What is Erectile Dysfunction?
Erectile dysfunction in men is explained as the situation where the penis cannot reach sufficient hardness during sexual activity or the erection cannot be maintained sufficiently. Erectile dysfunction (impotence) in men is also known as "erectile dysfunction", "impotence" or "erection problem". Erection means the hardening and erection of the penis.
What Causes Erectile Dysfunction?
There may be various physical and psychological reasons that cause this problem. 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.
This problem is different from sexual reluctance, infertility or ejaculation problems and should not be confused with these problems. A man with erectile dysfunction (impotence) can also have an orgasm. In other words, a patient with erectile dysfunction may experience sexual desire and ejaculate without any problems.
As we mentioned, 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 can be examined in 2 main groups;
1. Psychological reasons
2. Physical causes
What are the Psychological Causes?
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 experienced in marriage, disruption of role balance in the relationship, or emotional turmoil may also cause erectile dysfunction.
In addition, sexual traumas experienced during childhood and adolescence; Abuse, rape, abuse, incestuous relationships, bad results of the first sexual experience, lack of knowledge and experience can also cause erection problems in men. It is produced by factors. These; It occurs for reasons such as performance anxiety, fear of rejection by the woman, expectation of impotence due to the past experience of erection difficulties, excessive concern for the satisfaction of the woman, and guilt about culturally induced sexual pleasure.
Physical Causes What are they?
These causes usually occur with vascular diseases, nerve diseases, hormone diseases, anatomical or structural disorders. If we need to list these diseases;
• Hyperlipidemia (High levels of cholesterol, triglycerides, etc. in the blood)
b.) Neurological diseases affecting the nervous system;
• Strokes
• Trauma, blows, accidents and spinal cord diseases
• Diseases that cause brain degeneration (Parkinson, Multiple Sclerosis, etc.)
• Brain tumors
• Type 1 or Type 2 Diabetes involving the nerves
• Chronic kidney failure
• Nerve incision during surgeries in the pelvis area
c.) Diseases that develop 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)
d.) Anatomical or structural disorder diseases;
• Hypospadias, epispadias
• Micropenis (small penis)
• Peyronie's disease
• Congenital penile curvatures
< br /> In addition, the use of some medications can also cause erectile dysfunction. can open. These drugs are;
• Some drugs used in the treatment of high blood pressure
• Some antidepressant drugs
• Antiandrogenic drugs (drugs that suppress the male hormone testosterone)
What are the factors that increase the risk of erectile dysfunction?
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, alcohol and drug use
• Obesity
• High blood cholesterol level
• Metabolic Syndrome
Chronic diseases have also been identified as an important risk factor. The main ones of these diseases are;
• Diabetes
• Hypertension
• Chronic kidney failure
Continuous use of medication for chronic diseases is also considered among the risk factors. In addition, some surgeries and radiation treatments also increase the risk. These are:
• A surgery performed in the treatment of prostate cancer, such as radical prostatectomy. br />
Men with erectile dysfunction should first be evaluated by a specialist urologist to investigate the presence of physical (organic, structural) factors.
How is Erectile Dysfunction Diagnosed?
Evaluation begins with taking the patient's history. In the story part, risk factors are questioned. Diabetes, high blood pressure and heart disease must be questioned. It is important whether the patient has undergone surgical intervention or 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. The next step after the story is physics muay ene. Attention should be paid to the genital area. Vascular and nerve functions should be tested. Peyronie's disease should also be investigated. A digital rectal examination can be performed to obtain information about the prostate. In addition, it is necessary to perform 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 penis vessels with the help of sound waves. The injection of erectile dysfunction drugs (papaverine) into the penis and the response of the penis tissue to this application can be observed. If there is no problem with blood flow, erection occurs.
In some patients, further examinations may be necessary. The first of these is the bulbocavernous reflex measurement, which is a neurological test. During this test, the doctor places one finger in the anus and squeezes the head of the penis with the other hand. Under normal conditions, the muscles around the anus contract. Thanks to another test, information is obtained about the presence and degree of erection during sleep. Every man experiences nocturnal erection 3-4 times during sleep. If the problem is physical, the frequency and degree of erections decrease. In the presence of psychological reasons, the patient continues to experience these erections. This test provides important information to the doctor in distinguishing between psychological and physical causes.
How is Erectile Dysfunction Treated?
Treatment must be carried out under the examination and management of a specialist urologist. .
Psychological causes are similar to those of vaginismus in women. In some cases, erection problems may also occur due to vaginismus. A man who cannot have sexual intercourse feels inadequate and suffers from anxiety disorder. In this case, sexual therapy is applied to the couples and the source of the problem is determined and tried to be solved. If the problem is physiological, it is tried to be treated with medications prescribed by the doctor. Generally, problems are resolved with the use of medications. If drug therapy is applied together with sexual therapies, the result will be more effective and achieved in a short time. In the later stages of the disease, medication is injected into the penis tissue. In some cases, medications are also injected into the urinary tract. Surgeries called penile prosthesis are also used in treatments.
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