more serious and lead to cystic acne formation.

For more severe cases, antibiotics and retinoids may be prescribed by your doctor. However, contraceptive pills have been used alone for simple to moderate cases with good effect.

2. Premenstrual Dysphoric Disorder

Premenstrual dysphoric disorder (PMDD) is similar to premenstrual syndrome (PMS) but more serious, leading to severe irritability, depression, or anxiety. This can happen in the week or two before your period starts. Symptoms usually go away two to three days after your period starts.

Select serotonergic antidepressants are first-line treatments but there have been studies to show that drospirenone is effective in treating the mood, physical and behavioral symptoms of PMDD and symptoms specifically associated with food, water retention and negative interpersonal relationships.

While the results showed that the drospirenone combination pill reduced impairments in productivity and social functioning in women with PMDD, there was insufficient evidence of benefit for those with PMS, so it is important to distinguish the difference between the two.

3. Bloatedness

It is true that many women notice less bloating and weight gain during their period after starting Yaz. Drospirenone/ethinyl estradiol birth control like Yaz can also manage period pain, reducing bloatedness, cramping and muscular discomfort.

Not all birth control pills can prevent bloatedness, some contraceptives can even lead to bloatedness. Check with your physician to find out more.

4. Improved period regularity and period pain

The average cycle takes place over the course of 28 days, of which most of the cramps occur from day 1-5.

Low-dose estrogen/progestin combined oral contraceptives have been shown to reduce the severity of period cramps. This is ofen provided as a 28-day cyclic regimen of ethinylestradiol/drospirenone. However a study in Japan showed that a flexible regimen (28-120 days) was more beneficial in reducing pain from dysmenorrhoea and that women were more likely to be satisfied when on the flexible regimen.

Period cycles can also be regulated through continuous or extended use of oral contraceptives. This provides number of advantages to women, including fewer menstrual-related syndromes and reduced absenteeism from work or school.

For women whose goal is to reduce but not necessarily to eliminate monthly bleeding, the cyclic use of estrogen-progestin contraception is suggested.

For women whose goal is to stop period altogether, depot injections, continuous oral contraceptives, and the levonorgestrel intrauterine device (such as Mirena) are all effective.

It is however important to note that bleeding is common during the first three months of OCP use. It is important to adhere to your prescribed regime before switching oral contraceptive medications. Speak to your doctor if you are not sure about your current regime.