Erectile dysfunction

Sexual function disorders in men may be presented by erection failure, lack of sexual drive or Peyronie's disease which is also known as penile curvature. All these problems which also cause "impotence" in men may have different causes as well as different methods for treatment. 

According to the numbers, erection problem in our country, especially in men over 40 years of age is substantial.  We may say roughly that one of each three men over 40 years has erection problem and the incidence increases by age. Although differing individually in an aging man, a decrease in sexual power and function is observed physiologically. A decrease in erectile power of the penis appears due to atherosclerosis, decrease in testosterone level and weakness of the nerve tissue.  Sexual desire, namely libido also decreases and duration of orgasm also prolongs.

Know about your enemies!

The factors decreasing the blood flow into the penis and disrupts erection include hypertension, diabetes, atherosclerosis, smoking, hypertension drugs and drugs used for sedation. Along with, one of e most important reasons for erectile problems is psychological factors, which may be observed in 30% of the patients. This rate increases more in sexual function disorders appeared in young men in particular.  Hormone disorders affect 5% of the patients. For example, testosterone hormone failure and prolactin elevation are the most common hormonal disorders. A disorder in nervous system exists in 10-20% of the patients. Diabetes, important surgeries of the prostate or urinary bladder may cause neural weakness or injury and prevent sufficient erection. Obesity, which is one of the most important problems of the modern ages, also causes metabolic problems as well as sexual function disorders.

Some chronic diseases such as chronic kidney failure, liver failure, cirrhosis, thyroid diseases may also cause erectile dysfunction. Furthermore, radical prostatectomy, which is performed to treat prostate cancer, brain and spine surgeries, rectum surgeries, cardiovascular surgeries may cause erectile dysfunction.

Moreover, Peyronie's disease which affects sexual life or men negatively and cause importance should also be remembered.  This disease appears after 50s and causes curving of the penis so that penis cannot be inserted into the vagina and thereby may lead to impotence.

May erectile dysfunction be temporary?

Although erection problems with psychological origin may be temporary, symptoms to achieve a sufficient erection level to provide a successful sexual intercourse or fail to continue the erection for 3 months or longer are accepted sufficient for diagnosis. If the problem persists at the end of this period, the individual should see a specialist.

Refer to a doctor for correct diagnosis

A well investigation is very important to detect if a man referring by a complaint of erectile dysfunction really has this condition, if yes, if it is caused by psychological or organic factors. To talk with the doctor personally is useful to give tips about the actual problem. Then, patient's complaints may be graded through international and validated national investigation forms.  A detailed physical examination, blood tests, especially determination of testosterone and other hormone levels should be performed to detect the problems and to define concomitant chronic diseases such as diabetes, cardiovascular diseases, and hypertrophy of prostate. Although it was used frequently before, penile Doppler ultrasonography which shows blood circulation grade of the penis during erection may be performed by deciding on the surgery in the patients whom medical treatment is failed.

Alternatives for treatment

The priority of the treatment is to eliminate the risk factors that may cause erectile dysfunction. Excessive weight should be lost through a suitable diet, regular exercise should be performed and stress should be avoided as much as possible. Since negative effect of nicotine on sexual functions, smoking should be avoided. Some drugs prescribed for chronic diseases like hypertension and psychological disorders may be discontinued or replaced.  If the problem exists after elimination of negative factors as a cause of erectile dysfunction, medical therapy is tried.  The most common drugs used for this purpose is inhibitors. These drugs must be used under supervision of a doctor, especially those with heart disease or who have risk to develop a heart disease and individuals who use drugs for any heart disease.

Patients with sexual function disorder who complain about lack of sexual desire should have a test for serum testosterone level. Decrease in testosterone, which was believed to be effective on sexual desire only, was shown to have negative effects on the penis by recent studies. Therefore, for a therapeutic achievement, testosterone should be replaced for these patients first.

Peyronie's disease which may cause penile curves and erection problems so that sexual intercourse becomes impossible may be treated by a long-term drug therapy or surgery.

What is vacuum procedure?

Another treatment option for erection problem is vacuum application onto the penis. Vacuum device consists of a cylinder applied on the penis and a pump connected to it. When the air inside the cylinder is deflated with the pump, blood fills inside the penis by negative pressure and erection occurs. Sexual intercourse is performed then. However, many of the patients do not find vacuum practical.

Injection into the penis

Drug injection into the penis is another treatment option used for the patients with erectile dysfunction. Patients may be taught to make this injection by themselves.  However, every patient may not make this healthily and undesired outcomes may be seen if not performed carefully. There are special needles and pens prepared for this purpose.  Since prolonged erection may be seen more, all precautions should be told by a doctor in detail.

Last cure: penis prosthesis

If impotence cannot be treated by other methods, the final chance for cure is penile prosthesis placement by surgery. Penile prosthesis consists of two silicon cylindrical bars which are placed inside the penis. Prosthesis cannot be noticed outside. When it is inflated through a pump placed inside the testicle sac, the silicon cylinders inside the penis fill with serum which was placed next to the urinary bladder and penis becomes erected. The patient terminates the erection by pressing on reverse side of the pump at the end of sexual intercourse by directing the serum inside the cylinders into the reservoir.

Penile prosthesis surgeries are frequently performed for a long period all over the world and outcomes are good. Approximately 90 percent of the patients report their satisfactions after the surgery. The only disadvantage of prosthesis surgery is being an irreversible treatment method. When it is required to be removed due to any reason, penis cannot be erected with other treatment methods. 

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