Erectile dysfunction, locally referred to in Malay as Sakit Tuan, encompasses diseases and functional disorders affecting the male reproductive organs. According to Mohd Ismail Tambi (1995), a renowned Malaysian andrologist, sakit tuan is defined as “diseases and functional problems that occur in the male reproductive organs,” which may involve the penis, testicles, scrotum, and other related structures. Common issues include erectile dysfunction, problems with penile rigidity, premature ejaculation, and delayed ejaculation. This definition is consistent with the European Association of Urology (EAU), which highlights erectile dysfunction and premature ejaculation as the main concerns (Wespes et al., 2002).

In modern medicine, erectile dysfunction (previously referred to as impotence) is defined as “the inability to maintain penile rigidity for sexual intercourse, resulting in dissatisfaction for the patient” (Feldman et al., 1994). Ragg (1997) further categorizes erectile dysfunction into several conditions: never experiencing an erection; previously achieving erections but no longer; having erections only during sleep or upon waking; achieving erections but not during intercourse; experiencing erections with a partner but finding them inadequate or short-lived; and finally, achieving erections only after prolonged effort.

Premature ejaculation is also recognized as a major problem related to erectile dysfunction. The International Society for Sexual Medicine (ISSM) defines it as “the inability of a man to control ejaculation, which almost always or always occurs within 1 minute of vaginal penetration, and the inability to delay ejaculation on all or nearly all penetrations, leading to distress, frustration, interpersonal difficulty, and avoidance of sexual activity” (McMahon et al., 2008). It is often classified as a form of secondary impotence that may arise from psychological factors (such as limited sexual experience, unstable arousal levels, or other psychogenic conditions) or biological causes, including penile hypersensitivity (Paick et al., 1998; McMahon et al., 2004).

The broader problem of erectile dysfunction also extends to male infertility, which refers to the inability of sperm to achieve conception. Infertility is considered a profound issue because it affects both emotional well-being and physical life goals, given that procreation is a fundamental human aspiration (Mahlstedt, 1985). Inhorn (2004, p. 162) defines infertility as “the failure to achieve pregnancy after one year or more of unprotected intercourse, resulting in involuntary childlessness.” Male infertility may be caused by oligospermia (low sperm count), asthenospermia (poor sperm motility), teratospermia (abnormal sperm morphology), or azoospermia (absence of sperm). Although infertile men may retain normal sexual function, the social stigma remains severe, as infertility is often seen as a failure to fulfill the cultural and familial responsibility of fatherhood (Inhorn, 2004, p. 163).

In Malay society, modern medical treatments are widely accepted; however, traditional healing methods remain integral to addressing erectile dysfunction. Malay traditional medicine views men’s health as not only physical or biological but also connected to energy balance, vitality, and spiritual harmony with nature. As such, treatment is holistic, involving the body, mind, and spirit.

Three principal traditional approaches are commonly practiced:

1. Genital Massage

This manual therapy, performed by trained practitioners, improves blood circulation in the penis and adjacent areas such as the waist and thighs. It is believed to strengthen penile muscles, enhance vital energy, and restore rigidity. Beyond its physiological function, Genital Massage is also valued for restoring men’s confidence, particularly in marital life.

2. Traditional Remedies

For generations, the Malay community has relied on herbal formulations including tongkat ali, akar ubi jaga, halia bara, kacip fatimah, and daun sirih. These herbs are believed to possess aphrodisiac effects, boost vitality, and support reproductive health. Herbal treatments remain popular due to their natural origins and perceived safety compared to chemical-based medicines.

3. Wafak (Spiritual Treatment)

Wafak involves spiritual elements such as prayers and Qur’anic verses written or recited by traditional healers. This practice is based on the belief that erectile dysfunction may also stem from spiritual imbalances or subtle disturbances. It is often used alongside physical treatments like genital massage and herbal remedies.