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Anthea Rowan

If you are a man struggling with erectile dysfunction (ED), or someone you care about is, know that it is more common than you may think.
“A staggering 322 million men globally could be affected in the near future,” states a review of ED studies published in October in BMC Public Health.
ED is the persistent inability to attain or maintain an erection sufficient for satisfactory sex.
A widely cited study from 1994, based on the Massachusetts Male Ageing Study, suggests more than half of all men at some time in their lives experience some form of ED.

It also found that the prevalence of complete impotence triples from 5 to 15 per cent between the ages of 40 and 70.
While age is a risk, young men often suffer too – more than a quarter of all men under 40.
There are many reasons behind ED.
There is a clear link between hypertension, diabetes and cardiovascular disease – all physical diseases that a person is more at risk of developing as they age – and sexual problems.
Meanwhile, 20 to 30 per cent of ED cases are caused by mental health issues such as depression and anxiety, according to Hong Kong urologist Dr Andrew Yip.
Yip says most men suffering from poor mental health will also have ED.

According to a 2018 study in The Journal of Sexual Medicine, people with depression have a 39 per cent higher chance of developing ED than those without.
“Patients reporting ED should be routinely screened for depression, whereas patients presenting with symptoms of depression should be routinely assessed for ED,” said the researchers, from universities in Wuhan, China.
The link between ED and mental health
Depression predisposes a man to ED because a major symptom of depression is anhedonia – the absence of enjoyment or interest in the things a person once used to enjoy. This extends to the interest in – and the satisfaction from – having sex.
The low, distracted mood that comes with mood disorders also affects how confident a man may feel sexually.
“When our minds are consumed with mental health challenges, we tend to focus on the problem at hand,” Hong Kong psychotherapist Asa Sanderson says. “As a result, more enjoyable thoughts tend to take a back seat.”

Addressing mental health challenges, such as overcoming anxiety, can sap energy levels, Sanderson says. Yet intimacy and having sex require a good deal of energy, too.
Many of the drugs prescribed to treat mental health disorders can also have a negative impact on libido – whether you are a man or a woman.
Commonly prescribed antidepressant drugs known as SSRIs (selective serotonin reuptake inhibitors) may dampen a man’s interest in sex and make it difficult for him to get – or sustain – an erection.
SSRIs increase the levels of the “happy chemical” serotonin in the brain, which is important for mood. But they can also interfere with other neurotransmitters, like dopamine, and hormones such as testosterone. They can also disrupt healthy communication between the brain and sex organs.
Patients with ED also tend to have low testosterone levels, Yip says. Studies show that as many as one in three men who mention ED to their doctors have low testosterone.
Just as hormone levels drop in women as they approach menopause – the end of their child-bearing years – they do in men too. Beginning anytime from around age 30, men’s testosterone levels will fall by about 1 per cent each year.
If a man worries he is failing to satisfy his partner, which may be caused by this low testosterone level, this can lower his confidence and affect his mood.
There’s no shame in [ED]. It’s just one of the realities of life, just like a slower metabolism or potential hair loss
Hong Kong psychotherapist Asa Sanderson
At the same time, low libido or challenges with sexual performance often negatively affect mental health, Sanderson says.
“In many cases, men have been conditioned to use their sexual performance as an indicator of their self-worth. If they are able to attract sexual partners and ‘perform’ well with those partners, they may feel more confident.”
On the other hand, if the ability to “perform” sexually is compromised, that individual will often question their sense of worth, which can lead to depression and anxiety, Sanderson says.
The lower they feel, the worse it gets. So there is a risk of a vicious cycle in which mental ill health and sexual difficulties perpetuate one another.
Given the close relationship between how a man feels about his sex life and life in general, men who are struggling with either their mental health or ED may resort to alcohol or street drugs.
“Chemsex” – using substances including drugs and alcohol to enhance sexual experiences – has become much more mainstream in recent years, Sanderson says.
Some recreational drugs such as cocaine can increase the intensity and duration of the sexual experience, he explains.
The use of Viagra, the little blue pill that helps a man get and keep an erection, is now seen as normal – even among young men.

Yip warns, though, that the abuse of any of these substances, legal or otherwise, can have a severe effect on a man’s potency.
Excessive use of alcohol, for example, can negatively affect a man’s ability to get or sustain an erection – a problem often dubbed “brewer’s droop”.
Speak up to find a solution
Too few men with ED or a related problem speak up about it. On average, Yip says, only 10 per cent of men who are struggling talk to their doctors about it.
If men resist opening up on what is going on in their heads, then talking about what is going on in their beds can be even more painful, Sanderson says.
The subject is fraught with misconceptions and unnecessary shame over issues with sexual performance.
“Individuals experiencing low libido or erectile dysfunction often feel emasculated and inferior, which results in an understandable reluctance to talk through the challenges and overcome them,” Sanderson says.
In reality, it is common for both men and women to suffer from low libido from time to time.
“There’s no shame in it,” Sanderson says. “It’s just one of the realities of life, just like a slower metabolism or potential hair loss.”

