Erectile Dysfunction Treatment

Erectile Dysfunction

Erection problems, also called “erectile dysfunction,” are the most common male sexual dysfunction after premature ejaculation. They can be defined as the inability of the penis to become sufficiently hard for satisfying sexual intercourse, or the inability to maintain the erection until the end of intercourse.

Erection problems can arise from physical and/or psychological causes. Their frequency increases with age, but they can also affect young men. An erection problem may be permanent or temporary; indeed, the recurrence of the problem is an important criterion for making a diagnosis.

Closely identified with the perception of “manhood” in our society, this sexual dysfunction can cause men psychological distress, problems in their sexual life, partner dissatisfaction and communication barriers between couples. Beyond all this, erection is a complex process, and a disruption in this process may point to various health problems. The subject is sensitive; women as well as men have to face the consequences of erection problems. To take the necessary measures and evaluate treatment options, it is important to know the answers to the question “what is erectile dysfunction?”

Before going into the details of erection problems, I would like to share some information about the anatomy of the penis. This way, the delicate and complex nature of this sexual dysfunction can be understood more clearly.

How Does the Penis Become Erect?

Behind the question “how does an erection happen?” lies a series of chemical and physical processes. Nerves, blood vessels, hormones, muscles and much more come into play during erection. A chain of successive events results from different centers in the body working simultaneously. Let us explore the details together.

There are three separate channels inside the penis. Two of these channels are cylindrical, tube-like structures called the “corpora cavernosa.” Outside the corpora cavernosa there is a protective capsule called the “tunica albuginea.” The last channel is known as the “corpus spongiosum” and contains the canal through which urine and semen are expelled.

These tubes, which allow the penis to become erect before intercourse and to stay erect during intercourse, contain millions of tiny blood vessels. When sexual arousal occurs as a result of exposure to stimuli such as smell, touch, sound or sight, the central nervous system, hormones, blood vessels, nerves and the smooth muscle tissue in the penis are activated and increase blood flow to the vessels inside the tubes.

As the tubes begin to fill with blood, they expand and lengthen. Then the protective capsule called the “tunica albuginea” compresses the veins so that the blood stays in the tubes and the erection is maintained, and the blood is thus trapped inside both tube structures. After sexual satisfaction, the process reverses and the blood in the tubes drains back.

So what exactly is an erection problem? Let us answer from a different perspective…

What Is Erectile Dysfunction?

Erectile dysfunction is when, upon arousal, the tube structures inside the penis do not fill with blood, in other words the penis is not engorged; or, although blood flows into the tubes upon arousal and they fill with blood, the blood in the tubes returns to the body through the veins before intercourse is over.

From this, we can speak of two separate physiological processes that cause erection problems. Despite arousal, either not enough blood reaches the tubes and they do not fill with blood (we call this “Arterial Insufficiency”), or although blood reaches the tubes, the veins cannot perform their task of holding the blood. (We call this “Venous Insufficiency.”)

In arterial insufficiency, the penis cannot reach sufficient hardness for intercourse; in venous insufficiency, the penis cannot maintain its erection until the end of intercourse. Patients who complain, “I can have intercourse, but I lose my erection before intercourse is over,” must be evaluated for venous insufficiency. This is because the treatment applied to patients with sexual dysfunction caused by arterial insufficiency does not work in patients with venous insufficiency. I will discuss these differences in treatment in more detail.

Now let us look at the causes behind erection problems…

What Are the Causes of Erection Problems?

Like other sexual dysfunctions, erection problems can result from physical and psychological causes. Evaluating the causes separately is a more accurate approach.

Physical Causes of Erection Problems

Insufficient blood flow to the penis: Many different and serious health problems can reduce blood flow to the penis. Blood supply to the penis may decrease due to risk factors such as hardening of the arteries, cardiovascular disease, smoking, high cholesterol, obesity, hypertension, advancing age and a sedentary lifestyle.
Inability to hold blood in the penis during intercourse: The reasons for not maintaining an erection throughout intercourse parallel the causes of venous insufficiency. A history of cancer treatment such as for prostate cancer, diabetes, cardiovascular disease, smoking and high cholesterol can unfortunately affect the veins of the penis and cause erection problems.
Central Nervous System Problems: Due to causes such as multiple sclerosis, spinal cord injuries, antidepressant use and operations in the pelvic region, communication between the brain, spinal cord and penis may be damaged, resulting in erectile dysfunction.
In addition to all this, Peyronie's disease, characterized by the formation of scar tissue in the penis, alcohol and substance addiction, sleep disorders and low testosterone levels can also lead to this sexual dysfunction.

