Erectile Dysfunction Disorders
Erectile dysfunction, or “erectile dysfunction ” as doctors prefer, is a common problem that affects one out of every ten men throughout their lifetime. Sexuality is an important element in human life that affects the quality of life beyond the biological reproductive function. For this reason, problems related to sexuality can affect social relationships in a very negative way. Here you will find answers to some questions about the causes of erectile dysfunction, diagnosis and treatment methods.
What is the Hardening Problem?
The erection problem is defined as the inability to reach the level of hardness that can ensure successful sexual contact or the inability to maintain this level of hardness adequately. It does not mean the same as premature ejaculation or infertility (infertility). it appears more often in men over the age of 40. Other sexual functions of men who have erectile dysfunction are usually normal. To give an example, a patient who has an erection problem may feel sexual desire and ejaculate without problems.
What is the Incidence of Hardening Problem?
The problem of hardening is a very common problem. It includes a wide range ranging from an occasional hardening problem to a completely lost hardening function. Deceleration is a problem that occurs from time to time. Most men experience problems with hardening at a certain time in their life, especially when they are under stress or when they are suffering from a serious illness. If this problem persists for a long time, medical help should be sought. it has been found that 30% of men between the ages of 40 and 70 have problems with getting Decapitated in any way. With advancing age, the incidence and severity of the erectile dysfunction problem increases. Cigarette and alcohol consumption, high blood pressure, diabetes, high blood fat, heart disease, depression and drugs used in the treatment of these diseases are risk factors for erectile dysfunction
How Does Hardening Occur?
Hardening is the result of a complex mechanism. The brain, spinal cord, nerves, blood vessels, penile smooth muscle and hormones play a role in the occurrence of this event. Nov. For hardening, arousal is required as a result of images, thinking, touch, smell, sound or a combination of them. As a result of the stimulation, the brain sends activating signals to the nerves of the penis. Signals sent from the brain reach the erection rings, called the corpora cavernosa. Under the influence of signals, the penile tissue relaxes and the arteries dilate. The corpora cavernosa consists of 2 cylinders standing side by side in the penile tissue. An elastic connective tissue called the tunica albuginea surrounds the corpora cavernosa.
When the penile tissue relaxes and the arteries dilate, the amount of blood entering the erection rings increases. As a result, the penis expands and lengthens. The balls that allow blood to move away from the penis compress the veins of the inner wall of the tunica albuginea. Thus, the blood is trapped in the penis. The continuation of sexual stimulation ensures the continuation of this process and, as a result, the level of stiffness. Hardening continues until ejaculation or sexual interest ends. Then the penis returns to its former soft state.
What are the Causes of the Hardening Problem?
The problem of erectile dysfunction often has more than one cause. The causes may be psychological, physiological, or a combination of both. The separation of psychological and physiological causes is important for the choice of treatment. The causes of the hardening problem can be examined in 3 main groups:
- Psychological reasons
- Physical causes
- Psychological and physical reasons
1-) Psychological reasons:
Among the psychological causes, stress and anxiety are the main ones. Dec. For example, a sexually active man may have erectile dysfunction problems that start suddenly after he is fired from his job. In case of stress and anxiety, penile mechanisms are normal. But the signals that the brain sends to the penis can be blocked. Fear of failure is another important cause of hardening problem. If a patient who is worried about his ability to achieve sexual contact is unable to achieve successful sexual contact, his anxiety increases even more. Psychiatric diseases such as depression can also lead to erectile dysfunction.
2-) Physical reasons:
Vascular diseases: The most common physical cause of erectile dysfunction is vascular-related diseases. Vascular diseases affect the amount of blood that reaches the penis and provides erectile dysfunction. At the same time, the retention of blood in the penis and therefore the maintenance of hardening may also be affected. Hardening of the veins and any disease affecting the vascular system is a risk factor for hardening problems. Arteriosclerosis (atherosclerosis) is a serious problem, especially for men over the age of fifty. It causes the arteries to narrow and the blood flow to the penis decreases. Smoking, high blood pressure, diabetes (diabetes), heart disease and high blood fat are other important risk factors.
