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Dr Walter is a strong proponent of evidence based treatments that are safe and effective. As an advocate of lifelong learning, he continues to attend conferences and workshops in his free time to keep up with the latest developments, and to learn from the best in the region and the world.



Studies show that while ED gets more common as one gets older, it is not unheard of among younger men. Many men do not talk about it due to social stigma and embarrassment and suffer in silence. It is important to know that there are options to get treated, but first we must explore the possible causes of ED.


It will be beyond the scope of this article to list all possible causes of ED, but we will briefly discuss the common ones.

1 ) Chronic Diseases

Among those who are older, ED is often associated with chronic medical problems that affect the health of blood vessels. These include diabetes, hypertension, high cholesterol, and heart disease. In such patients, ED is an indication of poor cardiovascular health and having problems with erections is a sign that blood flow to the peripheries is poor. The significance of this is that organs like the eyes and kidneys are also likely already affected to some extent.

2 ) Lifestyle

A lifestyle that involves heavy drinking, smoking and high stress can weaken erections. Obesity can also decrease the function of testosterone, causing sexual dysfunction.

3 ) Psychological

ED can be attributed to psychological issues. Depression and anxiety may cause ED, as can marital problems. 

4 ) Medications

Certain classes of antidepressants and beta blockers are also possible causes of ED.

5 ) Testosterone deficiency

Low testosterone levels are a possible culprit for ED. This will be discussed in further detail in subsequent posts.

This is how I upkeep an active lifestyle!

Not long ago, I wrote about how an active lifestyle helps me cope with the demands of work. Apart from running, I also do a fair bit of resistance training in the gym.

Previous hip and back injuries mean that I would have to be less ambitious with my workouts. These days, I just try to maintain my strength and endurance, rather than attempt to smash personal records and risk an injury.

I tend to favour compound exercises like squats and deadlifts. They are the closest there is to a full body workout, allowing me to expend calories more efficiently. Furthermore, these are highly functional moves that are beneficial for most sports and in our daily lives.

For example, work sometimes requires me to stand for extended periods of time, and this previously gave me back pain. Since starting on these exercises, my posture has improved significantly, and back pain is an uncommon occurrence now.


The Society for Men’s Health Singapore organised the 5th Certificate Course in Andrology in Bali last month. It was an educational treat for those who have an interest in men’s health. Among the topics were tackling common problems like erectile dysfunction, premature ejaculation and testosterone deficiency. It was an enlightening experience as these topics do not usually receive a lot of publicity.

Sexuality plays an important role in most partnerships. This is common among different nationalities, cultures, ethnic groups and ages. Many studies show that sexual health is often not maintained in older men, and this becomes more common and severe as a man gets older. The 2 most common cause of sexual dysfunction in men are erectile dysfunction (ED) and premature ejaculation. We will discuss more about erectile dysfunction in this article.


To treat ED, we must first assess the cause of the ED. It is not uncommon for sufferers to have multiple causes of ED. Those with chronic diseases should aim to get them under control. Simple measures like regular exercise, a healthy diet and weight loss can significantly improve erectile function. Research has shown that these effects can be seen in as early as 8 weeks. If you suspect the cause of ED to be due to medications, ask your physician if an alternative drug could be prescribed instead. Never attempt to stop the medications on your own!


Treating testosterone deficiency is a huge topic that will be covered in a future post.


Phosphodiesterase 5 (PDE5) Inhibitors are a popular way to treat ED. The introduction of PDE5 Inhibitors into the market revolutionised the treatment of ED. There are currently 3 brands in the market, Viagra, Cialis and Levitra. Viagra, the first of its kind in the market, needs no introduction. All of them have slightly different mechanisms of action. There is no conclusion on which brand is the best, but some do find one brand to be more effective, or easier to use than the others.

PDE5 Inhibitors are generally safe. Common side effects include headache, flushing of the face and blocked nose. Most of these are tolerable. Those who take nitrates for heart conditions cannot take PDE5Is.


Low intensity Extracorporeal Shockwave Treatment (LiESWT) is a novel way of treating ED. Research has shown that shockwave therapy can encourage the growth of new blood vessels in the penis, improving erectile function over time. There are a few different shockwave devices in the market. They can only be operated by a physician.

Other more invasive treatment methods include injections into the penis, vacuum erection devices and surgical insertion of a penile prosthesis.


As you can tell, treating sexual health issues requires a holistic approach. At Astute, we take this fact seriously. Our doctors will first take a comprehensive history from our patients, especially if they are seeing them for the very first time. This will usually be followed by a medical examination. A blood test may also be warranted. We at Astute believe in taking our time to provide a quality and individualised consult.

Following that, our doctors will counsel you on appropriate treatment options. Depending on the cause of the erectile dysfunction, our doctors may prescribe you a trial of PDE5 Inhibitors. We stock Viagra and Cialis (both the 30mg and 5mg variants). There is also the possibility of Low intensity Extracorporeal Shockwave Treatment for suitable candidates. This uses gentle shockwave to stimulate the growth of new blood vessels in the penis. It is painless. At Astute, we use the well established ED1000. A course of shockwave therapy consists of 3 sessions per week for 2 weeks, or 2 sessions per week for 3 weeks. Each session takes about 20 minutes. Some patients might benefit from a second course.

We understand that it might sometimes be uncomfortable and intrusive to talk about matters relating to sexual health. However, it is important that we do not rush through the process to ensure a safe and desirable outcome. You can be assured that our staff will maintain their professional standards to provide a comfortable experience.


(East Coast)

(Central Business District)


11:00AM - 8:00PM

SATURDAY 10:00AM - 7:00PM

SUNDAY (by appointment only)


11:00AM - 8:00PM

SATURDAY 10:00AM - 7:00PM


137 East Coast Road, Tembeling Centre #01-08, Singapore 428827 (diagonally opposite Katong i12)

18 Cross Street, Cross Street Exchange #01-112, Singapore 048423 (facing Capri Hotel by Fraser)


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