What is erectile dysfunction, and when does it count as a problem?
Occasional difficulty with erections happens to most men and does not on its own mean illness. We speak of erectile dysfunction when the complaint persists continuously or recurrently for at least three months and has a negative effect on the person’s sexual life and relationship.
The assessment does not stop at whether it happens or not. Whether the onset was sudden or gradual, whether morning erections are still present, and whether it occurs with a particular partner or in every situation all help to separate a physical cause from a mainly psychological one.
The main causes of erectile dysfunction
Erectile dysfunction is usually not down to a single cause; several factors tend to be present together. The most common are:
- Vascular causes: reduced blood flow into the penis, or blood not being held within the vascular bed (venous leak). Closely related to cardiovascular disease, high blood pressure and raised cholesterol.
- Diabetes: among the most frequent causes, because it affects both small blood vessels and nerves. Blood glucose control is part of the treatment plan.
- Hormonal causes: low testosterone, thyroid disease and raised prolactin can all contribute.
- Medication: some blood pressure medicines, antidepressants, prostate medicines and certain drugs used for hair loss can affect erections.
- Nervous system causes: spinal disc surgery, pelvic surgery, radical prostate surgery and some neurological conditions.
- Lifestyle: smoking, excessive alcohol, inactivity, obesity, sleep apnoea and chronic sleep deprivation.
- Psychological factors: performance anxiety, depression, intense work stress and difficulties within a relationship.
The assessment in Denizli and the tests performed
A detailed history is taken at the first consultation: how long the complaint has lasted, how it began, any accompanying conditions, the medication you take and your smoking and alcohol habits. A general urological examination follows.
Depending on the examination findings, the tests judged necessary may be requested. These can include fasting blood glucose and HbA1c, a lipid profile, a morning total testosterone measurement, thyroid function tests and a prolactin level. Where a vascular cause is suspected, a penile colour Doppler ultrasound comes into play.
This step should not be skipped: erectile dysfunction can appear years before cardiovascular disease gives any other sign. The right approach is to find the cause, not to suppress the complaint.
Treatment options
Treatment is not one single method and is always planned according to the cause. The options are generally considered in these steps:
- Lifestyle changes and control of accompanying conditions: managing blood glucose, blood pressure and cholesterol, stopping smoking, weight control and regular physical activity form the foundation of treatment.
- Medication: oral PDE5 inhibitors are prescription-only; because of the risk of interaction with heart medication they should not be used without a physician’s assessment.
- Correcting hormone deficiency: where low testosterone is confirmed by laboratory testing, treatment is planned under a physician’s follow-up.
- Low-intensity shockwave therapy (Li-ESWT): a session-based method that may be considered in selected mild to moderate vascular cases.
- Injection treatments into the penis: these may come into play where oral medication has not given an adequate response; the first administration takes place in a controlled setting.
- Penile implant: a surgical option considered in persistent cases that have not benefited from other methods.
- Psychological support and sexual counselling: planned alongside medical treatment where the anxiety component is prominent.
A warning about products bought online
Products sold as “herbal” through websites, herbalists or other unreliable sources have been found to contain undeclared pharmaceutical active substances. They carry serious risks, including a drop in blood pressure, cardiac rhythm disturbance and, when taken together with nitrate-containing heart medication, life-threatening reactions.
If erectile dysfunction needs treating with medication, the choice of drug and its dose must be determined by a physician after examination and any necessary tests.
Frequently asked questions
Is erectile dysfunction permanent?
Not every case is permanent. Where the picture is due to stress, lack of sleep or a temporary course of medication, it can resolve once the cause is removed. Where there is vascular or neurological damage, the aim of treatment is to support function. The distinction is made through examination and testing.
Can erectile dysfunction be a sign of heart disease?
It can. Because the arteries of the penis are narrower than those of the heart, they can show signs of arterial disease earlier. For that reason a cardiovascular risk assessment is advised, particularly for new-onset complaints over the age of 40.
Which tests are requested before treatment begins?
Usually fasting blood glucose and HbA1c, a lipid profile and a morning testosterone measurement. Depending on the history and examination findings, thyroid tests, a prolactin level or a penile colour Doppler ultrasound may be added.
Can erectile dysfunction occur at a young age?
It can. In younger men performance anxiety, heavy pornography use, smoking, substance use and irregular sleep are more prominent; but it should not be called “psychological” until hormonal and vascular causes have been excluded.
How do I book an appointment in Denizli?
You can send your appointment request through the form on this website, on 0541 159 56 36, or by WhatsApp. Your request is handled on the basis of confidentiality.