ERENCE PROBLEM
Erection problem in men (impotence), 'erectile dysfunction', 'impotence' or 'erection' It is also known as the 'problem'. Erection means the hardening and erection of the penis.
Work and spouse problems, economic problems, mental tensions, fatigue, other problems in the relationship, etc. For various reasons, every man may encounter erection problems at some point in his life. This is a natural and normal situation. Because it is not normal to expect adequate erection at all times and under all conditions. However, if the erection problem recurs frequently, is persistent, and prevents sexual intercourse frequently, this condition requires treatment.
Impotence is not lack of sexual reluctance. It is different from ejaculation problems. And it should never be confused with premature ejaculation or infertility. An impotent man can orgasm and father. In other words, a patient with erectile dysfunction may feel sexual desire and ejaculate without any problems.
The age factor has an important place in those with erectile dysfunction (erectile dysfunction). Its incidence increases in men over the age of 40. Men may have periods of erection problems throughout their lives, but permanent erection problems under the age of 40 are rare. This rate gradually increases with age, and 65% of 70-year-old men have erection problems.
Although some age-related changes occur in later ages, these changes do not always cause erection problems. Most men need more penile stimulation (touching stimulation of the penis) for erection in old age, the degree of hardness of the penis during erection decreases and there is no discomfort during sexual intercourse. A distraction results in loss of firmness. The frequency of sexual intercourse has decreased, but the relationship is equally satisfactory. This is very important for the man to feel good.
Erection is a natural reflex of a healthy penis and nervous system. This reflex may be damaged if there is any problem in the anatomical structure of the penis or in the nervous system.
Anatomy of the Penis and How Does Erection Happen?
Anatomically Inside the penis, there are two spongy cylinders called Corpora Cavernosa, parallel to the urethra. When a man is sexually aroused, the nervous system stimulates the penis to come to life. The muscle of the penis and the arteries coming to the penis relax to fill the sinusoids inside the spongy cylinders with blood. This provides erection by enlarging and hardening the organ. As the sinusoids fill with blood, the increasing pressure and tension within the organ puts the veins under pressure and, in a way, the circulation is blocked and the blood flow is adjusted. Adjusting the blood flow in this way ensures the continuity of the erection. The brain, spinal cord, nerves, blood vessels, penile smooth muscle and hormones play a role in the occurrence of this event. The muscles of the spongy cylinders are managed by special centers in the brain and spinal cord, ensuring erection and relaxation of the penis. While these centers provide erection by being affected by sexual contact, erotic stimulation or fantasies, anxiety, insecurity, excitement, fear and stress also negatively affect erection.
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. Distinguishing between psychological and physiological causes is important in terms of treatment selection. The causes of erectile dysfunction are in 3 main groups. can be examined:
1. Psychological reasons
2. Physical reasons
3. Psychological and physical reasons
1-) Psychological reasons:
Stress, constant professional pressure, feeling of failure in professional and family life, constant problems between spouses, physical antipathy and fear of the woman getting pregnant, fear of failure, misinformation about sexuality or being discovered, rejection, sadness, etc. Mental distress such as anxiety and depression arising from various reasons may cause erectile dysfunction.
Problems related to marriage; Disruption of role balance in the relationship, the dominant character structure of the female partner, negativities related to marriage, communication problems, cheating or infidelity can cause erection problems in men.
Negative perceptions about sexuality depending on the man, strict, normative, traditional family. structure, upbringing with strict religious and moral rules, and not being given any sexual information can lead to erection problems 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 erection problems in men. Both unconscious, intrapsychic and couple-related conflicts can cause erectile dysfunction. These conflicts are likely to arise when the vulnerable man is about to engage in sexual activity. However, many of the erectile dysfunction 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, expectation of impotence due to past experience of erection difficulties, excessive concern for the satisfaction of the woman, and culturally induced sex drive. It covers the feeling of guilt about sexual pleasure.
