Erection problem in men, or medically known as erectile dysfunction (ED), is the most important sexual dysfunction. By definition, erectile dysfunction is the inability to maintain the hardness of the penis at a level that does not allow initiating or continuing sexual intercourse. It can occur in men of all ages, whether young, middle-aged or elderly. Although it is basically caused by some psychogenic or organic problems, the reality is this: In every erection problem, a more or less psychogenic factor is either present at the core of the event or is added to the event later. Therefore, psychogenic factors play a huge role in the rooting of erection problems.
Of course, erection problems are not a vital health problem. However, it is a very important issue that disrupts psychosocial life, couple relationships and therefore quality of life. Studies show that half of men between the ages of 40 and 70 have erection problems. It is reported that approximately 10% of the same age group has severe erection problems. The frequency and severity of erection problems increase significantly with age, especially after the age of 60. In scientific studies conducted in our country, it has been determined that one in every 3 men in the 40 to 70 age group has moderate to severe erection problems.
The first issue addressed in men with erection problems is undoubtedly whether the problem is organic or not. Whether it is of psychogenic origin. Organic problem means that the disease is caused by a physical (vascular or neurological) disease. Generally, organic causes are considered more prominent in men over the age of 40 who complain of ED. Psychogenic erection problem (PsED) is the name given to erection problems that are not due to a physical disease, but only due to psychological distress and lack of skills. A significant portion of erection problems, which generally occur at young ages, are due to psychogenic background. We generally think that the core problem may be psychogenic under the age of 40 and organic after the age of 40. However, the opposite situations are not uncommon and should always be kept in mind. Although there is an organic cause at the core of the problem, psychological factors (disappointment, hopelessness, Hurt feelings of timidity, etc.) cause the incident to grow like a snowball. It should not be forgotten that it is a small stone particle that starts an avalanche, but it is the piles of snow that create the real destruction.
ERECTILE DYSFUNCTION OF ORGANIC ORIGIN
1 -ED due to Vascular Insufficiency (Vasculogenic type)
a) arterial insufficiency (due to arterial narrowing)
b) cavernous insufficiency (due to venous leakage)
c) mixed (two in one)
2-ED Due to Nerve Damage (Neurogenic type)
3-ED due to hormonal imbalances (Endocrinological type)
4-Drug ED developing due to side effects
5-ED due to various surgeries or radiotherapy (Iatrogenic type)
In organic type, there is always an underlying physical disease. is the subject. And the condition often begins gradually and is progressive. That is, most of the time (unless there is an acute trauma or surgery), it does not start suddenly and starts from mild within 6 months and reaches levels that will only disturb the person after a certain period of time. If the patient gives a very recent date for the ED problem, we can say that the problem is most likely psychogenic, not organic.
Risk Factors: The person develops ED of organic origin, especially in middle age. If this is the case, there are often risk factors that predispose to this. These factors cause the problem to be more serious and to occur earlier. Even reducing or keeping these risk factors under control can be therapeutic in itself. Moreover, studies have shown that men who have experienced serious health problems such as heart attack and stroke begin to complain of ED at least 2 years in advance. In other words, erectile dysfunction should be interpreted as an alarm given by the body in middle and older ages. The main risk factors are:
Diabetes
Hypertension
Heart Diseases
Smoking
High cholesterol
Obesity
Sedentary inactive lifestyle (sedentary life)
ED Due to Arterial Insufficiency: A common disease that we often call atherosclerosis. It is a reflection of the arteriosclerosis problem. In other words, the artery that sends clean blood to the penis (internal pudendal artery) It occurs due to narrowing of the r-dorsal penile artery) and the resulting decrease in blood pressure in the penile cavernosal tissue. The artery of the penis is an extremely thin vein and reaches the penis directly from a main large artery. If a person has atherosclerosis problem, this delicate artery leading to the penis is first affected. For this reason, ED problems may begin in a person months or years before problems such as heart attack or stroke occur. Very rarely, in cases such as a traffic accident, the pudendal artery may rupture alone, and in this case, ED may develop due to traumatic-acute arterial insufficiency. The diagnosis of ED due to arterial insufficiency is made by penile doppler ultrasonography. Some treatments are applied depending on the severity of the narrowing.
ED Due to Cavernosal Insufficiency (Venous Leak): Normally, as the penis fills with clean blood, the veins in the cavernosal - spongy tissue are compressed and closed. Therefore, blood is trapped in the penis cavernosa and erection continuity is ensured. If the vein valve structures are somehow damaged, blood leaks from the penis and this can cause erection problems. It usually manifests as an inability to achieve a full erection or to maintain an erection even if it is achieved. Especially in positions where the woman is on top, the erection problem is felt more severely due to gravity. Cavernosal insufficiency, also known as venous leakage, can occur in both young and old people. Degenerative changes due to aging, Peyronie's disease, diabetes, traumatic consequences of penile fractures, and unnecessary excessive use of penis pumps are the main factors that deteriorate the valve structures. Diagnosis is again made by penile doppler USG examination.