Diseases of the nervous system: In this group of diseases, the message from the brain to the penis is blocked. Examples include spinal cord injuries, diseases related to brain vessels, multiple sclerosis, surgical procedures for the bladder, prostate and large intestine. Some diseases, such as diabetes, affect both the vascular and nervous system, leading to erectile dysfunction.
Medications: Many medications used for high blood pressure, heart diseases, and psychiatric diseases can be the cause of erectile dysfunction.
Hormonal causes: The relationship between low testosterone levels produced from the testicles and the problem of erectile Deceleration has not yet been clarified. Studies have shown that low testosterone levels do not always negatively affect hardening. But having testosterone lower than normal can reduce sexual desire.
With advancing age, the incidence of erectile dysfunction also increases. The reason is not aging itself, but diseases that affect the vessels, such as high blood pressure, diabetes, which appear more often in elderly patients, and medications used to treat these diseases. Smoking and alcohol consumption also have an impact. Pelvic bone fractures or traffic accidents can also lead to an erection problem. As a result of the accident, the vessels that supply the penis and/or the nerves that stimulate the penis may be injured. Some surgical methods and radiation treatments also negatively affect hardening. For example, surgical treatments for prostate, bladder and rectal cancer pose a risk for erectile dysfunction. As mentioned earlier, the hardening problem often has more than one cause. A diabetic patient may also be consuming cigarettes and alcohol. The same patient may have blood pressure disease and an increase in blood fats. All this can affect the vessels and/or the nervous system. Each of them is a separate risk factor for erectile dysfunction.
Why Should One Insist On Treatment When There Is An Erection Problem?
Today, almost all men who have erectile dysfunction problems can be treated in a way that can please both the patient and the partner. It is important to know that there are many treatment alternatives and that treatment success may vary depending on the severity of the disease. Therefore, even if the first treatment approach cannot solve the problem, secondary treatment alternatives should be questioned. During diagnostic attempts, diabetes, high blood pressure, neurological diseases and heart disease can be diagnosed. Improvements in hardening can also be achieved while treating these diseases.
How To Tell If There Is an Erection Problem Or Not?
The erectile dysfunction problem can only be diagnosed after an examination by a doctor. For this reason, it is necessary to discuss the issue with the doctor and seek treatment. A diagnosis is often made with the information obtained from the patient and a physical examination. Some simple tests may be requested to help make a diagnosis. Advanced examinations come into play in young patients and in the presence of certain special diseases.
How is Erectile Dysfunction Diagnosed?
The evaluation begins with taking the patient’s story. Risk factors are questioned in the story section. Sugar disease, high blood pressure and heart disease should definitely be questioned. It is important whether the patient has undergone surgical intervention, whether he has been exposed to radiation therapy. Serious accidents, smoking and alcohol consumption, other risk factors that should be learned about the medications he uses and has used in the last year.
The patient should be asked if he feels pain when the penis hardens, or if he develops deformity, curvature. If you answered “yes” to any of these questions, Peyronie’s disease should come to mind. Psychological reasons should also be questioned. The next step after the story is a physical examination. Attention should be paid to the genital area. Vascular and nerve functions should be tested. At the same time, Peyronie’s disease should be investigated. A rectal examination with a finger can be performed to obtain information about the prostate
It is necessary to do some blood and urine tests. Testosterone and sugar levels in the blood should be measured. The level of blood fats should be known. Color Doppler Ultrasonography is a sensitive test that provides information about the penile vessels with the help of sound waves. The injection of drugs that provide erection into the penis and the response of the penile tissue to this application can be observed. If there is no problem with blood flow, hardening will occur. In some patients, it may be necessary to perform further examinations. The first of these is bulbocavernous reflex measurement, which is a neurological test. During this test, the doctor places one finger on the breech and squeezes the penis head with the other hand. Under normal conditions, the muscles around the breech contract. Nov. Thanks to another test, information about the presence and degree of hardening during sleep is obtained. Normally, every man experiences erection 3-5 times during sleep. If the problem is physical, the frequency and degree of hardening decreases. In the presence of psychological causes, the patient continues to experience these hardenings. This test provides important information to the doctor in the separation of psychological and physical causes.
How is the Erectile Dysfunction Problem Treated?
The choice of treatment method depends on whether the cause is physical or psychological. For example, if a young patient has erectile dysfunction during sleep, if a physical examination, blood/urine tests are normal and his general condition is good, why is it most likely psychological In such a situation, the help of psychologists specializing in sex therapy should be sought. Interviews can be conducted with the participation of the patient’s partner.
