The problem of erection in the penis, or inability to get an erection, is known as the problem of impotence, and the medical name of the disease is erectile dysfunction. Erectile dysfunction is one of the most common male sexual health problems in the world.
Even if the problem is only biological, it is a disease that should be evaluated mostly in the presence of accompanying psychological, sociological and cultural differences.
For this reason, in terms of its consequences, it is not only a problem of the patients, but also a disease that negatively affects his spouse, his children, and the entire social environment of the them, as it disrupts the communication within the family.
In the article below, biological factors related to erectile dysfunction are discussed in the form of more informative questions and answers. It should not be forgotten that a doctor’s evaluation is absolutely necessary for the correct diagnosis and appropriate treatment.
What is erectile dysfunction?
The inability to achieve the erection required for a satisfactory and sustainable sexual intercourse in the penis or the inability to maintain the erection that has occurred in the penis at the beginning is known as the erection problem. Previously, the Latin expression “impotence” was used more frequently in medicine, but today this disease is called “erectile dysfunction”.
Is only the patient affected in the erection problem?
Even if it does not appear to be a serious problem in practical life, it is an important health problem that seriously affects the physical, psychological and social life of the person and his partner. A serious deterioration in the quality of life of couples with this problem is observed and it causes significant negativities in their family communication, peace and happiness.
For this reason, erection problem is not only a male problem, but also an important health problem that concerns both men and women in the family. Therefore, it is a health problem that affects two people at the same time.
What is the Frequency of Erectile Dysfunction?
In different studies, according to the data obtained on a large number of human groups, the incidence of erectile dysfunction in men between the ages of 40-70 was determined as 52%. However, when the erection problem was graded as low- mid- high, in the same age group, low 17%, medium 25%, and 10% high erectile dysfunction were determined.
What are the risk factors for having erectile dysfunction?
1. Cardiovascular diseases.
The following risk factors that lead to heart diseases are also risk factors for erectile dysfunction:
- Lack of activity
- Cigarette
- Obesity
- High blood cholesterol level
- Metabolic Syndrome
2. Chronic diseases.
Diabetes, Hypertension, Chronic kidney failure are among these diseases. All chronic diseases are a risk factor.
3. Medicines
Continuous drug use is also considered among risk factors.
4. Surgeries
It can be seen after prostate cancer treatment such as radical prostatectomy or surgical interventions applied to the pelvic region.
5. Radiotherapy, Brachytherapy
Having received radiation therapy for organs in the pelvic region, especially the prostate (radiotherapy or brachytherapy)
What are the causes of erectile dysfunction?
1. Diseases involving the veins
- Cardiovascular diseases
- Hypertension (high blood pressure)
- Diabetes Mellitus
- Hyperlipidemia (high blood cholesterol, triglyceride, etc.)
- Smoking
- Having serious surgery on the pelvis
- Receiving radiation therapy in the pelvis
2. Neurological diseases affecting the nervous system
- After strokes
- Trauma, impact, accidents and spinal cord diseases affecting the spinal cord
- Diseases with brain degeneration (Parkinson, Multiple Sclerosis, etc.)
- Brain tumors
- Type 1 or Type 2 Diabetes involving nerves
- Chronic renal failure
- Nerve incision during pelvic surgery
3. Diseases that cause anatomical or structural disorders in the penis
- Hypospadias, Epispadias
- Micropenis (small penis)
- Peyronie disease
- Congenital penile curvature
4. Diseases due to hormonal disorders
- Hypogonadism (low level of male hormone in the blood)
- Hyperprolactinemia (high prolactin hormone in men)
- Hyper-Hypo thyroidism (high or low thyroid hormones)
- Hyper-Hypo cortisolism (such as Cushing’s disease)
5. Erectile dysfunction due to drug use
- Antihypertensive drugs (blood pressure lowering drugs)
- Antidepressants (drugs used to treat depression)
- Antiandrogenic drugs (drugs that reduce male hormone)
- Alcohol and drugs
Many psychological disorders or drugs used for these diseases can cause erectile dysfunction. Psychological problems may also occur after erection problems that occur due to a physical reason.
7. Traumas
Traffic accidents, electrical burns, stab wounds or erectile dysfunction after self-amputation are among the leading traumas. However, penile fractures also cause erectile dysfunction when they are not treated properly and on time.
How is the patient with erectile dysfunction evaluated?
First of all, the details of the disease are questioned. It is important to learn the detailed history of the patient. Many questions are asked, such as when it started, the number of weekly/monthly intercourse, the duration before intercourse, the duration of ejaculation, and how long the stiffness can last.
