#HEALTH: "Hard" times for younger men

New Straits Times

30-05-2025

ONCE thought of as an ageing man's problem, erectile dysfunction, or ED, is becoming an issue that young Malaysian men are now grappling with.
Since bedroom woes are rarely discussed openly in the country, these problems persist among them, resulting in turmoil at home and broken relationships.Recently, Deputy Health Minister Datuk Lukanisman Awang Sauni said that two out of three Malaysian men are at risk of ED.
The 2019 National Health and Morbidity Survey also indicates that 31.6 per cent of men aged 18 and above have moderate to severe levels of ED.
ED is a condition in which a man is unable to maintain an erection that's sufficient for sexual intercourse.
It can range from an inability to achieve an erection at all, to difficulty sustaining one throughout intercourse, says senior consultant urologist and lecturer at the Faculty of Medicine, Chancellor Tuanku Muhriz Hospital UKM, Professor Datuk Dr Zulkifli Md Zainuddin.
Some men may still be able to get an erection, but not consistently, while others may be unable to achieve one despite having sexual desire, he says.
Age is a primary factor in ED as the natural ageing process leads to physiological changes in men, such as a decline in testosterone levels and reduced blood vessel function.
However, most cases of ED among younger men are caused by other health-related factors that are on the rise, such as diabetes, heart disease, obesity, high blood pressure and low testosterone levels.
"These conditions disrupt blood flow, which is essential for normal erectile function."
Mental health problems, including stress and depression, are also contributing factors, he adds.
Studies show that more young men are experiencing stress due to increasingly complex life pressures, including work-related stress, financial issues and unstable personal relationships.
This trend is concerning to health experts not just because it affects sexual function, but also because it may reflect declining health and can serve as an early indicator of coronary heart disease.
Dr Zulkifli says young men are more likely to lead sedentary lifestyles, neglect healthy eating habits and engage in smoking and drinking alcohol, and avoid physical exercise.
"These habits increase the risk of developing illnesses that contribute to ED.
"Coupled with a lack of awareness about sexual health, young men become more vulnerable to this issue."
AN UNDENIABLE FACT
We are seeing more men in their 30s and 40s presenting with erectile dysfunction in Malaysia. It's not just ageing - it's modern life, says Prince Court Medical Centre consultant urologist Dr Datesh Daneshwar.
"Sleep deprivation, vaping, poor metabolic health, and rising testosterone deficiency all contribute to the condition."
With 54.4 per cent of Malaysians either overweight or obese based on the National Health and Morbidity Survey 2023, and rising rates of diabetes and high blood pressure, the spillover into the bedroom is only to be expected.
In Malaysia, more men are experiencing ED at a younger age due to rising rates of diabetes, obesity and stress, says Dr Datesh.
Prevention is possible - regular health screenings, clean living and early intervention can make a huge difference.
"We need to move away from the idea that ED is inevitable."
While "occasional difficulty" in the bedroom is common, persistent ED is not normal at any age, he says.
Many men believe it's just part of getting older, but this mindset is dangerous. Dr Datesh says with a proper lifestyle, hormonal balance and vascular health, many men can maintain good sexual function well into their 70s.
However, there's a deep cultural stigma in Malaysia where ED is concerned.
Men feel ashamed, emasculated, or worry they'll be judged if they open up about their problems.
"ED is a treatable medical condition, not a personal failure."
These days, more men are starting to come forward, especially when their relationships are affected, but too many still suffer in silence or try unsafe supplements, he adds.
"The fear of seeing a doctor is stronger than the problem itself. We must normalise these conversations."
ED clinics should be discreet, respectful and scientifically grounded - not run by profit-driven "miracle cure" shops, says Dr Datesh.
ED affects far more than sex, he says. It erodes confidence, emotional connection, and self-worth.
In Malaysia, where intimacy is rarely discussed openly, many couples suffer in silence.
YOUNG AND IMPOTENT
Awareness about ED treatment is growing, particularly with discussions on social media, enabling more men to access information about available treatment options, says Dr Zulkifli.
However, many turn to unproven remedies.
"They may buy unapproved medications or follow advice from unreliable sources, such as so-called 'TikTok doctors."
In fact, those with ED should seek treatment from medical professionals rather than relying on vague or risky recommendations.
"Proper treatment must be based on an accurate diagnosis by a healthcare professional to avoid unwanted side effects or health risks," says Dr Zulkifli.
TREATMENT OPTIONS
Recommended treatments for ED include the use of medications such as PDE5 inhibitors, which have been proven effective in helping patients achieve satisfactory erections.
"There are various PDE5 inhibitors to suit the sexual needs of patients. Some act within just 10 minutes, while others can last up to 36 hours and more," says Dr Zulkifli.
However, patients need to have realistic expectations and understand that treatment may take time, especially for older men, he adds.
Aside from medication, other treatments include hormone therapy, vacuum devices, penile injections, and in some cases, surgical implantation of penile prostheses.
Each treatment must be tailored to the individual and monitored by doctors.
LIFESTYLE CHANGES
However, treatment with medication alone is not enough. A healthy lifestyle plays a crucial role in the success of ED treatment.
Avoiding harmful habits like smoking, drinking alcohol and physical inactivity is essential.
Consistent physical activity can improve blood circulation and boost health, says Dr Zulkifli.
Furthermore, maintaining a balanced diet with plenty of vegetables, fruits and antioxidant-rich foods can help preserve vascular health and enhance sexual function.
He also says that mental and emotional factors must not be overlooked.
"Men with ED often face self-confidence issues and strain in their personal relationships.
"Therefore, psychological support is important to help them cope with the emotional impact of sexual problems."
Therapy such as counselling or support from partners can help reduce stress and improve the mental wellbeing of men experiencing ED.
Young men with health issues or unhealthy lifestyles are encouraged to seek treatment early and adopt healthy habits to address this problem.
"Taking early steps to care for sexual health and adopting a healthy lifestyle can help prevent ED and improve quality of life."
With greater awareness and proper treatment, young men no longer need to feel ashamed or isolated when facing ED.
THE HIDDEN FACTOR
ONE often-missed cause of ED is Chronic Pelvic Pain Syndrome (CPPS), a poorly understood condition involving nerve and muscle dysfunction in the pelvis.
CPPS is surprisingly common in younger men and often mislabelled as prostatitis, says Prince Court Medical Centre consultant urologist Dr Datesh Daneshwar.
It causes pain, anxiety, and sexual dysfunction. Many men suffer silently for years because no one connects their pelvic pain to their ED.
While stress associated with our modern lifestyle is a major trigger for ED, it doesn't act alone.
ED often reflects a deeper problem involving hormones, circulation, pelvic muscle tension, or nerve hypersensitivity, especially in men with undiagnosed CPPS, he says.
"In Malaysia, I see many men who've been wrongly treated for prostatitis with repeated antibiotics when the real issue is pelvic floor dysfunction causing pain and erection problems."
CPPS is a silent epidemic - poorly recognised, under-treated and closely linked to ED.
"So yes, stress plays a role, but it often sets off a chain of physical changes that get missed if we don't look deeper."
When ED is linked to pelvic pain or CPPS, men may avoid intimacy altogether for fear of discomfort, embarrassment or failure.
Their partners may misinterpret this as disinterest. Over time, this creates tension and emotional distance.
But with the right help, including pelvic pain assessment, couples can regain intimacy, says Dr Datesh.