Erectile Dysfunction (ED)

Check our our new articles on Erectile Dysfunction and Premature Ejaculation.

Erectile dysfunction or ED as it is commonly known is a very common problem.

Most men at some point in their lives have some problem getting or maintaining an erection.

Even if you do get an erection but it is not as hard as it was, this is also considered to be ED.

A useful partially objective way to determine how good your erection is is the IIEF Questionnaire or the Erection Hardness Score

Grade 1 Grade 2 Grade 3 Grade 4
Penis is larger but not hardLike Tofu Hard but not hard enough for penetrationLike a peeled banana Hard enough for penetration but not completely hardLike an unpeeled banana Completely hard and fully rigidLike a cucumber

Erectile Dysfunction (ED) should not be confused with Premature Ejaculation (PE) although they can both be related.

Men with ED requires a lot of stimulation to maintain their erections and this could then make them ejaculate faster then they would like thereby causing PE.

So you would find that the medicines used to treat ED can also work rather well in treating PE.

Erectile dysfunction might be an indicator of more serious underlying medical problems like:

  1. High Blood Pressure
  2. High Cholesterol
  3. Diabetes
  4. Blocked Arteries
  5. Depression
  6. Low Thyroid Hormone Level
  7. Low Testosterone Level
  8. Medication Side Effects
  9. Enlarged Prostate

When you see our doctors, we will take a careful history and conduct a physical examination to determine if you have any medical conditions that might be contributing to the erectile dysfunction problem. You might also need some blood tests to help with your diagnosis.

Treating any underlying medical problem will help with ED.

What are the options to treat erectile dysfunction?

There are many treatment options currently available for erectile dysfunction. The most popular are the medications known as PDE5 Inhibitors.

Levitra, Cialis and Viagra are all known as PDE5 Inhibitors. They all inhibit an enzyme called PDE5 (phosphodiesterase 5) and this causes the blood vessels to dilate. Dilated blood vessels provide better blood flow and thereby helping erection. By this same mechanism, they all can potentially cause side effects like flushing, headache etc.

Viagra – Marketed to cause the best HARDNESS. Onset about 30 to 45 mins lasts for about 24 hours. Also has the most reported side effects. Its absorption is greatly affected by food and should be taken on an empty stomach.

Viagra now comes in a new kind of tablet that Melts in your Mouth. These are called Viagra Melt Tabs or ODT. Click here for more info.

Levitra – Most POTENT and SAFEST. Very good for people with diabetes or after prostate surgery. Onset about 15 to 30 mins lasts about 12 hours. Also the only PDE5 that has been shown to increase DURATION. It’s absorption is not as affected by food as Viagra but maximal effect is still achieved when it is taken on an empty stomach.

Cialis– last LONGEST. Usual favourite of young people with no problems but want an extra kick. Onset about 30 mins lasts about 36 hours. Taking 5mg everyday has exactly the same effect as taking 20mg when you need. This method of dosing disassociates the taking of pills with sex. It is very good value for people who take more than 2 tablets of 20mg a week. At the same time, this method of taking the pills will improve the lining of your blood vessels.

The 5mg Cialis low dose once-per-day pill has several advantages:

1. There is no need to plan and time when you take the pill and when you will have intercourse.

2. When taken daily, the effect of Cialis 5mg is MORE than 5mg. In other words, just because the dose is only 5mg, you do not get only a quarter of the effect of the 20mg.

3. If a patient is taking 2 or more 20mg pills per week, it is cheaper to take the 5mg pill daily.

4. The Cialis 5mg once-a-day pill has been found to be very effective in treating symptoms due to prostate enlargement.

5. The Cialis 5mg once-a-day pill  has been found to be very effective in treating Premature Ejaculation when taken with Dapoxetine (Priligy).

These medicines are not addictive like morphine or cocaine BUT they might cause a psychological dependence.

These medicines CANNOT be taken with any medicines that contain Nitrates. Nitrates are commonly found in medicines for the heart or blood pressure. Please let our doctors know of any medication you are on.