The causes of the hardening problem are examined. Apart from the erection problem, other health problems are examined. Psychosocial issues, physical examinations, laboratory and radiological diagnostic methods are used.
Which laboratory tests are required for men with erectile dysfunction?
- Fasting blood sugar
- Lipid profile (research for blood fats)
- Male hormone level (early morning blood sample)
Apart from these, the laboratory is expanded according to the patient’s condition.
What are the special diagnostic tests used to examine erectile dysfunction?
In some cases that cannot be diagnosed with routine tests in patients with erectile dysfunction, additional special diagnostic tests are needed. Not for every patient, but as a result of the doctor’s evaluation, the following tests are requested.
- Nocturnal Penile Tumescence (NPT):
It is an examination that investigates whether the erection problem is psychogenic. Although it was used more frequently in the past, its use is limited today.
- Intracavernosal (into the penis) injection test:
It is a test that evaluates blood supply and erection by injecting various drugs into the penis.
- Penile Doppler Ultrasonography:
It is a procedure in which the blood flow in the penis is measured by injecting a vasodilating agent into the penis.
- Cavernosometry-Cavernosography:
It is a special diagnostic method used in patients who are planned for special surgery. Its use has been gradually abandoned in recent years.
- Psychiatric evaluation:
It is a special evaluation method applied for patients with accompanying psychiatric complaints.
What is the treatment for erectile dysfunction?
The treatment of erectile dysfunction is based on 3 basic principles:
- Identification and elimination of correctable causes of erectile dysfunction
- Lifestyle changes and regulation of risk factors
- Ensuring adequate sexual education and communication for the patient and his partner
While applying all these, it is important to know the expectations of the patient and his partner. It is most appropriate to decide on the treatment to be applied together with the couples. While solving the erection problem on the one hand, it is important to support the couples psychosocially and to solve the other health problems of the man, on the other hand.
What methods are used in the treatment of erectile dysfunction?
Medication treatments:
- Oral tablets
- Medicines injected into the penis
- Medicines that are squeezed into the urethra
Non-drug treatments:
- Vacuum therapy devices
- Shock Wave Therapy
- sexual therapies
- Psychological treatments
- family therapies
- Surgical treatments
Which oral medications are used in men with erectile dysfunction?
Many existing drugs that are used as phosphodiesterase type 5 inhibitors can be used in treatment.
What is the difference between phosphodiesterase type 5 inhibitor drugs used orally in men with erectile dysfunction?
Although the efficacy of this group of drugs is generally similar to each other, the things that make the difference are the side effects and duration of activity.
What are the most common side effects observed in patients taking Phosphodiest*** Type 5 inhibitors?
- Headache
- Feeling of redness on the face
- Hot flush
- Indigestion
- Runny nose
- Visual disturbances
- Back pain
- Muscle pain
- Low blood pressure
Which patients should absolutely not use phosphodiester** Type 5 inhibitor group drugs?
- All Phosphodiesterase Type 5 inhibitors; Nitr**t should not be used within the first 48 hours after use.
- Ta**da***l should not be used in patients with severe hepatic impairment.
- V**ar***afil should not be used in drugs that use antiarrhythmics for the heart.
Can heart patients use Phosphodiesterase Type 5 (P D E **5) inhibitor?
The drugs that heart patients will use for their sexual life should be arranged after a detailed cardiological and urological examination. Heart patients should not use Phosphodiesterase Type 5 inhibitor group drugs without the advice of a doctor. Provided that they are under the supervision of a doctor, heart patients can also use Phosphodiesterase Type 5 inhibitor group drugs.,
What are the surgical methods used in patients with erectile dysfunction?
Surgical applications for veins:
Their efficacy is rather limited and their use is not common. Due to the fact that the success rates are not as high as expected and the long-term results in patients are below the expected level, they are abandoned today and are applied in rare cases.
Surgical correction of penile curvatures and plaques on the penis:
Erectile dysfunction is encountered in Peyronie’s patients who are middle-aged and older and present with penile curvature. Treatment is performed with surgical applications in order to solve the erection problem caused by curvatures and to improve the structural changes in the penis.
Happiness Stick (Penile Prosthesis) applications:
In cases where there is no response to other treatment methods, penile prosthesis surgery applications, also known as the happiness stick among the people, come to the fore. With these surgeries, the success rates of patient and spouse/partner satisfaction reach 90%.
Who is penile prosthesis surgery applied to?
