Erectile Dysfunction

1.What is an erectile dysfunction?

Erectile dysfunction is the inability to provide sufficient penile rigidity for sexual intercourse or the inability to maintain a penile erection. Erectile dysfunction is a very common health problem that increases with age. Erectile dysfunction, the frequency of which is increasing day by day in society, is a disorder that has a negative impact on the incumbent and his spouse, affecting approximately 150-200 million men in the world, and the number of affected people is expected to reach 320 million in 2025. Studies have reported that 52% of men between the ages of 40-70 have erectile dysfunction. In a study conducted by the Turkish Andrology Association in our country in the early 2000s, the rate of erectile dysfunction was determined to be 69%. It has been determined that the frequency and severity of erectile dysfunction increases with age. Although erectile dysfunction is generally thought of as a health problem observed in the 50s and 60s, it is also frequently encountered at younger ages (in the 20-30s). In the past, it was believed that the cause of erectile dysfunction was mainly the result of psychological issues, but nowadays, with the developments in the field of health and new diagnostic methods, it has been understood that the majority of patients have erectile dysfunction as a result of an underlying ailment.

Erectile dysfunction has become a health problem that affects a large number of people due to the prevalence of modern life all over the world, decrease in physical activity, high calorie food consumption, obesity, bad habits such as smoking and alcohol, and the increased stress level. Erectile dysfunction affects a person’s daily life, work life, success at work, and domestic relationships. We see many problems such as depression, failure in business life, and a dissatisfactory married life in people with erectile dysfunction. Therefore, erectile dysfunction is not a health issue but also causes serious social problems.

2.When should patients with erectile dysfunction see a doctor?

Patients with erectile dysfunction should consult a urology specialist as soon as possible instead of trying to find a solution on their own. Progression of the problem can be prevented by early measures when the erection problem starts or occurs. If erection problem develops due to reasons such as diabetes or metabolic syndrome and adequate precautions are not taken, the effect of drug treatments to be applied to patients will end early and penile prosthesis treatment, which is the last treatment option, will need to be implemented to the patient earlier. The primary treatment method of erectile dysfunction is the elimination of risk factors, and precautionary and protective measures to be taken at an early stage will prevent the occurrence of other ailments.

Since erectile dysfunction occurs due to other underlying ailments, the full implementation of recommendations regarding healthy lifestyle will be beneficial in preventing erectile dysfunction as well as prevent it from getting worse.

3.What are the reasons of erectile dysfunction?

The causes of erectile dysfunction are evaluated under two main headings as organic (caused by a disease) and psychological. Organic causes are also called physical causes. Erectile dysfunction occurs as a result of physical reasons, vascular, hormonal and neurological problems. Diabetes, coronary heart disease and hypertension can be cited as examples of vascular causes of erectile dysfunction. Hormonal reasons, low testosterone, high prolactin can also be mentioned. Multiple sclerosis and prostate cancer surgery can be mentioned as neurological causes that can lead to the development of erectile dysfunction.

Non-age-related risk factors for erectile dysfunction are coronary heart diseases, hypertension, diabetes, obesity, metabolic syndrome and urinary tract diseases. The frequency of urinary tract disorders (prostate enlargement, prostate cancer) increases in men with advancing age, studies mention the association of urinary tract problems and erectile dysfunction. The frequency of diseases increases with advancing age, and the frequency of erectile dysfunction resulting from them increases at the same rate.

Some patients consult a urology doctor for erectile dysfunction and learn that they have diabetes as a result of tests. Erectile dysfunction can sometimes be the first symptom of diabetes. In this case, if  diabetes is undetected or not under control, it manifests itself as an erection problem by creating problems in penile veins as well as in all the veins in the body.

Erectile dysfunction can also occur at an early age with obesity and metabolic syndrome. Erectile dysfunction can be treated by reducing weight, exercising and eliminating the metabolic syndrome.