The other options for treating erectile dysfunction include:

  1. Vacuum Pumps
  2. Penile Injections
  3. Implanted Pumps
  4. Electro Shock Wave Treatment – this is the latest painless potential CURE for ED. Click here to learn more. 

Conclusion and Summary

If you are suffering from ED, please seek medical help. There is no need to suffer in silence. Getting treatment not only improves your sex life, it will also improve your overall quality of life and likely improve your relationship with your partner.

There is no shame or harm in taking medicines for ED. In fact, some of these medicines like the Cialis 5mg low-dose once-a-day pill has other health benefits like on your prostate and blood vessels and not just cure your ED.

ED might also be an early warning sign of a more serious illness like Testosterone Deficiency. This is another good reason to see a doctor.

Need more advice?

Come down to Our Clinics for a discussion with Our Doctors, or call our clinics for more information:



  1. embarrassed_man

    Hi Dr Tan. I am 25 years old. I can get an erection when i am with my partner, but as soon as i want to penetrate, i become soft again. I am a smoker, i do not drink. I am standing at 178cm tall & about 90kg. What would you put my condition down to?

    • drtan

      I really cannot make a diagnosis over the internet. You are welcome to visit me at my clinic at Novena Medical Center #08-31.

  2. I am 46 years old and I was diagnosed with low testosterone and doctor advised me testogel 5mg once a day but I haven’t used it regularly for 30 days. I have a good errection but cannot hold errection for more than 2 mins. I have BP 160/85 and I am on tablets for BP and also have a stress because I was jobless for couple of months. What is the best option for me. I have a too much desire but not proper erection.

    • It sounds to me like your ED is probably due to a combination of stress, artherosclerosis and side effect of your blood pressure medicine. I doubt low T plays a major role in your ED. I cannot give you medical advice over the internet. You are free to visit my clinic anytime you wish. Click here to find us.

  3. Hi Dr,

    I’m a 20 years old guy having problems with my erections. Sometimes when I’m with my partner it is hard for me to get hard even if I’m horny. I think it is harder for me to get a grade 4 as you described. I mean, I can get erections, when I’m alone and when I’m with my partner, but without stimulating it goes away quickly too. As I’m young, do you think this can have a physical cause? Also, I took fynasteride for 2 years in the past, but it’s been over a year that I stopped this medication.

    • Dr Justin Sim

      Most often the cause is due to anxiety, particularly if it was normal before. Sometimes behavioural techniques is all it takes to improve your symptoms. Some men, even young men, use medication like viagra to help overcome the performance anxiety.

  4. Hi mr tan,

    What do you think of acupuncture treatment for Ed ?
    Or better for me to consult doc for an advice?

    • I am not an expert on acupuncture so I would refrain from commenting on its efficacy. For western medicine, we first test to find out what the underlying problem is and treat it accordingly. For example if the problem is a low testosterone level, we replace the testosterone. If the problem is with the blood vessels, we use shock wave treatment etc

  5. stop illegal sex

    Is it possible to cure permanently in case of Grade 3 ED problem or need to take medicine till death?

    • As far as I know there is no permanent cure for ED. The closest thing you can get to a cure is to use the ESWT for mild to moderate ED. Even then, the effects last about a year. The other option you have for a “cure” is to get a penile implant.

  6. stop illegal sex

    Dear sir,
    I m 30 & married. I have ED problem. can well penitrate inside but not last more than half minute. before I used to take oxat-20 medicine each a day what my docyor advised. But after stopping again I m facing problem with sex. Become strong but not straight. seems like the tree with less strength in root level. I already read ur journal u told to have cialis 5 mg each a day. my question is I hve to take this medicine till my death? or how will I b able to cure permanently.

  7. Dr Tan

    i am a 35 yr old I have issues with ejaculating even with a full erection. I suspect this may be due to my addiction to web porn and fetishism. Is my problem more pychological or physiological? Would it be better to see a psychologist first?

    • Given your age and history, the problem is most likely psychological. Yes you can see a psychologist or a sex therapist first. Or you can also see a doctor first to rule out any minute possibility of a physical problem. There is no hard and fast rule. I think both routes are logical.