This group of surgical methods is applied if there is no complete response to drug or other non-drug treatments or if patient compliance is not achieved. It is essential that other treatment options have been tried and failed before penile prosthesis surgery.
Is penile prosthesis surgery satisfactory?
According to the results of many applications in different centers of the world, the satisfaction of many patients and partners has been achieved. It has been reported in the literature that satisfaction rates have reached around 90% by both men and women, thanks to the improvements applied in prosthetic technologies in recent years.
Is penile prosthesis surgery noticeable from the outside?
It varies according to the type of prosthesis fitted. It is inevitable to notice it on the outside in permanently hard (malleable) prostheses. Because this type of prosthesis is always rigid, even if they are satisfactory in function, they cause difficulties in terms of carrying. In addition, it is very difficult to notice from the outside the prostheses (inflatable, inflatable) that only harden during intercourse and deflate at normal times.
Is there a herbal treatment for erectile dysfunction?
For many years, herbal treatments have been widely used for this purpose, especially before the production of synthetic drugs. Some of the drugs used for this purpose were used to increase the level of sexual desire, some to provide erection, and some to delay ejaculation.
Some of the foods used in daily life and some of the herbal solutions have also been accepted in the modern medical literature. However, it should be noted that today, all of these treatments can only be evaluated within the scope of complementary medicine and do not form the basis of the treatment of erectile dysfunction.
What are the drugs that cause erectile dysfunction?
It is known that many drugs used today cause erectile dysfunction (erectile dysfunction). Especially psychiatric drugs, various blood pressure lowering drugs, cardiac drugs, arrhythmia drugs, drugs acting on the central nervous system, anti-epileptics, histamine receptor blockers that reduce stomach acidity and many other drugs negatively affect the erection capacity of the penis.
Which antidepressant is used to treat erectile dysfunction?
Antidepressants are generally not preferred for treatment in patients with erectile dysfunction, since they reduce libido (sexual desire). The only antidepressant drug that can be used in patients with both erectile dysfunction and accompanying psychiatric symptoms is the drug starting with Traz***.
Is erection problem common in heart patients?
Heart diseases are common diseases in the society and their incidence increases with age. Considering that the incidence of erectile dysfunction increases with age, the probability of both occurring together is quite high.
There are many scientific studies on this subject in the medical literature. Heart diseases constitute a risky group in terms of erectile dysfunction. Particularly in cardiovascular diseases called coronary heart disease, negative effects of penile vessels is a frequently encountered picture.
What is the most important issue to be considered in the treatment of erectile dysfunction in coronary artery disease?
The most important issue in this group of patients is to inform the patients about not using random drugs for erectile dysfunction. This group of patients should definitely use erectile dysfunction drugs under the supervision of a doctor for erectile dysfunction complaints. Especially, P*D*E Five inhibitor drugs should not be used together with NITR**AR.
Do patients who use heart medications have erectile dysfunction?
A wide variety of drugs are used in the treatment of heart diseases. Many drugs such as those that increase the force of contraction in the heart (positive inotropics), rhythm regulators (antiarrhythmics), blood pressure reducers (antihypertensives), diuretics (diuretics) etc. are used.
While heart diseases can cause erection problems themselves, some of the drugs used for these diseases directly affect erection negatively. Among these drugs, especially those used as beta-blockers, impair erection more frequently.
Does erection deteriorate after heart bypass surgeries?
Coronary bypass surgeries are applied in cardiovascular occlusions. After surgery and depending on the drugs used, some patients have erectile dysfunction.
Is erectile dysfunction common in diabetics?
Diabetes Mellitus (diabetes) is a disease that affects the whole body system. All cells in the body, from the brain to the toenails, are affected by this disease. Therefore, diabetes mellitus is considered a systemic disease. The disease realizes all these effects in various ways:
- cular damage (vasculopathy)
- Nerve damage (neuropathy)
- Eye damage (retinopathy)
- Kidney damage (nephropathy)
Erectile dysfunction is one of the most common problems in diabetics, especially due to vascular damage and nerve damage.
E-S-W-T What is shock wave therapy?
The use of shock waves created outside the body by transferring them to the body with the help of an applicator is known as shock wave therapy. This service is also offered to our patients in our clinic located in Kale Ofis Plaza in Çukurambar, Ankara/Turkey.
In which diseases is shock wave therapy applied?
Its use is increasing in many departments in medicine, especially in the fields of Physiotherapy and Orthopedics. One of these departments is Urology. It was initially used to break up kidney stones, but in recent years, it has been increasingly used in patients with erectile dysfunction.