4. What are the physical causes of erectile dysfunction?

The physical causes of Erectile dysfunction can be listed as follows:

– Vascular causes: Arterial problems, Vein problems (venous leakage), Diabetes, Cardiovascular diseases, Hypertension

– Hormonal causes: Testosterone deficiency, elevated Prolactin, Hypogonadism, Hypothyroidism,

–Neurological causes: Parkinson’s disease, Strokes, Dementia, Encephalitis, Multiple sclerosis, Spinal canal diseases (Disc herniation, tumors)

Abnormalities caused by diseases manifest as erectile dysfunction. Today, the increase in the prevalence of obesity has increased the incidence of Type II Diabetes (Diabetes), and accordingly, the frequency of erectile dysfunction has increased. The use of vehicles brought by modern life, a sedentary and non-exercising lifestyle, the high rates of additives and sugar in food have led to an increase in the frequency of cardiovascular diseases, and accordingly, an increase in erectile dysfunction has been observed.

5. What are the psychological causes of erectile dysfunction?

Erectile dysfunction was generally thought to be caused by psychological reasons before developments in medicine enabled the evaluation of its causes at the present level. Research has  revealed that erectile dysfunction can be caused by vascular or neurological reasons associated with a disease in the body. Nowadays, although erectile dysfunction occurs due to physical reasons, it is accompanied by psychological reasons ranging from mild to severe in all patients.

In the evaluation of the causes of erectile dysfunction, psychological causes are examined in two main groups as standing and situational. Standing psychological erection problems can be counted as lack of sexual desire, decreased sexual desire due to aging, long-lasting problems related to sexuality, while partner-related reasons, performance problems, feeling of inadequacy, depression, major life stress can be counted as situational ones..

6. What risk factors are associated with erectile dysfunction?

General risk factors associated with erectile dysfunction are the overall health status, diabetes, cardiovascular diseases, diseases of the reproductive organs (prostate, testis, kidney and urinary tract diseases) and psychiatric – psychological disorders.

Well-known risk factors for erectile dysfunction are smoking, medications, and hormonal causes. Obesity, drugs used to combat diseases, a sedentary lifestyle (no exercise – no sports), excessive alcohol use can also be counted among risk factors.

7. What are the complications of erectile dysfunction treatment?

Depending on the drugs used in the treatment of erectile dysfunction, if they are used without the recommendation of a doctor, this can lead to a heart attack and even death. Problems may arise depending on the interaction with other drugs used by the patient. Such drugs should be used after the patient is examined and recommended by a urologist.

In the treatment of penile injection used in the treatment of erectile dysfunction, problems such as bruising and curvature of the penis can occur due to incorrect application if the patient is not given prior training. The risk of developing infection in penile prosthesis surgery, which is applied as the last option in the treatment of erectile dysfunction, varies between 1-3%, and in some cases, an infection rate can reach 7-8%.  In cases of infection, different procedures are applied, up to replacement of the prosthesis.

8. Can the erection problem be prevented?

Erectile dysfunction can occur for many reasons. Erectile dysfunction can be prevented or its progression can be stopped with some measures to be taken. Erectile dysfunction can be prevented by treating such ailments as diabetes mellitus completely, ensuring that the patient follows his diet, exercises daily, and takes measures to control his weight. When the hormonal problem is corrected with the treatment, the erection problem will also be solved if the hormonal problem has been the reason for the erection problem.

Let’s assume that the patient presenting with erectile dysfunction has had uncontrolled diabetes for years and is overweight. The idea is that if weight loss is achieved with bariatric surgery and the diabetes is controlled, and the erection problems will improve in patients who have undergone surgery. However, if the patient has been under the influence of uncontrolled diabetes for 7-8 years, it is not possible to completely eliminate post-operative erection problem. If the penile veins have incurred irreversible damage due to uncontrolled diabetes mellitus, the erection problem needs to be corrected with drugs, needles or penile prosthesis surgery that helps erection.

9. How is an erection problem diagnosed?

Detailed information about the onset and progression of the problem is obtained from the patient who complains of erectile dysfunction, the medications he uses, any surgeries and interventions he has undergone, smoking, alcohol habits, weight, height, daily or weekly exercise amount and what kind of exercises he does. The person’s eating habits, sleep patterns, stress status, and whether he has family problems with his spouse are questioned in detail. The genital area and a prostate examination is performed if the patient is over 50. Necessary blood tests are requested. According to the examination and the patient’s history, a penile Doppler ultrasound examination is requested if necessary. As a result of the evaluation of the examinations and the patient history, the cause of the erection problem is clarified and the treatment option is determined according to the treatment alternatives.