  8. hi doctor tan,

    I have seen a urologist and he said that my testorone test tesults were ok, but I dont get whats causing all the problem. I asked for further test to find out the caused but was turned down. cant I ask for further test to get to the answer? I was hoping to get a ultrasound test which is gonna be conclusive weather theres a problem but the doctor just brush me off and said that theres nothing to worry.

    • I cannot comment on the advice given by other doctors. If you are uncomfortable with the advice you have been given, you are free to seek a second opinion elsewhere.

  9. hi doctor,

    im a 19yo male, I recently realise ED but it is very unlikely for a 19yo to experience ED right? cause Im not sure whats wrong. it feels like I have a non existing penis I lost almost all sensitivity in my penis. cant get erections through thinking or watching porn anymore only vigrous hand stimulation can get it up and only at most 70% I guess I dont feel the complete rigid I previously have. im not diabetic, normal bp, not sure of cholesterol. please tell me what I should do or have an idea of before consulting doctor. this has been very depressing issue for me for a month already.

    • I agree with you that it is very unlikely for a 19 year old to have ED. From your description, I would be worried about some kind of nerve damage. You definitely need to see a doctor. Click here for more information on ED.

      • hi again doctor,

        I did hurt my back in the past but with no such problem, now what is happening is that I cant feel my penis, cant really feel a touch or sensation. what kind of nerve problem could lead to lost of touch feelings

        • hi doctor,
          I got my cholesterol, bp and sugar level checked. they are all in normal range. could testorone be the problem? tyhroid level are good too

      • so Im wondering if I should get my testorone levels checked too?

        • You can but again it is very unlikely for a 19 year old to have testosterone issues. If you did, there will probably be a lack of secondary sexual characteristics. Your back injury history is very suspicious. You should get that checked out. That may have damaged some nerves that is causing your current problem.

          • if testorone is to be the problem, do I have to be on trt life long?? cause Im very afraid of this things im still young my life is gonna be ruined

          • If Testosterone is the problem you first need to find out why. At your age there must be a secondary cause. If it is due to things like Klinefelters Syndrome or other genetic causes then yes you need to be on TRT for life. Stop making assumptions and scaring yourself. Go see a doctor. If you wish to see us, Click here for location info.

          • hi doctor tan,

            is there any chances like ateries problem? I do not have high bp, diabetes or high cholesterol. is there anyway that the small ateries are damage? cause what I read from the net is that if you have high bp, diabetes or high cholesterol you can have damage the ateries or blood vessels. but I have none of this medical conditions. urologist have also examine it with touch and said it looks fine. I wonder with this examination what does he check for? It feels so hard for me to get a full erection like last time or maintain a long erection. I really wonder if its testorone problem cause ive been working out regularly and cant lose weight eating well as well but cant lose fats or weight.

          • No point pondering. You need to see a doctor to find out what is wrong. You are always welcome to see us. Click here for location info.

  10. Hi Doc

    I’m 47 and I have problems maintaining an erection during intercourse. What’s the ballpark cost of a low dosage of cialis? Is it safe to take this on a regular basis say 3x a week?


    • There are 2 types of Cialis. The ad-hoc pill which you take as and when necessary and the low dose once-a-day pill. Both types are safe to be taken DAILY. Although for the ad-hoc pills you would not need to since the duration of action is 36 hours. Cialis 20mg costs $88 for a box of 4 pills. Cialis 5mg once-a-day costs $215 for a box of 28 pills.

  11. Michael

    Hi Dr. Tan,

    I have recently encountered this problem and it has been on-going for the past 1 week.

    I gets sexually aroused but not an erection. I also do not have sleep erection for the past 1 week. I also have not been getting morning erection since last week.

    Is there anything I can do?