Psychological Causes of Erection Problems

As I always say, for a healthy sexual experience the mind and body need to act together. If men have emotional problems, they may experience erection problems, and the problem may also become progressive.

Depression and anxiety,
Relationship problems,
Stress and
Performance anxiety are psychological causes that can lead to erection problems.
Because erection problems have different causes, treatment also needs to differ. In this sense, an accurate diagnosis is critically important. This brings us to our next topic, the diagnostic process.

How Is Erectile Dysfunction Diagnosed?

People with erection problems should not overlook the fact that various health problems may be causing them. Although the frequency increases with age, young men can also have erection problems, and various conditions, including diabetes and cardiovascular disease, may lie behind them.

In light of all these facts, comprehensive investigations are essential to make an accurate diagnosis in patients presenting with erection problems. Of course, a medical history is taken first. This includes how long the complaint has been present, its severity, how often it occurs, whether there is a chronic illness, whether the patient smokes or drinks alcohol, and details about lifestyle.

It is important to complete the physical examination of the penis and testicles and to obtain information about nerve sensitivity. Blood tests and hormone tests can determine the testosterone level and check for the presence of chronic diseases. In addition to blood tests, a urine test may also become necessary.

In addition, it is important to investigate whether blood flow in the penis is healthy. Penile color Doppler ultrasonography may be needed to evaluate whether blood flows into the tubes inside the penis, the arteries that carry blood to the penis, and the function of the veins that keep the blood inside the tube structures throughout intercourse. Thanks to this imaging technology, it is possible to identify the vascular causes of erection problems.

“I always emphasize that because erection problems can arise from many different organic causes, the diagnostic process must also be carried out comprehensively.

If no organic cause of the erection problem can be found, psychological support is recommended, with the partner or spouse taking part in therapy if possible.

The accuracy of the diagnostic process will be one of the most fundamental bases for determining the most suitable treatment methods for the patient. The causes identified can be quite varied, which brings to mind the question “can erection problems be prevented?” Let us find the answer to this question together…

Can Erection Problems Be Prevented?

Whether erection problems can be prevented depends on their causes. While some causes cannot be prevented, this sexual dysfunction can be prevented or delayed by taking measures that protect and/or improve heart and vascular health. I can list the recommendations that help with erection problems as follows:

Excessive alcohol consumption and smoking, if present, should be avoided.
A healthy diet and regular exercise are important to prevent diseases that damage vascular health, such as diabetes, high blood pressure and high cholesterol. This can reduce the risk of two major diseases that cause erection problems: heart disease and obesity.
If chronic diseases are present, they should be kept under control.
If possible, a stress-free lifestyle should be adopted.
Ultimately, despite all precautions, preventing erection problems may not always be possible. People experiencing erection problems should first consult urology and andrology specialists and undergo a comprehensive diagnostic process. The results obtained are critically important for correctly determining and planning treatment options.

Erectile dysfunction is a TREATABLE sexual dysfunction. When planning treatment, the patient's age, general health, the cause of the erection problem and how advanced it is should be taken into account. So which treatment methods can correct erection problems?

How Is Erectile Dysfunction Treated?

Treatment methods for erectile dysfunction can basically be considered in two separate groups, depending on whether the sexual function problem is caused by arterial insufficiency or venous insufficiency.

Treatment of Erectile Dysfunction Caused by Arterial Insufficiency

In arterial insufficiency, characterized by the tubes not filling with the amount of blood needed for sufficient hardness, in other words the penis not becoming engorged, treatment methods such as medication, PRP (P-Shot) therapy, shock wave therapy (ESWT), SVF stem cell therapy and penile prosthesis surgery can be applied.

At our clinic, PRP therapy, shock wave therapy and SVF stem cell therapy are provided for the treatment of erectile dysfunction caused by arterial insufficiency.

Like all our treatments, the methods we use for erection problems are determined individually for each patient, with the aim of choosing methods that can provide our patients with the most effective results in the shortest time.

All treatments are performed in a clinical setting, and our patients are given detailed information about the requirements before and after treatment.

Treatment of Erectile Dysfunction Caused by Venous Insufficiency

At our clinic, venous insufficiency is treated with Dorsal Vein Ligation surgery. For our patients who achieve sufficient hardness for intercourse but cannot maintain it until the end of intercourse, penile color Doppler ultrasound technology is used to diagnose venous insufficiency; if the results indicate leakage in the veins and the patient's general health does not prevent an operation, surgery can be planned.