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After premature ejaculation, the most common sexual dysfunction is called 'erectile dysfunction' or also known as 'impotence,' which is defined as the inability to achieve sufficient penile hardness for sexual intercourse or the inability to sustain an existing erection.
Although erectile dysfunction is commonly considered a problem that occurs after the age of 50, it can also occur in younger individuals. Mild, moderate, or severe erectile dysfunction can be observed in half of men between the ages of 40-60 in society. Despite its prevalence, patients often delay seeking medical attention due to psychosocial concerns, and as with any illness, delayed diagnosis reduces treatment success in erectile dysfunction. In this article, we will seek answers to common questions about erectile dysfunction. However, in order to understand erectile dysfunction, we first need to know the anatomy of the penis and the physiology of erection.
There are three channels inside the penis. Two of these channels facilitate erection and are called 'corpus cavernosa.' The other channel, 'corpus spongiosum,' surrounds the urethra, allowing the passage of urine and semen. When the senses of sight, smell, touch, hearing, and thought stimulate the body, signals are sent to the penis's blood vessels through the nervous system. After these signals, the arteries within the penis expand, and blood begins to fill the aforementioned 'corpus cavernosa' channels. As these channels fill with blood, the veins close, trapping blood inside the penis, resulting in an erection.
As can be understood from this, in addition to appropriate psychosocial conditions for a healthy erection, a person must also have a healthy vascular structure, nerve tissue, and smooth muscles. If damage occurs in any of these tissues, erectile dysfunction begins.
Erectile dysfunction can occur due to physical or psychological reasons. Now let's take a detailed look at the conditions that can lead to erectile dysfunction…
In the diagnosis of erectile dysfunction, a detailed medical history and physical examination by an andrology specialist are often sufficient. During this stage, factors that could contribute to erectile dysfunction, such as psychological factors, medications used, underlying diseases, and previous surgeries, are questioned. Additionally, a careful genital physical examination of the patients is performed.
After these stages, blood tests, including cholesterol and blood sugar levels, are requested to assess the risk of cardiovascular disease in patients. Furthermore, in cases where hormone-related erectile dysfunction is suspected, blood tests measuring hormones such as testosterone and prolactin must be conducted, as the treatment for hormone-related erectile dysfunction differs. Doppler ultrasound of the penis is requested in patients with suspected vascular-related erectile dysfunction. For the evaluation of psychologically related erectile dysfunction, assistance can also be sought from sexual therapists.
It should also be noted that men over the age of 40 with erectile dysfunction have an increased risk of heart attack within the next 5 years. Therefore, a comprehensive cardiovascular assessment is necessary for these patients.
Erectile problems can be prevented by avoiding risk factors and making certain lifestyle changes. These include:
However, even with all these precautions, some individuals may still experience erectile dysfunction. In such cases, after a detailed examination by an andrology specialist, appropriate treatments recommended by the physician should be utilized.
There are many treatments available for erectile dysfunction, depending on the underlying cause. In cases of erectile dysfunction related to vascular problems, medications that promote blood vessel dilation and regeneration, as well as shockwave therapy (ESWT), are the initial treatments. However, in cases where these treatments are insufficient or in patients with evidence of damage to smooth muscle and nerve structures, treatments such as PRP (platelet-rich plasma), SVF (stromal vascular fraction), and exosome therapies should be added to the protocol.
In addition to these treatments, there are injection therapies that can provide instant erections in the penis. For patients who do not benefit from any of these treatments, 'penile prosthesis (penile implant) surgery,' which permanently resolves erectile dysfunction, is performed.
In cases of erectile dysfunction due to venous insufficiency, deep venous ligation surgeries, shockwave therapy (ESWT), and stem cell treatments (SVF) are combined for treatment.