What is Erectile Dysfunction (Impotence)?

Erection is a process that occurs when the penis fills with blood and this blood is trapped in the penile tissue as a result of the interaction between hormonal, vascular, and nervous systems following sexual stimulation. This process enables the penis to become ready for sexual intercourse. However, if there is any disruption in this process—meaning the inability to achieve or maintain an erection—this condition is called erectile dysfunction. Erectile dysfunction is a common sexual health problem that can significantly affect the quality of sexual life. Moreover, scientific studies have shown that erection problems may also be an indicator of cardiovascular diseases.

Causes of Erectile Dysfunction

There are many causes of erectile dysfunction. The most common causes include:

• Cardiovascular diseases
• Diabetes
• Hypertension
• Obesity
• Sedentary lifestyle
• Smoking and alcohol use
• Cancer and cancer treatments (especially prostate, bladder, and testicular cancers)
• Penile deformities (such as Peyronie disease)
• Hormonal disorders (originating from the pituitary, thyroid, or testes)
• Neurological diseases (Parkinson, MS, stroke, spinal cord injuries)
• Certain medications (especially antihypertensives and antidepressants)
• Psychological factors (stress, anxiety)
• Renal and hepatic failure

Diagnosis of Erectile Dysfunction

Diagnosis of erectile dysfunction involves taking the patient history and performing a physical examination. Subsequently, basic laboratory tests such as complete blood count, fasting blood glucose, lipid panel, testosterone levels, and liver-kidney function tests are requested. In men over 50, a prostate-specific antigen (PSA) test should also be performed. Advanced tests such as penile Doppler ultrasonography and nocturnal erection testing may also be required.

Treatment Methods

The primary goal in treating erectile dysfunction is to eliminate the underlying risk factors. After this, appropriate treatment methods are selected:

• Lifestyle Modifications: Quitting smoking and alcohol, regular exercise, healthy nutrition, and stress reduction form the basis of treatment.
• Medication: PDE-5 inhibitors (tadalafil, sildenafil, vardenafil) are the most commonly used drugs. They support erection by increasing blood flow to the penis. However, these medications should be used with caution in patients with heart disease.
• Penile Shockwave Therapy (ESWT): This method is applied to patients who do not respond to medication or cannot tolerate it. Low-intensity sound waves are used to promote vascular regeneration in the penis. The procedure is painless and short.
• Intracavernosal Injection Therapy: This treatment, which is applied directly to the penis, is highly effective but may have disadvantages such as pain and difficulty of application.
• Penile Prosthesis: When medications and other treatments fail, a penile prosthesis is surgically implanted. This method is generally considered a last resort and has high satisfaction rates.

What is Premature Ejaculation?

Premature ejaculation is the condition where a man ejaculates involuntarily very early during sexual intercourse. It usually occurs before or shortly after vaginal penetration. This can cause dissatisfaction for both the man and his partner and negatively affect the quality of sexual life.

Treatment of Premature Ejaculation

The most common treatment for this problem is medication. Especially SSRI-type drugs prolong the time to ejaculation. In addition, behavioral techniques (such as stop-start or squeeze techniques) can help learn ejaculation control. Topical anesthetics applied to the glans penis can also be effective by reducing hypersensitivity.