As a result, the psychologically caused erectile dysfunction (impotence) mentioned above is a problem we encounter quite frequently in all age groups. The largest and most functional sexual organ is the brain. Long-term or newly started psychological traumas or psychological traumas experienced in the past can cause erectile dysfunction. Men's reactions to erectile dysfunction (impotence) include shame, guilt, confusion, loss of self-confidence, It is in the form of boredom and fatigue. Increasing performance pressure prevents the spontaneous erection. Instead of concentrating on the feeling of pleasure and sexual contact with his sexual partner, the man says "If I don't get an erection", >"I wonder if my penis will become hard?" Consciously or unconsciously struggling with questions such as ,"will my erection last until the end of intercourse?", "will my erection disappear again?", "if it goes down before entering the vagina" These negative thoughts can turn into a fear of failure, causing loss of motivation and performance in the next sexual intercourse and putting the man in a vicious circle. 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 performance will be inadequate and his thoughts about the problems that may arise as a result of inadequate performance will cause intense anxiety and avoidance of sexual intercourse, sexual reluctance, and even depressive symptoms.
Premature ejaculation, orgasm disorders and decreased sexual desire are also interconnected. It may cause erectile dysfunction in the province.
2-) Physical causes:
a.) Diseases involving the veins
• Cardiovascular diseases
• Hypertension (high blood pressure)
• Diabetes Mellitus (diabetes mellitus)
• Hyperlipidemia (High blood cholesterol, triglyceride etc.)
• Smoking
• Having serious surgery on the pelvisregion
• (pelvis)region receiving radiation therapy (radiotherapy)
b.) Neurological diseases affecting the nervous system
• After strokes
• Trauma, impact, accidents and spinal cord diseases that affect the spinal cord
• Diseases that lead to brain degeneration (Parkinson, Multiple Sclerosis, etc.)
• Brain tumors
• Type affecting the nerves 1 or Type 2 Diabetes (diabetes mellitus)
• Chronic kidney failure
• Nerve incision during surgeries to the pelvic region
c.) Diseases that cause anatomical or structural disorders in the penis
• Hypospadias, epispadias
• Micropenis (small penis)
• Peyronie's disease
• Congenital penile curvatures
d.) Diseases that develop due to hormonal disorders
• Hypogonadism (low levels of the male hormone called testosterone in the blood)
• Hyperprolactinemia (high levels of prolactin hormone in men)
• Hyper-Hypo thyroidism (high levels of thyroid hormones or low)
• Hyper-Hypo cortisolism (such as Cushing's disease)
e.) Erectile dysfunction due to drug use
• Some drugs used in the treatment of high blood pressure
• Some antidepressant drugs
• Antiandrogenic drugs (drugs that suppress the male hormone testosterone)
• Alcohol and drug use (heroin, cocaine, marijuana, etc.)
f.)Traumas (penis ruptures, penis fractures, etc.)
In erectile dysfunction What are the risk factors?
1. Cardiovascular diseases are the leading risk factors. The following risk factors that lead to heart diseases are also risk factors for erectile dysfunction:
• Lack of regular exercise
• Smoking
• Obesity
• High blood cholesterol level
• Metabolic Syndrome
2. Chronic diseases have been identified as an important risk factor. The leading diseases include Diabetes, Hypertension and Chronic Renal Failure.
3. Continuous use of medication for chronic diseases is also considered among the risk factors.
4. Some surgeries: Having undergone a surgery performed in the treatment of prostate cancer, such as radical prostatectomy
5. Having received radiation therapy to the pelvic area and organs in the pelvic area, especially the prostate (radiotherapy or brachytherapy)
Physical ( organic, structural) Men with erectile dysfunction should first be evaluated by a specialist urologist to investigate the presence of factors.
How is Erectile Dysfunction Diagnosed?
Evaluation It starts with taking the patient's history. In the story part, risk factors are questioned. Diabetes, high blood pressure and heart disease must be questioned. Surgical intervention of the patient It is important whether or not the patient has been exposed to radiation therapy. It is necessary to obtain information about serious accidents he has had, smoking and alcohol consumption, and the medications he is using and has used in the last year.
The patient should be asked whether he feels pain when the penis becomes erect or whether it develops deformity or curvature. If these problems exist, Peyronie's disease should come to mind. Psychological reasons should also be questioned. Hik�
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