Dear Dr G,  

My name is David and I am 55 years old.

I work as an executive in the banking industry and have been married for nearly 30 years.  

At this age, when my career is stable and the kids are all grown up, I am beginning to reflect on my own life.  

I spent at least two decades of my life putting the priority of family, financial security and career progression high up on the agenda.  

Now reaching my mid-50s, I realised perhaps I have compromised on my sexual relationship with my wife. And that has recently caused some tensions in the relationship.  

To be honest, I am struggling at the moment to sustain an erection upon penetration.  

I thought this might be temporary, but it has persisted for at least six months. Of course, I have been out of practise for a while.  

I went to see my GP (incidentally is a woman and a family friend) and she advised me to take the pills for Erectile Dysfunction.  

She gave me the options to try four different ones, without further elaborating. Frankly, I think we were both too embarrassed to talk about this further.  

Sorry to put Dr G on the spot, but can you tell me whether I am really suffering from ED? If so, why? Because I always assume I am healthy!  

Also, I wonder if you are able to help me to decide which would be the best pill for me.  

Regards 

David  

Technically, Erectile Dysfunction (ED) is defined as the inability to achieve or maintain erectile rigidity during sexual intercourse.  

Although the condition is associated with comorbidities such as hypertension, dyslipidemia and smoking, there is no real identifiable causes found. Needless to say, anxiety and stress are a major obstacle in sustaining an erection.  

In a Malaysia, especially in the urban setting, the prevalence of sexual dysfunction is on the increase, and is reported to affect one in five men.  

In reality, the condition may not be associated with any medical etiology, as sex lives are hugely personal to all couples, no matter how passionate their relationship is. Other priorities in life can easily let the regularity of intimacy slide.  

Since the introduction of the blue pills in 1998, many couples have returned to nurture their sexual relationship, regardless of the etiology of the ED.  

In addition, the advancement of medicine has also provided a range of medication interventions to suit different needs in the bedrooms.  

There are essentially four types of medications (PDE5-I) in the market, namely Sildenafil, Tadalafil, Vardenafil and Udenafil.  

All the medications have the ability to enhance the blood flow to the penis, and the overall efficacy is around 80%.  

The general side effects of the drugs include indigestion and headache, which are mild and well tolerated.  

Technically, the only two real differences that distinguish the drugs from each other are the speed of onset and duration of action.  

Generally, the fastest onset of the medication is around 30 minutes, and some may take up to two hours to see the effect.  

The other consideration many users will take into account before usage is the duration of action.  

Men who prefer some form of predictability (and manage to persuade their spouses to agree, of course) may opt for the shorter-acting medications that provide the window of opportunity for intercourse.  

And for others who prefer spontaneity, is the long-acting medication is generally the only option.  

When couples are both breadwinners in the family, a busy lifestyle may not offer the “luxury of spontaneity” in a relationship.  

In a recent sexual health survey on men taking ED medication, four out of five plan a specific time to have sexual intercourse.  

The same study also revealed that 71% of men planned sexual intimacy several hours ahead of the prospect of “getting lucky”.  

In a busy urban society, Dr G is constantly put on the spot to address issues faced by someone in David’s predicament.  

After an interval of “sexual draught” due to other commitments in life, it is hardly surprising that men would face some “hardness” issues.  

Although many of these men may just be facing temporary ED issues, the help of medications is often the only solution to help them to regain confidence and get back into action.  

When it comes to choosing the right pills for the "action", one has to ask whether “spontaneity” in sex is a luxury you can afford in your busy lifestyle.