Neurogenic Type ED: Neural damage at both peripheral and central levels can also cause erection problems. In order for an erection to occur, the smooth muscles in the cavernosal tissue must relax. This relaxation occurs thanks to some molecules we call neurotransmitters, released from nerve endings. If there is a nerve damage, they cannot be released, and therefore, even if the vessels are intact, the cavernosal pools cannot expand because muscle relaxation cannot occur. Damage to peripheral nerves The most important disease that causes diabetes is undoubtedly diabetes. Apart from this, chronic alcoholism, chronic renal failure, and nerve damage after radical prostate surgery are the most common causes of peripheral neurogenic type ED. In addition, central neurogenic causes such as MS, Parkinson's disease, spinal cord injuries (due to spinal fractures) are other diseases that can cause ED.
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Hormonal Type ED: Caused by the hypothalamus, pituitary gland and testicles. Low or high levels of secreted hormones can both reduce sexual desire and cause erection problems. The male hormone we call testosterone is like the fuel of the entire system. It is produced regularly in the testicles every day and released into the blood in a certain amount, especially in the morning hours. And this hormone allows the system to work by attaching to the appropriate receptors from the brain to the skin. In this way, the continuity of both masculine instincts, sexual desires and masculine appearance (beard, hair, voice thickness, muscles, etc.) is ensured. Any disease that causes a decrease or suppression of the testosterone hormone (hypogonadism) causes problems in sexual desire and sexual behavior. It is not known exactly what function the prolactin hormone, secreted from the pituitary gland located at the base of the brain, has in men. However, excessive production of this hormone (hyperprolactinemia) causes suppression of testosterone hormone. Low secretion of FSH-LH hormones, which are responsible for stimulating the testicles from the pituitary gland (hypogonadotropic hypogonadism), may also cause a decrease in testosterone production. Apart from this, it has been shown that testosterone production from the testicles gradually decreases with age (approximately 1% each year). This condition develops a little earlier and faster in some men and may cause that man to experience sexual problems due to testosterone deficiency at an early age. In medical terms, this condition is called ADAM (androgen deficiency in aging men) syndrome or, more commonly, Andropause. The main symptoms of PADAM syndrome are:
Decrease in sexual desire and motivation
Erection problem
Fatigue, exhaustion, feeling of lack of energy
Extreme anger and anger
Construct your skin thinning of the body
Decrease in muscle strength and muscle mass
Decrease in hair growth
Gynecomastia (enlargement of breasts)
Sleep disorders
< If such symptoms begin in men over the age of 40, it is necessary to check whether there is a decrease in male hormones, that is, ADAM syndrome. This condition not only affects sexual life and mental health, but can also have more serious consequences such as osteoporosis. The problem can be solved with appropriate hormone replacement and vitamin-food supplements. The diagnosis of erection problems due to hormonal problems can be easily made by checking various hormone levels in the morning fasting blood and sometimes by pituitary MRI film.ED due to drug side effects: Various medications can also cause erection problems. It can open. In fact, in almost 25% of patients presenting with ED complaints, the main cause of ED is some medications used. Some antipsychotic-antidepressant drugs, some hypertension drugs (especially beta blockers) and drugs with antiandrogenic effects are the most common drugs that can cause ED. The problem can be solved by making an arrangement regarding the medications, taking into account the person's disease and side effect status.
Iatrogenic and Traumatic Type ED: Sometimes the nerves cannot be protected in patients who have undergone radical pelvic surgery due to Prostate Cancer. This This is a situation related to the spread of cancer and the erectile capacity before the operation. If the nerves are severely damaged, ED may develop in these patients. Radiotherapy applied to this area (for reasons such as prostate rectum cancer) can also damage the nerves. Traumatic events such as penile fracture (breakage of the penis) or posterior urethra injury (rupture of the urinary tract from the bottom in traffic accidents) can cause nerve damage and ED complaints. Treatment often involves penile prosthesis application, depending on the person's health condition.
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MEDICAL EVALUATION OF THE MAN WITH ERECTION PROBLEMS:
First, a detailed psychosexual history (when and how it started) is taken, and then risk factors, medications used and past treatments are analyzed. Whether the ED complaint is situational (that is, whether it varies depending on the partner and the situation) or whether it is a persistent
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