    • drtan

      If you are young I would put it down to psychological stress. If you are older I would suspect Testosterone deficiency. This is assuming you do not have any other medical conditions. Please post any follow up questions on

  12. I m a healthy early 30 male who until recently found out that I have ED problem. I could not maintain my erection. Have went to do the test for testoerene but it was found to be normal. Doc which I consulted mention that i have varoecles leak and it was fixed thru surgery.
    I dun alwasy have moring erection, at times yes, and at times no….
    Is there any thing I could do to improve my condition?


    • Aerobic excercise regularly. Eat lots of fruits and vegetables. Stay away from animal fat. Test for other hormones besides Testosterone eg Estrogen, Thyroid Function etc. See a sex counsellor/therapist. Please post any follow up questions on

  13. Hi Dr. Tan,

    May i check with you if there’s a required duration before we can take Nitrates containing medication if we have been on Viagra.

  14. Anxious Married Man

    Hello doctor, Warm regards for the wonderfull work!

    I have done through lot of literature available online, and i can understand that i do not have ED ( since i am able to get erection during masturbation / morning erections / on visual or touch stimuli).

    But so saying when i attempt to have sex with my wife, my erection does not last longer and i am unable to penetrate at all. I really don’t know if it is due to regular masturbation previously or a psychological issue or anything else. We used to have regular arguments & fights early on after marriage, but that has completely stopped now and we understand each other very well. I would like to know if taking small doses of viagra or other medicine in order to be comfortable initial on and later stop depending on it. I dont ahve any health conditions as of now, except for being a bit obese around tummy.

    I would definitely like to come in for a personal consultation to your clinic, hopefully by this week!

    • Hi Anxious Married Man,

      I deleted your Avatar Pic before approving this message. I assume you would rather remain anonymous. I agree with you that this does not sound like a vascular issue, however, I would be interested to know your testosterone levels if you are above 40 years old. PDE5Is can definitely play a role in helping you get your confidence back. I think you will probably just need them for a short while. Look forward to seeing you.


      Dr Tan

      • Anxious Married Man

        I am 27 years old. And I suppose,the best way forward now would be to come for a personal check-up before I can take up medication. Thank you very much Dr. Tan

  15. Larry60

    Hi Doctor, I am 60Y now, recently my doctor prescripted Sildenafil Citrate 50mg Tab to treat my ED. May I know can it be replaced by Levitra or Cialis. Can I purchase from your clinic.

    • Hi Larry60,

      Each PDE5I has its unique features. You can try Levitra and Cialis the decide which works best for you. I will be happy to see you at my clinic.


      Dr Tan

      • Larry60

        Hi doc.. thank for yor response, what is your general consultation service charge and payment mode?

        • drtan

          Hi Larry60,

          Consultation $35. Payment – Cash, NETS, VISA, Mastercard, Amex.


          Dr Tan

  16. Hi!doctor i want to know can i take levitra 20mg because im using co-tareg for high blood pressureand and using cholesetrol pil some times i use pil for prostat infection (seldom)im 43years

    • Hi b.i.,

      All these meds are ok to take with Levitra.


      Dr Tan

  17. Hi doctor,I’m 32 yr old and may i ask some question,Does the penis size matter to get wife pregneant? How to judge the erection? my full erection is hard enough for penetration but it always up to horizon never erect beyond that consider normal?appreciate your reply.thanks

    • Hi John80,

      Penis size has absolutely nothing to do with fertility. As long as you are able to achieve an erection adequate for penetration and you can ejaculate, you can get your wife pregnant. The common description for appropriate hardness is an unpeeled banana. As long as it is that hard, you are OK.


      Dr Tan

  18. Hi dr tan

    May i know you are situated at oub or roberston?

  19. Dear Dr.Tan,
    Should I go to you for the serum testosterone test cost $40.00, any other additional cost besides the test? Will you advice on the course of action if I were to visit you in person? As to the daily intake of Cialis, in your opinion how long will it take to overcome ED? What about the new drug –
    “Priligy” – can I take this drug?

    Thanks for your help and hope to see you soon.


