Erectile Dysfunction
What Is Erectile Dysfunction?
Definition of Erectile Dysfunction (ED)
Erectile dysfunction (ED), commonly known as impotence, is a condition in which a man is unable to achieve the penile erection necessary for sexual intercourse, is unable to maintain it at an adequate level, or loses his erection during intercourse.
Medically, erectile dysfunction is defined as a condition that persists for at least 3 months and negatively affects a person’s quality of sexual life.
Key Points
Erectile dysfunction ≠ temporary difficulty achieving an erection
Erectile dysfunction ≠ an inevitable consequence of aging
How Common Is Erectile Dysfunction?
In men over 40: 30–40%
Among men aged 60 and older: more than 50%
Among men with diabetes: 60–70%
In people with cardiovascular disease: much higher
📌 Erectile dysfunction can often be an early warning sign of heart and vascular diseases.
How Does the Mechanism of an Erection Work?
For a normal erection, the following systems must work in harmony.
The Brain and the Central Nervous System
Sexual desire (libido)
Psychological warning
Visual, tactile, and mental stimuli
Peripheral nervous system
Pelvic nerves
Cavernous nerves
Circulatory system
Dilation of the penile arteries
Blood flow in the corpora cavernosa
Inhibition of venous outflow
Endocrine system
Testosterone
Thyroid hormones
Prolactin Balance
📌 A disruption in any link of this chain results in erectile dysfunction.
Causes of Erectile Dysfunction
Vascular erectile dysfunction
is the most common cause of ED.
Arteriosclerosis (atherosclerosis)
Hypertension
Diabetes
Cigarette
Hyperlipidemia
Metabolic syndrome
📌 Because the blood vessels in the penis are very thin, erectile dysfunction can occur years before a heart attack or stroke.
ED caused by neurological factors
Spinal Cord Injuries
Surgery for a herniated disc
Multiple sclerosis (MS)
Parkinson's
Diabetic neuropathy
Nerve damage following pelvic surgery
📌 ED that occurs after prostate, bladder, and rectal surgeries falls into this category.
Hormonal (endocrinological) causes
Low testosterone
Hypogonadism
Thyroid Disorders
Elevated prolactin levels
Cortisol imbalances
📌 Testosterone deficiency;
The quality of the erection
Sexual desire
directly affects the response to treatment.
Psychological erectile dysfunction
It is particularly common among young men.
Performance anxiety
Depression
Anxiety
Relationship problems
Traumatic sexual experiences
📌 Psychogenic ED is the primary cause in men who experience morning erections but are unable to achieve an erection during intercourse.
Medication-induced erectile dysfunction
Antidepressants (SSRIs)
Blood pressure medications
Prostate medications
Some heart medications
Chemotherapeutic Agents
📌 In cases of medication-induced ED, switching medications is often sufficient.
ED Following Surgery and Radiation Therapy
Radical Prostate Cancer Surgeries
Bladder Cancer Surgeries
Pelvic radiation therapy
Testicular surgeries
📌 The risk increases in patients who do not undergo nerve-sparing surgery.
Risk Factors for Erectile Dysfunction
Advanced age
Obesity
Sedentary lifestyle
Cigarettes and alcohol
Sleep apnea
Chronic stress
Long-term bicycle use
How Is Erectile Dysfunction Diagnosed?
Detailed medical history
Duration of erection
Start time
Hardness rating
Morning erection
Partner Status
International surveys
IIEF (International Index of Erectile Function)
SHIM score
📌 It is used not only for diagnosis but also to evaluate the success of treatment.
Laboratory tests
Total and free testosterone
Fasting blood sugar
HbA1c
Lipid Profile
Prolactin
TSH
Viewing
Penile Doppler Ultrasound
Arterial insufficiency
Venous leak
The vascular structure is evaluated
📌 It is the gold standard for diagnosing ED.
Treatment Options for Erectile Dysfunction
Lifestyle changes
Oral medications
Intracavernosal injection therapies
Vacuum devices
Shockwave therapy
Regenerative therapies
Penile prosthesis surgery
📌 Treatment should be tailored to the individual and based on the underlying cause.
The Basic Principle in the Treatment of Erectile Dysfunction
Erectile dysfunction cannot be treated with a single type of prescription;
why
age
comorbidities
expectation
partner status
It should be tailored to the individual, taking this into account.
Lifestyle Changes (The Foundation of Treatment)
It may be sufficient on its own for mild to moderate ED.
Quitting Smoking
Weight loss
At least 150 minutes of exercise per week
Mediterranean-style diet
Sleep Schedule
Reducing alcohol consumption
📌 These measures improve not only ED but also cardiovascular health.
Oral Medications (PDE-5 Inhibitors)
Sildenafil
Tadalafil
Vardenafil
Avanafil
Mechanism of action
Relaxation of the blood vessels in the penis
Increased blood flow
Facilitating the onset and maintenance of an erection
📌 They are not effective without sexual stimulation.
Medication Comparison
Sildenafil: 30–60 minutes / 4–6 hours
Tadalafil: 30 minutes / 24–36 hours
Vardenafil: 30 minutes / 6–8 hours
Avanafil: 15–30 minutes / 6 hours
📌 Tadalafil is also known as the “weekend pill.”
If There Is No Response to Oral Medications
Saying “The medicine didn’t work”
does not mean “the treatment is over.”
Intracavernosal Injection Therapies
Direct administration of the drug to the corpora cavernosa
Severe vasodilation
Effect independent of the nervous system and hormones
It is one of the most effective non-surgical treatments.
Vacuum Devices
It promotes blood flow using negative pressure
It causes mechanical stiffening
The natural sensation is faint but functional.
Shock Wave Therapy (ESWT)
Supports new blood vessel formation
Improves vascular function
It is not a miracle on its own; it is part of a combination therapy.
Regenerative Therapies (PRP – Exosomes – Stem Cells)
Tissue repair
The goal is to promote nerve and vascular healing
It is not an alternative to standard treatment, but rather a complement to it.
Penile Prosthesis Surgery (Permanent Solution)
It is performed when all other treatments have failed and a permanent solution is desired.
Malleable
Inflatable
Today, patient satisfaction is over 90 percent.
What Happens If It Isn't Treated?
Loss of sexual desire
Depression
Relationship problems
Loss of self-confidence
Social isolation
Conclusion and Overall Assessment
Erectile dysfunction is a condition that can be treated with a high success rate today.
The important thing is;
correct diagnosis
identifying the underlying cause
It is a personalized treatment plan
Erectile dysfunction is not inevitable.
With early intervention and a scientific approach, a solution is possible.
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