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Erectile Dysfunction

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Erectile dysfunction in men (impotence) is also known as “erectile dysfunction”, “impotence” or “erection problem”. Erection means the hardening and erection of the penis. Due to work and spouse problems, economic problems, mental tensions, fatigue, other problems in the relationship, etc., every man may encounter erection problems at some point in his life. This is natural and normal. Because it is not usual to expect to achieve an adequate erection at all times and under all circumstances. However, if the erection problem recurs frequently, is persistent and often prevents sexual intercourse, this condition requires treatment. Impotence is not sexual aversion. It is different from ejaculation problems. And it should never be confused with premature ejaculation or infertility. An impotent man can orgasm and become a father. In other words, a patient with erectile dysfunction can have sexual desire and ejaculate without any problems.

Age plays an important role in erectile dysfunction. In men over 40 years of age, the incidence increases. Men may have periods of erectile dysfunction throughout their lives, but permanent erectile dysfunction is rare under the age of 40. This rate increases with age and 65% of 70-year-old men have erectile dysfunction. Although a number of age-related changes occur in advanced age, these changes do not always cause erectile dysfunction. Most men need more penile stimulation (stimulation of the penis by touch) for erection in old age, the degree of hardness of the penis when erect decreases and any distraction during intercourse leads to loss of erection. The frequency of sexual intercourse has decreased, but it is equally satisfying. This is very important for a man to feel good about himself.

An erection is a natural reflex of a healthy penis and nervous system. This reflex can be damaged in any problem in the anatomical structure of the penis or in the nervous system.

Anatomy of the Penis and How Does Erection Happen?

Anatomically, there are two spongy cylinders called corpora cavernosa inside the penis parallel to the urethra. When a man is sexually aroused, the nervous system stimulates the penis to come alive. The muscle of the penis and the arteries to the penis relax to fill the sinusoids inside the spongy cylinders with blood. This leads to enlargement and hardening of the organ and an erection. As the blood fills the sinusoids, the pressure and tension that increases in the organ puts the veins under pressure and the blood flow is adjusted by blocking the circulation. This adjustment of the blood flow helps to maintain the erection. The brain, spinal cord, nerves, blood vessels, smooth muscle of the penis and hormones are involved. The muscles of the spongy cylinders are controlled by special centers in the brain and spinal cord, which allow the penis to erect and relax. These centers are influenced by sexual contact, erotic stimuli or fantasies to produce erections, while anxiety, insecurity, excitement, fear and stress have a negative effect on erections.

What are the Causes of Erectile Dysfunction?

Erectile dysfunction often has more than one cause. The causes may be psychological, physiological or a combination of both. Differentiation between psychological and physiological causes is important for the choice of treatment. The causes of erectile dysfunction can be examined in 3 main groups:

  1. Psychological reasons
  2. Physical causes
  3. Psychological and physical causes

1) Psychological reasons:

Stress, constant professional pressure, a sense of failure in professional and family life, constant problems between spouses, physical antipathy and fear of the woman becoming pregnant, fear of failure, misinformation about sexuality or discovery, rejection, sadness, etc. Mental distress such as anxiety and depression caused by reasons such as anxiety and depression can cause erectile dysfunction. Problems related to marriage; disruption of role balances in the relationship, the dominant character structure of the female spouse, marital problems, communication problems, deception or infidelity can cause erectile dysfunction in men. Negative perceptions about sexuality depending on the man, strict, prescriptive, traditional family structure, being raised with strict religious and moral rules, not being given any sexual information can lead to erectile dysfunction in men. Sexual traumas experienced during childhood and adolescence; harassment, rape, abuse, incestuous relationships, bad results of the first sexual experience, lack of knowledge and experience can also cause erectile dysfunction in men. Both unconscious and intrapsychic and couple-related conflicts can cause erectile dysfunction. These conflicts are likely to arise in the vulnerable male when he is about to engage in sexual activity. However, many of the erectile dysfunctions we see in the clinic are produced by simpler, much more easily corrected emotional factors. These include performance anxiety, fear of rejection by the woman, anticipation of impotence due to past experience of erectile dysfunction, excessive concern with the woman’s satisfaction, and guilt about culturally induced sexual pleasure.