    • Hi BILL,

      I cannot provide medical advice over the internet. I cannot tell you what you should or should not do. I am happy to provide you with information and my opinions but your have to decide what you want to do yourself. If you wish to seek my medical advice you will have to come to the clinic for a formal consultation. Priligy is a medicine for premature ejaculation. It will not be relevant to you.


      Dr Tan
      Help test out our new forum at

      • Dear Dr.Tan,
        My apology for coming back to you again after a
        lapse of time.

        Your advice: Quote:
        As to the daily intake of Cialis, in your opinion how long will it take to overcome ED? Unquote:

        What will be the cost to daily intake of Cialis
        as advised. How long do I need to take the Cialis
        – is it in 20MG or 100MG? My guess?

        Upon your reply I will decide whether to seek
        an appointment with you with regards to the test
        for serum testosterone test – cost $40.00.

        Thank you Dr.Tan for your assistance and under-


        • Dear Dr. Tan,
          Missing your reply to my e-mail on July
          06, 2012 as append below.


          Bill Jul 6 19:16 0

          Dear Dr.Tan, My apology for coming back to you again after a lapse of time. Your advice: Quote: As to the daily intake of Cialis, in your opinion how long will it take to overcome ED? Unquote: What will be the cost to daily intake of Cialis as advised. How long do I need to take the Cialis – is it in 20MG or 100MG? My guess? I came across an articles on “VIMAX” and “ALPROSTADUL” which is a cure for ED. Are this pills safe? Upon your reply I will decide whether to seek an appointment with you with regards to the test for serum testosterone test – cost $40.00. Thank you, Dr.Tan for your assistance and understanding. Regards, Bill

          This question will be answered within 72 hours.

          • Dear Dr. Tan,
            Missing your reply to my queries
            since July 06, 2012.

            Appreciate your reply.

            God Bless

  20. I am suffering from ED. I have high blood pressure and high
    cholesterol and am on the following medication: 1. Fenofibrate 300mg; 2. Nifedipine LA 30mg; 3. Aspirin 100mg;
    4. Simvastatin 20mg; 5. Enalapril Maleate 10mg. I am 71 years old and have been treated at Tan Tock Seng Hospital for a number of years without success. I was given and tried Viagra, Levitra and Cialis by the hospital and this did not help my ED. I also went to see and treated by TCM also without success. I am now turning to you and your recommendation to your panel of doctors to see if you or your experienced urologist who have had success in treating ED? You can refer my case history with TTSH. Thank you in advance for your expert advice and regret for the inconvenience caused.


    • Hi BILL TAN,

      I appreciate your faith in our medical system and technology. Unfortunately, we have not reached that level where we can access a patient’s medical information from the public hospitals. Furthermore, to protect your confidentiality, doctors are only allowed to release your medical information when there is a signed consent from you. Back to your question: Have you checked your testosterone levels? You should do that first as well as optimize the PDE5Is. If that still doesn’t work, you can consider penile injections and if that still doesn’t work, you can consider penile implants.


      Dr Tan

      • Dear Dr.Tan,
        Greatly appreciate your prompt reply and advice.
        I believe I have checked my testosterone level
        which is normal. However, can you do another test
        for me and what is the cost? Is it possible for me to take a LOW dose of say 5mg. Cialis a day – your
        advice is appreciated. What will be the cost of penile injections (where do you inject to?) and penile implants – what’s the different? Thanks for your advice.

        Rgs, Bill

        • Hi BILL,

          Serum Testosterone test – $40. I am unable to provide you with medical advice over the net. From what I understand of your case, my opinion is that you will certainly benefit from a daily low dose Cialis treatment. Penile injections cost about $80. You inject it into the base of the penis. As you can imagine, it is not a very popular treatment. Penile implants are platic tubes that are surgically inserted into the penis. These tubes are attached to a saline resevoir that can be pumped up to achieve an erection.


          Dr Tan

  21. Worried

    Hi dr,

    I pretty positive that i suffered from ED
    I am 29 years old
    May i know whats the cost for consultation n tests at your clinic?


    • Hi Worried,

      Our consultation rate starts from $35. Costs of tests really depends on what tests you need. You would probably require a test for blood cholesterol levels, blood sugar levels and maybe testosterone levels. This should costs about $70 in total.


