More Singaporeans are coming
forward to seek medical help for
sexual disorders and disabilities
that affect sexual function.
Sexual dysfunction is still an
uncomfortable subject for many,
but the increasing availability of
treatments and awareness about
them have led some people to be
more forthcoming about problems
in their sex lives.
Occupational therapist Shirlene
Toh said she saw one or two patients
a month when the Sexual
Wellness Service was set up at Tan
Tock Seng Hospital’s (TTSH) Rehabilitation
Centre in 2009. She now
sees two or three patients a week.
“Patients today are Internet savvy
and read up online. They then
come to us seeking clarification.”
Dr Lee Fang Jann, a consultant in
the department of urology at
Singapore General Hospital (SGH),
said: “We’ve noticed more patients
opportunistically bringing up the
issue during consultations for
non-related conditions. They are
generally more willing to attempt
treatment as well.”
The bulk of patients who seek
medical help for sexual dysfunction
are married men aged between 40
and 70. Older men form the
majority of patients.
Erectile dysfunction is the most
commonly seen condition in hospitals
here; the prevalence and
severity increases with age.
Diagnosed cases of premature
ejaculation and testosterone deficiency
are also on the rise, with SGH
seeing a 30 to40 per cent increase in
the number of such patients in the
last six to eight years.
Premature ejaculation patients
are usually younger, ranging
between 20 and 40 years old.
Dr Lee said: “This has very much to
do with publicity in the media and
the increasing availability of treatments.”
Women who go for help may be
suffering from vaginal pain during
intercourse, or low desire, among other symptoms.
There are also physically disabled
patients of both genders whose sex
lives have been affected by injury to
the spinal cord or strokes.
Treatment options for sexual
dysfunction have broadened in the
last five years.
Ms Toh started the Sexual Wellness
Service to cater primarily to
physically disabled patients but she
has been seeing more able-bodied
patients after TTSH’s Complex
Erectile Management Clinic was
set upin 2014.
The patients are referred to her
for counselling after undergoing
medical evaluation at the clinic.
SGH introduced a dedicated andrology
clinic service for complex
erectile dysfunction cases in 2014.
Hospitals here are increasingly
using a multi-pronged approach to
treat sexual dysfunction, where
doctors and therapists work in
tandem to address medical and
psycho-social aspects respectively.
Since 2012, SGH has had a subfertility
clinic where couples with
fertility issues can be seen and
screened together. One of the
problems such couples face could
be sexual dysfunction.
The clinic is run jointly by a male
and a female fertility specialist.
SGH’s andrology and sub-fertility
clinics see about 20 to 25 patients
each every month.
The National University Hospital
(NUH) has a similar set-up, with
more patients today with erectile
dysfunction or premature ejaculation.
They are referred to the older
andrology clinic from the Relationship
Counselling Clinic, set up in
2012, for issues related to a couple’s
inability to conceive.
“Sexual intimacy is not just about
intercourse,” said MsToh.
“It’s also about communicating
and being open with your spouse,
especially if you or your spouse are
comingto terms with a disability.”
She said the most difficult patients
were men wanting a quick
medical solution for their conditions.
“They think the problem is
just about getting an erection but
their wives tell me separately that
their husband is not talking to them
about the issue,” she added.
Dr Lee said: “A frank and open
discussion will often draw out any
potential psychological triggers.
Relationship difficulties are best
dealt with as a couple.”
Psychological causes of sexual
dysfunction figure more prominently
among patients in their 30s or
younger, who are less likely to have
age-related physical symptoms.
For example, erectile dysfunction
in younger men could originate
from job or marital stress,
performance anxiety with a new
partner, or guilt from the inability
to satisfy their partner, said Dr Lee.
“The common distinguishing
feature for men with psychological
erectile dysfunction is that the
erectile difficulty occurs only with
sexual intimacy and does not affect
his ability in achieving erection
with masturbation,” said Dr Lee.
The younger patients Ms Toh has
seen are often married couples
who have trouble consummating
their marriage after a year or more,
and who require a different approach
from that of older patients.
“With older patients, we educate
them on how they have been
affected physically and what they
can do to cope,” she said.
“With younger patients, we work
on couple marital dynamics and
strategies to improve intimacy.”
Physical or organic causes of
sexual dysfunction are divided into
the vasculogenic (affecting the
blood flow to blood vessels in the
sexual organs) and the neurogenic
(affecting the nerves).
Vascular causes include chronic
smoking, diabetes, hypertension
and having an excess of cholesterol
in the bloodstream. “These are the
same conditions that predispose
patients to heart attacks,” said Dr
Neurogenic causes include
stroke, multiple sclerosis and
Ms Toh has seen an increase in
patients referred to her by
colleagues in other departments.
She pointed out that healthcare
professionals who encounter
opportunistic queries from
patients should put aside any personal
discomfort with the touchy
topic of sexual wellness temporarily when talking
“It is also a sensitive issue for
patients and you don’t want to give
them the perception that what
they are asking about is wrong,”
“If you are uncomfortable, you
can still show them their concerns
are important and offer to put them
intouch with another colleague.”