As a result, the above-mentioned psychologically-induced erectile dysfunction (impotence) is a problem that we encounter quite frequently in all age groups. Since the brain is the largest and most functional sexual organ, prolonged or recent mental traumas or mental traumas experienced in the past can cause erectile dysfunction. Men’s reactions to erectile dysfunction (impotence) include shame, guilt, confusion, loss of self-confidence, exhaustion and fatigue. Increasing performance pressure prevents the spontaneous occurrence of an erection. Instead of concentrating on the feeling of pleasure and sexual contact with his sexual partner, the man may have to struggle consciously or unconsciously with questions such as “what if I don’t get an erection?”, “will my penis get hard?”, “will my erection last until the end of the intercourse?”, “will my erection disappear again?”, “if it goes down without entering the vagina”. These negative thoughts can turn into a fear of failure, leading to loss of motivation and performance in the next sexual intercourse and putting the man in a vicious cycle. In other words, the most important psychological factor in the emergence or continuation of erectile dysfunction is negative expectations and thoughts about performance. The individual’s expectation that his/her performance will be inadequate and his/her thoughts about the problems that may arise as a result of inadequate performance will lead to intense anxiety and avoidance of sexual intercourse, sexual reluctance, and even depressive symptoms. Premature ejaculation, orgasm disorders and decreased sexual desire can also cause erectile dysfunction in an interrelated manner.

2-) Physical Causes:

a.) Diseases involving the blood vessels:

  • Cardiovascular diseases
  • Hypertension (high blood pressure)
  • Diabetes mellitus (diabetes)
  • Hyperlipidemia (high levels of cholesterol, triglycerides, etc. in the blood)
  • Smoking
  • Serious surgery on the pelvic region
  • Receiving radiation therapy (radiotherapy) for the pelvic region

b.) Neurological diseases affecting the nervous system:

  • After strokes
  • Trauma, impact, accidents and spinal cord diseases affecting the spinal cord
  • Diseases with brain degeneration (Parkinson’s, multiple sclerosis, etc.)
  • Brain tumors
  • Type 1 or type 2 diabetes (diabetes) involving the nerves
  • Chronic renal failure
  • Nerve incision during surgeries on the pelvic region

c.) Diseases that cause anatomical or structural defects in the penis:

  • Hypospadias, epispadias
  • Micropenis (small penis)
  • Peyronie’s disease
  • Congenital penis curvatures

d.) Diseases due to hormonal disorders:

  • Hypogonadism (low levels of the male hormone called testosterone 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)

e.) Erectile dysfunction due to drug use:

  • Some medicines used to treat high blood pressure
  • Some antidepressant drugs
  • Antiandrogenic drugs (drugs that suppress the male hormone testosterone)
  • Alcohol and drug use (heroin, cocaine, marijuana, etc.)

What are the Risk Factors for Erectile Dysfunction?

1 – Cardiovascular diseases are the leading risk factor. The following risk factors for heart disease are also risk factors for erectile dysfunction:

  • Lack of regular exercise
  • Cigarette
  • Obesity
  • High blood cholesterol level
  • Metabolic syndrome

2 – Chronic diseases have been identified as an important risk factor. Diabetes, hypertension and chronic renal failure are the most common of these diseases.

3 – Continuous use of medication for chronic diseases is also considered among the risk factors.

4 – Some surgeries: prostate cancer surgeries such as radical prostatectomy, rectal cancer surgeries, bladder cancer surgeries, aorta surgery, heart bypass surgeries can damage the pelvic area and nerves.

5 – Factors that increase vascular occlusion increase the risk for cardiovascular diseases and erectile dysfunction.

How is erectile dysfunction diagnosed?

To diagnose erectile dysfunction, a detailed history, physical examination and laboratory tests are required.

What are the Treatment Options?

After determining the cause of the erectile dysfunction, a personalized treatment plan is created. Treatment and control of other chronic diseases (e.g. diabetes, hypertension) is recommended for people with erectile dysfunction.

The main methods used in the treatment of erectile dysfunction:

  1. Medication: PDE5 inhibitors such as sildenafil (Viagra), tadalafil (Cialis), vardenafil (Levitra), avanafil (Stendra) are drugs that are effectively used in the treatment of erectile dysfunction. These medicines relax the blood vessels of the penis and increase blood flow, leading to an erection. However, you should be informed about the side effects and use of these medicines. It should be noted that taking these medicines can be dangerous for people with heart disease.
  2. Injection of medication into the penis: Some medicines that are administered into the penis are injected directly into the penis to achieve an erection. This method allows the medicines to work quickly and may be preferable for some men when oral medicines are ineffective.
  3. Penile implants: Implants surgically inserted into the penis can be a permanent solution to erectile dysfunction. However, this method is more invasive than other treatment options and should be considered as a last resort.
  4. Behavioral therapy: For erectile dysfunction caused by psychological reasons, therapy sessions and counseling can help. Therapy techniques are used to change the person’s thoughts, feelings and behaviors.
  5. Sexual therapy: These are therapy sessions between couples to address sexual problems. By strengthening communication between partners, it helps to solve problems in the relationship.
  6. Lifestyle changes: Adopting a healthy lifestyle can help prevent and treat erectile dysfunction. Steps such as exercising regularly, eating a healthy diet, reducing smoking and alcohol consumption, and avoiding stress can be useful in combating erectile dysfunction.

Treatment of erectile dysfunction may vary depending on the person’s age, health status, severity of the problem and personal preferences. Treatment options should therefore be discussed in detail with a health professional.

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