      Dr Tan

  22. Hi Dr.Tan, Is ED curable or treatable? Is there any permanent solution to the problem or PDE5I needs to be taken all the time?

    • Hi Chen,

      It really depends on what is the cause of the ED. For example is the ED was due to fear and anxiety, this could potentially be cured by seeing a psychiatrist. If the ED was secondary to a chronic disease like Diabetes then we need to control the Diabetes and see if it helps.


      Dr Tan

  23. Chio Chye Teck

    Hi Dr Tan,

    I have consulted Men’s clinic at Tampines for sign of ED. I have did a blood test to check for low testosterone level but the doc told me is not too low to be critical for injection and the solution given is just to take Viagra. Is there any permanent solution to this problem as I still do get erection in the morning but not always though. I am age 43 and what are the fees charged as I am worried about the high cost.

    Thanks a million and hope to hear from you soon.
    Best regards.

    • Hi Chio Chye Teck,

      First of all please let me remind you that this forum is not a substitute for a formal medical consultation. You should still defer to your doctor for medical advice. The solution to ED really depends on what we think in the cause. You will need to rule out the presence of chronic diseases and hormonal deficiency. I assume your doctor has done all this for you already. To manage the ED itself, I’m afraid there is very little in terms of a permanent solution. You can try regular low dose PDE5I which has shown evidence of penile rehabilitation. There is also the possiblity of electroshockwave therapy to the pelvic vessels but this treatment is still very new. Fees will really depend on what treatment you require.


      Dr Tan

  24. Hi Dr. Tan,

    Is ED hereditary and what are the chances for a guy under 30 getting it??


    • Hi Ray,

      That is a very good question. As far as we know: No it is not hereditary. Although, diseases that cause ED eg Diabetes, High Blood Pressure, High Cholesterol are hereditary. It is extremely unlikely for a guy under 30 to have an organic cause for ED. It is most likely psychological. However, we cannot jump to that conclusion until we have done the proper tests.


      Dr Tan

      • Hi Dr.Tan, I am 35 and I am suffering from a similar problem. What is the approx cost of the test and treatment I will be looking at in your Clinic?

        • Hi Chang,

          Again it really depends on what is the cause of your ED and what treatment you need. Example: if all you need is Levitra on an ad hoc basis, we seel 1 box of 4 tablets at $80. Some patients need only 1/2 a tablet each time making it even more cost efficient. If you need daily low dose Cialis then it will cost $213 for 28 tablets. This is just to give you an idea. I really would not know what kind of treatment you’ll end up needing.


          Dr Tan

  25. Hi Dr.Tan,

    I am 28 and I am pretty healthy and I dont have any disease. For the past one year I couldn’t get stiff erections when required. My erections are not strong enough to penetrate. I am very much worried now and What tests do I need to take and what may be the causes to my condition?

    • Hi Bernad,

      28 years old is very young to be having ED issues. You definitely need to see a doctor and be properly evaluated. This website is really not the platform to be giving you medical advice.


      Dr Tan

  26. Hi, I would like to know what you suggest for ED & PE for a man of 38Y diagnosed with metabolic syndrome and CAD?

    • Hi Sam,

      There are many considerations for your case. 1. I suspect that your PE is secondary to your ED. 2. Since you have metabolic syndrome it very likely that your serum Testosterone levels are low also. 3. Your metabolic syndrome must be well controlled. This will help with both ED and PE. 4. How bad is your CAD and what medications are you on? 5. Do you have a regular partner?
      The principles of treatment will be 1. Establish a good history with regards to the ED and PE 2. Optimize control of the metabolic syndrome. 3. Check Testosterone levels 4. If there are no contraindications, i.e. medications, lifestyle, severity of CAD etc, you might benefit from a daily low dose PDE5 inhibitor like Cialis 5mg once-a-day.
      These are just guides and truly this discussion is really outside the scope of an online forum. You need a formal consultation with a doctor for this.


      Dr Tan


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