In the case of erectile dysfunction due to physical causes, treatment for the cause can be applied.
If the cause is a pelvic injury, surgical intervention may be performed, if the testosterone level is low, testosterone replacement therapy may be performed. But in general, there are 4 main treatment methods used to treat erectile dysfunction:
- Medicines used by mouth
- Vacuum device
- Injection into the penis
- Penis prosthesis
These treatment methods do not eliminate the cause. But it ensures that the level of hardening that will allow sexual contact is reached. The first-line treatment of the erectile dysfunction problem is created by drugs used by oral intake and called phosphodiesterase type 5 enzyme inhibitors. The first member of this group is sildenafil citrate. Vardenatil and tadalafil are the other group members that have just been released to the market. Men with erection problems take these drugs before starting sexual activity. Medications strengthen the natural signals that occur during sexual contact. In this way, a better quality and long-lasting hardening is provided. These drugs are reliable and highly effective. It resolves the problem of erectile dysfunction in about 80% of patients. Phosphodiesterase type 5 enzyme inhibitors have mild and usually temporary side effects. The severity of side effects decreases with continuous use. The most common side effects can be listed as headache, a feeling of fullness in the nose, hot flashes and November.
Drugs Used by Mouth
Phosphodiesterase Inhibitors
These drugs came to the agenda towards the end of the 1990s. With the introduction of sildenafil, many patients have been turning to treatment. Sildenafil for the first time clinically. in 1991, it was tried in the treatment of ischemic heart disease. During these studies, patients complained of hardening as a side effect.
Sildenafil
Sildenafil is an inhibitor of the phosphodiesterase type 5 enzyme and provides hardening by increasing cyclic Guanosine Monophosphate (cGMP) levels. An increase in the level of cGMP leads to relaxation in smooth muscles and thus hardening. Nov. Sildenafil is recommended to be used in doses of 25, 50 or 100 mg. It is taken an hour before sexual intercourse. According to the cause of the erectile Deceleration problem, the effectiveness of the drug varies between 65-70%. In many groups of diseases that lead to erectile dysfunction (diabetes, endocrine, neurological, psychological, post-pelvic surgery, arteriogenic, venogenic. idiopathic) has proven its effectiveness. It has no effect
on increasing sexual desire. Sildenafil reaches its maximum level in the blood within 1 hour and leaves the body mainly through the liver. The effect lasts for 4 hours. within 8-12 hours, the entire drug will be excreted from the body. Although the maximum blood level is reached within 1 hour, the effect is observed in 20 minutes in 50% of patients. To increase the effectiveness, patients are advised not to eat or drink water until 1-2 hours before taking sildenafil. Sildenafil is a reliable and effective treatment option for heart patients who do not use nitrate group drugs.
Vardenafil
Vardenafil is another phosphodiesterase type 5 enzyme inhibitor. There are some pharmacological similarities between vardenafil and sildenafil. Dec. Vardenaftl has been shown to inhibit the phosphodiesterase enzyme 10 times more strongly than sildenafil. Vardenafil is more specific to the phosphodiesterase type 5 enzyme and blocks the phosphodiesterase type 6 enzyme less than sildenafil. Vardenafil is absorbed faster than sildenafil and reaches its maximum level in the blood in 0.7-0.9 hours. vardenafil, used in doses of 5,10 and 20 mg, has success rates of up to 80%. It gives the impression that it is superior to other PDE5 inhibitors in patients with sugar disease and patients who have undergone surgery for prostate cancer.
Tadalafil
Tadalafil also acts by blocking the phosphodiesterase type 5 enzyme. Its structure is different from other group members. Tadalafil. it gets into the blood slower than sildenafil and vardenafil. The maximum blood level is reached in 2 hours. In addition, the half-life of tadalafil (the time it takes for blood levels to decrease by half) is longer than its competitors (17.5 hours). Thus, tadalafil provides effectiveness for 36 hours. The fact that tadalafil is effective for 36 hours has led to the drug being called a “weekend drug”. The absorption of tadalafil is not affected by age, alcohol consumption or food. Tadalafil is used in doses of 5, 10 and 20 mg.