How does shock wave therapy affect erectile dysfunction?
It provides regeneration in the applied tissue. It provides an effect by increasing growth factors and accelerating the formation of new vessels. Therefore, tissue repair and healing
Shock wave therapy is used to solve which diseases in urology?
Studies on its effectiveness in various diseases such as Erectile Dysfunction, Peyronie’s disease, chronic prostatitis, chronic pelvic pain syndrome and painful bladder syndrome have been reported.
What is the role of shock wave therapy in the treatment of erectile dysfunction?
By increasing the formation of new vascularity, it ensures that the penis receives more blood and thus becomes harder.
Do mechanical devices and vacuum therapy devices have a place in the treatment of erectile dysfunction ?
Although its use in treatment is included in the main source books of urology, they have become less referred by patients with the emergence of other new treatments in recent years.
What is needle treatment for erectile dysfunction (erectile dysfunction)?
In cases where there is no response to oral drug treatments, it is tried to achieve an erection with some drugs that are squeezed into the penis. This is known as needle therapy for erectile dysfunction. For this purpose, drugs such as papaverine and alpros***l are used. These are drugs that must be used under the supervision of a doctor. It can be used initially after adequate training has been given to patients on how to use it.
Is there an erectile dysfunction cream?
There are medications that are sometimes used in the form of gel or cream in the treatment of erectile dysfunction.
Is erectile dysfunction related to masturbation?
One of the most frequently asked questions is whether masturbating too much will cause erectile dysfunction. From the point of view of evidence-based medicine, there is no clear data to confirm this claim.
Is erection problem seen in hemodialysis patients?
Hemodialysis is used in the treatment of chronic renal failure. In this way, harmful substances in the blood are removed from the body. Erectile dysfunction is a common complaint in patients with chronic renal failure.
Even if waste materials are removed from the body with hemodialysis, the negative effect of the disease is also on penile erection due to the systemic nature of the disease. With appropriate treatment, a happy sexual life can be maintained in this group of patients.
What can be the causes of erectile dysfunction in young men?
Young men often do not have a serious underlying physical organic cause. However, it does not mean that there will be no physical factors at all. In addition to congenital causes, many factors that may occur later (for example, after penile fracture) can cause erectile dysfunction in young men. However, the main factor to be investigated is the psychogenic ones.
Could it be a temporary erection problem?
Of course it can. In erection problems of psychogenic origin, there may be temporary erection problems that can change depending on the place, situation, time and occur in different degrees. This condition may heal completely or may recur from time to time.
Is there a relationship between chronic hepatitis and erectile dysfunction?
Chronic hepatitis is a disease that affects the entire body system. Although its relationship with erection is primarily through the metabolism of male hormon, which is one of the most effective hormones on erection, erectile dysfunction occurs in the penis through many mechanisms.
Is there a relationship between metabolic syndrome and erectile dysfunction?
There are many clinical studies showing the relationship between metabolic syndrome and erectile dysfunction. Many conditions such as obesity, increase in body mass index, negative changes in lipid profile, glucose intolerance, lack of regular physical education exercise, sedentary life are associated with metabolic syndrome and also cause erectile dysfunction.
Does nicotine (cigarette) use cause erectile dysfunction?
It is a scientific fact that has been proven by numerous experimental and clinical studies that nicotine (smoking) has a negative effect on erectile capacity in the penis. If you notice, this issue is emphasized with dramatic photographs on some of the cigarette packages sold in the markets.
In which conditions is neurogenic erectile dysfunction seen?
- Traumas
- Diseases involving the central nervous system
- Pelvic region surgeries
- Radiotherapies
- Multiple Sclerosis
- Diabetes Mellitus (diabetes)
When does erectile dysfunction improve after quitting smoking?
It is impossible to give an exact figure. Many factors such as the age of the person, the number of years he has been smoking, concomitant diseases, and the drugs he uses are important in determining this period.
AS A RESULT:
- Erectile dysfunction is one of the most common diseases.
- Although it is common in elderly patients, it can also occur in young people.
- It may occur due to vasculogenic, neurogenic, anatomical, endocrine, psychogenic, systemic diseases and some drugs.
- In addition to detailed anamnesis and physical examination, routine and special tests are used for diagnosis.
- Oral medications, drugs injected into the urinary canal and drugs injected into the penis are used in the treatment.
- Shock wave therapy is a promising treatment for patients with erectile dysfunction and is an area where more clinical studies are needed.
- Penile prosthesis is the most frequently applied surgical method for erectile dysfunction, and the treatment success rate has reached over 90%.