In recent years, though, Sanderson has seen more men seek therapy to talk through these challenges and find a long-term sustainable solution.
Therapy can help in several ways. For a start, it can help guide in making healthier lifestyle choices around diet, exercise, sleep and substance abuse.
Importantly, it can help in finding ways to manage stress and anxiety. Learning relaxation techniques and mindfulness can help reduce performance anxiety and boost a person’s overall sense of well-being.
Partners play a crucial role, Sanderson says, adding that couples therapy can be helpful because it can improve communication and emotional intimacy, fostering a healthier sexual connection.
“Being non-judgmental, supportive and understanding really helps,” Sanderson says.
Patience, even if it is really difficult, is key.
“In contrast, shaming, complaining and pressuring the individual is likely to have a negative impact and cause more damage.”
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Wellness

How erectile dysfunction links to poor mental health and vice versa, and what can help

More than half of all men at some time in their lives experience some form of erectile dysfunction, according to a widely cited study. Photo: Shutterstock

More than a quarter of men under 40 have experienced ED. Photo: Shutterstock 

Hong Kong urologist Dr Andrew Yip. Photo: Jonathan Wong

Hong Kong psychotherapist Asa Sanderson. Photo: Asa Sanderson

Viagra use is now seen as normal, even among young men. Photo: AFP

The key to overcoming ED is to work with a knowledgeable specialist to find a long-term sustainable solution, Sanderson says. Photo: Shutterstock

How weightlifting helped 2 older Singaporeans end back pain and build stronger bones

When Raj Grover developed severe back pain, he hit upon a surprising remedy: lifting weights. Here he is seen squat lifting 155kg. Photo: Shaun Pang

As mature powerlifters in Singapore like Patricia Lynn Meyer (pictured) have discovered, working out with barbells increases bone and muscle mass, and bone density, improves posture and slows the ageing process. Photo: Shaun Pang


When Raj Grover developed severe back pain, he hit upon a surprising remedy: lifting weights. Photo: Shaun Pang

Patricia Lynn Meyer, now 69, started strength training with barbells in Singapore seven years ago after being diagnosed with osteoporosis. Photo: Shaun Pang

Shaun Pang owns Hygieia Strength and Conditioning in Singapore, a gym that specialises in working with older adults to help them build and maintain their strength. Photo: Patrick Lau 

Meyer with her trainer Pang, who says using weights to train your muscles can help slow down, or even reverse, the ageing process. Photo: Shaun Pang

As part of the Singapore national team at the Southeast Asian Cup 2022, Meyer set an Asian dead-lift record of 122.5kg for women in her age group (60 to 69 years) and weight (under 52kg) category. Photo: Shaun Pang

Grover celebrates after breaking a record for the dead-lift, 195.5kg. Photo: Shaun Pang

How to encourage men to seek mental health support, and why many men don’t open up

Men, and especially men in Asia, find it difficult to open up about their feelings and seek counselling and mental health therapy. Photo: Shutterstock


To help a loved one open up about his feelings, create and maintain regular opportunities for honest communication. Photo: Shutterstock

Hong Kong psychotherapist Asa Sanderson says in Western culture, it has become increasingly accepted for men to be vulnerable. Photo: Asa Sanderson

Men, including men in Southeast Asia, have been reluctant to admit to themselves and others when they experience challenges with their mental health. Photo: Shutterstock

Michael Beckham, clinical counsellor at Central Minds in Hong Kong. Photo: Michael Beckham

The process of finding a therapist can be overwhelming, Beckham says. Offering to help can make it feel more manageable. Photo: Shutterstock

Why erectile dysfunction means a heart attack could be close

Few men recognise the link between cardiovascular health and impotence: about a third of men with erectile dysfunction, or ED, will also have heart disease. Photo: Shutterstock

Dr Boon Lim is a consultant cardiologist at Imperial College London in the UK.

Atherosclerosis is an inflammatory condition caused by the build-up of cholesterol inside artery walls that leads to a narrowing of the arteries and can impair the ability to have an erection. Photo: Shutterstock

Dr Andrew Yip is a Hong Kong-based urologist.

A loss of early morning erections is another sign all may not be well with a man’s heart, a recent study suggests. Photo: Shutterstock

Hugh Jackman’s weight loss journey: intermittent fasting, calorie counting, and a lot of chicken helps the actor lose pounds and get shredded

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To bulk up, Jackman ate meals that included salmon. Photo: Shutterstock

Jackman in a still from The Wolverine. Photo: Twentieth Century Fox Film

Jackman upped his protein intake by eating a lot of chicken. Photo: Shutterstock

Jackman regularly goes to the gym and has a weekly workout routine. Getty Images

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Lifestyle

Health & Wellness

Health

Family & Relationships

Erectile dysfunction (ED) and psychological issues such as anxiety and depression can form a vicious circle, making erection problems worse


Erectile dysfunction (ED) and psychological issues such as anxiety and depression can form a vicious circle, making erection problems worse.


Sex and relationships

Reproductive health

Mental health

How to age well