Erectile dysfunction (ED) is the inability to attain or maintain a sufficient erection for satisfactory sexual intercourse. Male ED is a commonly seen disorder worldwide. It has been reported that ED itself causes to depression and stress not only to men but also to their partners. Furthermore chronic ED can be a sign of health problems including cardiovaskuler system which need to be treated. Moreover, ED can also be a sign of emotional or relationship difficulties which may need to be addressed by a professional.
ED can be related to problems at any phase of erectile physiology. Erection is the consequence of increased blood flow into the penis. Blood flow is usually increased following by either sexual thoughts or direct tactile stimulations to the penis. Briefly, when a man is sexually excited, muscles inside the corpora cavernosas which are responsible for rigid erection are relaxed. This event leads increased blood flow through the penile arteries, and filling two corpora cavernosa inside the penis. As the corpora cavernosas fill with blood, the penis becomes rigid. On the other hand, when the muscles contract and the accumulated blood flow goes out through the penile veins, the penis becomes to the flaccid phase.
According to the recent literature, there are various co-morbidities reported to cause ED. Common co-morbidities include:
Cardiovascular diseases, Diabetes, High blood pressure, Increased cholesterol levels,obesity, low testosterone levels or other hormonal disorders, chronic kidney diseases, increased age, stress, anxiety,depression, relationship problems, chronically used medications, such as those used to treat high blood pressure or depression, sleep disorders, drug abuse, heavy and chronically alcohol use, using tobacco products, neurological diseases such as Parkinson’s disease or multiple sclerosis (MS), damage to the pelvic area through injury or surgery and Peyronie’s disease.
ED can be the results by only one of these factors or by several of them. Therefore, it is important to work with your doctor so they evaluate or treat any underlying medical conditions.
TREATMENT OF ERECTILE DYSFUNCTION
Treatment modalities of ED are usually based on the underlying cause. Obviously, regulation of any underlying co-morbidity (e.g. diabetes, high blood pressure, hormonal inbalance, hypercholesterolemia) will increase the success rate of spesific ED treatment.
Medical Treatmenot Options:
Nowadays, oral medication treatment is the first line treatment option for men with ED. Oral medications, improve ED symptoms roughly in 70-80% of men suffering from ED. This success rate is decreased to about 50% in 'Hard to treat' cases, namely in men with certain co-morbidies includind diabetes and atherosclerosis. The oral medications listed below, increase blood flow into the penis in the presence of sexual stimulation:
Sildenafil (50/100mg on demand use))
Tadalafil (5mg daily; 20mg on demand use)
Vardenafil (20/40mg on demand use)
Prostaglandin E1, papaverin and phentolamine alone or in any combination are altervative medications that can be used to treat ED. Actually, these drugs are considered as 'Second Line' treatment opsions and administered as a self-injection at the base or side of the penis. Usually that option is used in men who do not respond to oral medications
In tyhe presence of low testosterone levels Testosterone Replacement Therapy (TRT) may also be recommended.
More importantly, medications used for other conditions may cause ED. Therefore, it is mandatory to explain all the used drugs to your doctor and getting information if or not your medications have a potential to causing ED.
Men with ED need to remember that medications for ED can cause several side effects. In the case of encountering any unpleasant side effects, patients need to give up with the treatment and inform their doctor. Usually, the physician is able to recommend a different medication.
Surgical treatment options for ED are considered as 'Third Line' treatment option. In patients where medications do not work the physician may recommend surgical treatment. Mainly, surgical treatment options can be divided into two groups which are: placement of penile implants and vascular surgery.
Three-piece inflatable penile implants namely penile prostheses are commonly used in the modern sexual medicine era. Recently, improved biomedical technology allowed physicians to use developed types of prostheses with pretty high patient and partner satisfaction rates.
The goal of vascular surgery is to repair arteries which may be blocked or cut usually after traumas. These techniques aims to increase or restore adequate blood flow into the penis. Younger men with ED are typical candidates for this kind of surgery.
Patients need to keep in mind that every surgery has many benefits and drawbacks. Therefore, every patient who decide to undergo surgical treatment, needs to discuss the possible complications of surgical therapy with his physican in detail. For instance, all the candidates for penile prosthesis need to check out the related information guides, learn how they are placed, and discover how they work and what recovery is like.
Turkish Society of Andrology
Turkish Urology Association
The main purpose of the written content and images presented in this web site is only providing general medical information for interested population. This web site does not aims to give any advice for cessation or changing any patients ongoing medical treatment. The author of the present web site strongly suggests to the web site visitors to apply his/her medical doctor before starting any medical therapy.