The inability of the male sexual organ to become erect enough to have sexual intercourse is called impotence. It would be more accurate to define this condition, which can be defined as “permanent inability to achieve and maintain an erection sufficient to allow satisfactory sexual performance”, as “erectile dysfunction” or “erectile dysfunction”.
The Likelihood of Erectile Dysfunction Increases as You Get Older
It is reported that erectile dysfunction, which is seen in 10 to 40% of people at the age of 40, reaches 50 to 80% in the 70s. In a large-scale institutional study conducted in Turkey, the prevalence of erectile dysfunction was found to be 69.2% on average in all age groups over 40 years of age.
Why Does Erectile Dysfunction Develop?
“Erection” in humans develops through the joint work of nerve and vascular elements. When the signal from the cerebrospinal line reaches the penis, a series of chemical events are triggered that allow the spongy structure in the penis to relax and fill with blood. In this way, the penis fills with blood and becomes hard. Nervous diseases (nerve injuries resulting from surgery and similar conditions) that prevent the transmission here can disrupt erection. More importantly, vascular disorders that prevent the spongy structure from loosening and filling with blood (such as arteriosclerosis, diabetes, high blood pressure) are other important diseases that can lead to erectile dysfunction.
People with cardiovascular risk factors such as high cholesterol, high blood pressure, obesity, smoking and inactivity come first. Especially overweight; Increasing the size of the belly circumference and erection problems have recently been the subject of important studies and are shown to be serious risks. Diabetes is one of the most important factors. Most of the time, erectile dysfunction is an early sign of atherosclerosis and diabetes. Apart from this, those with neurological diseases, hormonal disorders and those who have undergone surgeries that may damage nerves are also at risk.
When evaluating a patient with erectile dysfunction, it is necessary to listen to the patient first. It is seen that in many patients the problem may not be organic but psychological or due to bilateral relations. Listening to the patient carefully and getting the necessary questions and answers is often more useful than many tests. A subsequent comprehensive physical examination will give clues about diseases that may cause secondary erectile dysfunction, such as Peyronie’s disease. In addition, fasting blood sugar, cholesterol, male hormone testosterone (especially bioavailable testosterone level), SHBG (Sex Hormone Binding Globulin) levels must be measured if they have not been measured in the last 12 months.
After this basic evaluation, further tests can be carried out if necessary. The most commonly used of these is the Doppler Ultrasonography test, which measures the blood flow in the main vessels of the penis following an injection into the penis that provides artificial erection. This test gives us very valuable information about penis functions.
Before moving on to medications to treat erectile dysfunction, modifiable risk factors need to be addressed. Quitting smoking, starting regular exercise, and losing weight can provide dramatic improvements in many patients. Even people who have made these changes in middle age reduce their erection problems by 70% in a short period of 2 years compared to those who have not made these changes. Decreases in male hormone (testoseterone) levels can be regulated with additional hormone support treatments. Patients who continue to have erection problems despite improving their lifestyle positively are treated with oral medication as the first step. PDE5 inhibitors form the basis of oral drug therapy. Sildenafil (Viagra), Vardenafil (Levitra) and Tadalafil (Cialis) are the most familiar names of this group. Although these drugs do not provide erection on their own, they strengthen very mild erections that occur due to significant sexual stimulation (visual-tensory). In this way, they start to take effect in a shorter time and are effective in providing better quality and longer-lasting sexual intercourse. The patient decides which molecule to choose by discussing the expectations from the drug and the specific side effects of the drugs together with his doctor. Generally, 50-80% success rate should be expected from medications.
