Although sexuality seems to be the result of an instinctive reproductive drive in all living things, it is actually an indispensable condition for the continuity of the couple's coexistence in humans. There are physiological and psychological conditions that prevent erection in the penis. We will talk about physiological causes and treatments.
Erectile dysfunction (ED) is defined as the inability to acquire or maintain penile erection for satisfactory sexual performance. While ED is not a life-threatening condition, it still plagues a large proportion of men around the world. Penile erection is a complex physiological process involving the integration of both neurological and vascular events as well as an adequate hormonal environment. ED may affect psychosocial health and have a significant impact on the quality of life of patients and their partners. Therefore, it is important to know the causes and to treat them.
Recreational habits (i.e., cigarette smoking, lack of regular physical exercise, obesity, cardiovascular diseases (e.g., hypertension, coronary artery disease, peripheral vascular disease) Type 1 and 2 diabetes mellitus; hyperlipidaemia; metabolic syndrome; hyperhomocysteinemia, major pelvic surgery (e.g., radical prostatectomy for prostate cancer) or radiotherapy (radiation therapy to the genital area). Parkinson’s disease, spinal cord diseases, stroke, central nervous system tumors, Chronic renal failure, chronic liver failure, hypogonadism (any type), hyperthyroidism, hyper- and hypocortisolism (Cushing’s disease, etc.) panhypopituitarism and multiple endocrine disorders. Psoriasis, gouty arthritis, ankylosing spondylitis, non-alcoholic fatty liver disease, chronic periodontitis, openangle glaucoma, inflammatory bowel disease, chronic fatigue syndrome, allergic rhinitis, obstructive sleep apnoea, depression. Antihypertensives (i.e., thiazidediuretics, beta-blockers) Antidepressants (e.g., selective serotonin reuptake inhibitors, tricyclics), Antipsychotics, Antiandrogens (GnRH analogues and antagonists; 5-ARIs), Recreational drugs (e.g., heroin, cocaine, marijuana, methadone, synthetic drugs, anabolic steroids, excessive alcohol intake), lack of arousability and disorders of sexual intimacy, partner-related, performance-related issues, traumas such as penile fractures and pelvic fractures are among the causes of erectile dysfunction. It has been reported in many international studies that ED is an independent predictor for some heart diseases. Therefore, the cardiac health of patients with erectile dysfunction should be evaluated.
A comprehensive medical and sexual history should be obtained from every patient presenting with erectile dysfunction. Patients should evaluate routine laboratory tests, including glucose and lipid profile and total testosterone, to identify and treat reversible risk factors and modifiable lifestyle factor.
Treatment:
- Identify and treat "curable" causes of erectile dysfunction.
- Lifestyle changes and risk factor modifications.
- Education and counseling should be provided to the patient (and spouse, where appropriate).
- Use PDE5Is as first-line therapeutic option. These drugs; Today, among the most widely used drugs with proven therapeutic properties, there are drugs with the active ingredient tadalafil, which is used at a daily dose of 5 mg.
- Topical/intra-urethral alprostadil can be used as an alternative first-line therapy in well-informed patients who do not want or are not eligible for oral therapy.
- Vacuum erection devices can be used as first-line therapy in well-informed patients with infrequent sexual intercourse and comorbidity requiring non-invasive, drug-free ED management.
- Intracavernous injections can be used as an alternative to first-line therapy or as second-line therapy in well-informed patients. For most men, a dose of 5-20 micrograms is sufficient, while some men may require a higher dose. Doses higher than 40 micrograms should never be used in one injection. If the erection is longer than 2 hours and less than 4 hours, the dose can be adjusted in consultation with the doctor. It should not be used more than 2 or 3 times in a week. It should not be used more than 2 or 3 times in a week and there should be at least 24 hours between them. If alprostadil is used to find the cause of erectile dysfunction, the dose to be used should be in the range of 5-20 micrograms
- Penile prosthesis implantation may be used if other treatments fail or at the patient's preference.
- Penile prostheses are placed in a surgical procedure. Important complications such as wound infection, penile injuries, urinary tract injuries may develop after penile prostheses. For this reason, it is appropriate to perform it in experienced centers where a large number of prostheses are applied. Penile prosthesis can be classified into malleable and inflatable groups.