The safety of phosphodiesterase type 5 enzyme inhibitors
Clinical studies and experience have shown that phosphodiesterase inhibitors are reliable drugs. Complaints such as headache, hot flashes, or a feeling of fullness in the nose may occur due to the dilation of blood vessels. Problems with vision may occur. This effect is due to the inhibition of the phosphodiesterase type 6 enzyme. In studies with tadalafil, undesirable side effects such as back pain and November muscle pain were observed in about 15% of patients rather than visual complaints. Phosphodiesterase inhibitors do not increase the risk of heart disease events. These drugs should definitely not be used in combination with nitrates.
Vacuum Device
Vacuum devices consist of a plastic cylinder, a vacuum pump and an elastic compression band.
A lubricating agent is applied to the penis. The penis is inserted into the cylinder
Air is pumped out of the cylinder. Thus, a vacuum effect is created and hardening occurs.
The compression band located at the free end of the cylinder is placed at the root of the hardened penis. Thus, the continuation of the hardness level is ensured. The cylinder separates from the penis. The compression band can stay on the penis for half an hour. It continues to harden until the tape is removed. This technique can be easily learned and many people have had successful results with treatment.
Intraperitoneal Injection
Vasodilator drugs are injected into the corpora cavernosa with the help of a fine needle. These drugs work by relaxing the penile tissue and dilating the vessels. Thus, the amount of blood entering the erection rings increases and hardening occurs. Intra-penile injection is applied to a group of patients in whom German oral medications have previously been tried and failed. This technique can be easily learned by the patient to use at home. The appropriate dose is determined separately for each patient. The patient makes an injection to himself 0-15 minutes before sexual intercourse and as a result of the appropriate dose adjustment, hardening is provided for about half an hour. Drugs injected into the penis are usually combined with each other. Papaverine/phentolamine. Papaverine/phentolamine /PgEl and PGEi are combinations used in the treatment of phentolamine. Vasodilator drugs can also be used to measure the response of the penis to these drugs. Patients who have intraperitoneal injections may have pain during erection, and nedbe tissue may develop in the penis during long-term use.
Penis Prosthesis
A penile prosthesis consists of two synthetic cylinders that are inserted into the penis by surgical intervention. The prosthesis does not affect the act of urination and sexual functions such as ejaculation, orgasm. 2 types of prosthesis are used. Malleable (malleable), semi-rigid prosthesis and inflatable prosthesis. Inflatable prostheses, in addition to the cylinders in the penis, contain one pump and one reservoir. Oct. The liquid is pumped from the reservoirs into the cylinders and thus the penis hardens. By pressing a button on the base of the pump, the liquid collected in the cylinders returns to the reservoir and the penis softens. Inflatable dentures have higher pest rates and provide a more natural appearance. Penile prostheses are rather applied to a group of patients who cannot benefit from the treatment methods listed above, this group consists of those with uncontrolled diabetes mellitus, patients who have undergone surgery or radiation therapy with a diagnosis of prostate cancer or bladder cancer. The placement of a penile prosthesis in this group of patients has resulted in patient satisfaction rates of up to 90%.
Vascular Surgery
In this treatment, it is aimed to increase blood flow and blood pressure in the penis. It is especially applied in young patients who have had an accident that will prevent normal blood flow. This treatment method is based on directing a healthy artery to the penis. Today, it is used in a very limited number of cases.
Application of Drugs to the Urinary Tract
In this treatment method, alprostadil is applied to the urinary tract by inserting a small plastic cylinder from the tip of the penis. Enough active substance reaches the penile tissue to ensure hardening. It is applied 10-15 minutes before sexual intercourse and provides success in 43% of patients. It may cause a temporary burning sensation in the urinary tract.
Psychological Counseling
Those who have erectile dysfunction problems will be affected psychologically, even if the cause is physical. Psychological counseling provides important benefits in terms of identifying the problem and solving it. Psychological counseling is especially needed in young male patients where physical causes rarely appear.
For any problems experienced with hardening, a doctor should definitely be consulted and as much accurate and detailed information should be provided as possible. In fact, it should be known that this discomfort is very common and there is no shame in it. New treatment methods are emerging every year, and it is possible to treat all kinds of erectile dysfunction problems.
