Erectile Dysfunction: Causes and Treatment Options

What is Erectile Dysfunction?

Erectile dysfunction (ED), commonly known as impotence, is the inability to achieve or maintain an erection firm enough for sexual intercourse. This condition is not just a physical health issue—it profoundly affects men's self-confidence, damages relationships, and significantly reduces quality of life.

Erectile dysfunction is far more common than most people realize. Approximately half of men over 50 experience varying degrees of this problem. Research conducted in Turkey shows that 69% of men over 40 experience ED. However, these numbers likely underestimate the true prevalence, as many men hesitate to discuss this issue with their doctors.

An important distinction: Occasional difficulties achieving an erection are considered normal. However, if the problem persists consistently for at least 3-6 months and affects your sexual life, you should consult a urologist.

How Does an Erection Occur?

An erection is a complex process. Following visual, auditory, or tactile sexual stimulation, the brain sends signals that cause blood vessels in the penis to dilate. Blood fills the spongy tissues inside the penis. When blood flow is sufficient, the penis becomes rigid and ready for sexual intercourse.

Three main systems work together in this process: the nervous system, vascular system, and hormonal system. Problems in any of these systems can lead to erectile difficulties.

Causes of Erectile Dysfunction

While once thought to be primarily psychological, we now know that erectile dysfunction most often stems from physical causes. In fact, ED can be an early warning sign of many serious diseases.

Physical Causes

Vascular Diseases: This is the most common cause. Conditions affecting heart vessels also affect penile blood vessels. Atherosclerosis (hardening and blockage of arteries) prevents adequate blood flow to the penis.

Diabetes: Diabetic patients experience erectile dysfunction three times more frequently than non-diabetics. High blood sugar damages both blood vessels and nerves.

High Blood Pressure: Both the condition itself and medications used to treat hypertension can cause erectile problems.

High Cholesterol: Causes vascular blockage, reducing blood flow to the penis.

Hormonal Disorders: Particularly low testosterone levels lead to decreased libido and erectile difficulties.

Neurological Diseases: Conditions affecting the nervous system such as multiple sclerosis, Parkinson's disease, and spinal cord injuries.

Surgeries: Nerve damage can occur during prostate cancer, bladder, or colon surgeries.

Medication Use: Antidepressants, blood pressure medications, some pain relievers, and eye drops can cause erectile dysfunction.

Psychological Causes

Stress and Anxiety: Work stress, financial worries, or daily life pressures negatively affect sexual performance.

Depression: Both the illness itself and antidepressant medications used contribute to the problem.

Performance Anxiety: A single episode of failure can develop into a recurring cycle.

Relationship Problems: Communication issues with a partner, lack of trust, or emotional distance.

Lifestyle Factors

• Smoking (constricts blood vessels)
• Excessive alcohol consumption
• Recreational drug use
• Sedentary lifestyle
• Obesity
• Insufficient sleep

What Are the Symptoms?

The main symptoms of erectile dysfunction include:

• Complete inability to achieve an erection
• Difficulty initiating an erection
• Inability to maintain an erection long enough
• Decreased sexual desire
• Delayed or difficult ejaculation
• Loss of morning erections

How is it Diagnosed?

A urologist will first take a detailed medical history. It's crucial to answer all questions openly during this consultation. Your doctor will ask about:

• Your level of sexual desire
• Your degree of erectile firmness
• Frequency of intercourse
• Whether you experience spontaneous morning or nighttime erections
• What medical conditions you have and what medications you take
• Your use of cigarettes, alcohol, or drugs

Several tests may then be conducted:

Blood Tests: Check for glucose, cholesterol, testosterone, and other hormone levels.

Physical Examination: Examination of the penis and testicles.

IIEF Questionnaire: An internationally recognized sexual function assessment form that determines the severity of the problem.

Doppler Ultrasound: Evaluates blood flow to the penis (in advanced cases).

Treatment Options

The good news: Erectile dysfunction is a treatable condition. Treatment is planned individually based on the underlying cause.

1. Lifestyle Changes

The first step in treatment is always lifestyle modifications:

• Quit smoking: Improves circulation
• Reduce alcohol: Maximum 1-2 drinks per day
• Lose weight: Obesity decreases testosterone
• Exercise regularly: At least 150 minutes of brisk walking per week
• Eat healthy: Mediterranean diet supports sexual health
• Reduce stress: Try yoga, meditation, or pursue hobbies
• Improve sleep patterns: Sleep 7-8 hours nightly

2. Medication Therapy

PDE5 Inhibitors (Oral Medications):

This is the most commonly used and first-choice treatment method. These medications dilate penile blood vessels, increasing blood flow. They are taken 30-60 minutes before sexual intercourse, with effects lasting 4-36 hours.

Important: These are prescription medications and must be used under medical supervision. They can be dangerous for heart patients and those taking nitrate medications.

Success Rate: 70-80%

3. Intracavernous Injection (Penile Injection)

Medication is injected directly into the penis. Erection begins 10-15 minutes after injection and lasts 30-60 minutes. Patients can self-administer this method at home.

Advantages: Effective and rapid results Disadvantages: Fear of needles, rarely prolonged erection (priapism)

4. ESWT (Shockwave Therapy)

Low-intensity shock waves are delivered to the penis, triggering new blood vessel formation. It's a painless procedure applied over 6-8 sessions.

Success Rate: 60-70% (especially for vascular ED)

5. Vacuum Devices

The penis is placed in a cylindrical vacuum device, and air is pumped out to create blood flow. A constriction ring is then placed at the base of the penis.

Advantages: Drug-free, safe Disadvantages: Not spontaneous, cumbersome to use

6. Testosterone Therapy

Hormone replacement therapy is administered to patients with low testosterone detected in blood tests. It can be given as injections, gel, or patches.

Important: Not used in patients at risk for prostate cancer.

7. Penile Prosthesis (Happiness Rod)

This is the permanent solution when all other treatments fail. A prosthesis is surgically implanted into the penis. There are two types:

Inflatable Prosthesis: Inflated via a pump placed in the testicles, provides the most natural appearance.

Semi-Rigid Prosthesis: The penis remains in a semi-erect state, with bendable properties.

Success Rate: 90-95% Patient Satisfaction: 85-90%

Surgery takes 45-90 minutes, with a 1-2 day hospital stay. Return to sexual activity is possible after 4-6 weeks.

Talk to Your Partner

Erectile dysfunction is not just your problem—it's a couple's issue. Open and honest communication with your partner facilitates the treatment process. Attending doctor's appointments together helps your partner understand the process.

When Should You See a Doctor?

• If the problem has persisted for more than 3 months
• If your sexual life and relationship are affected
• If you have chronic conditions like diabetes or heart disease
• If you experience sudden and severe erectile dysfunction

Common Myths

"Erectile dysfunction only occurs in elderly men." False! It can frequently occur in young men too.

"This problem will resolve on its own." False! There may be a serious underlying disease; treatment is essential.

"There is no cure." False! Very successful treatment methods exist today.

"Medications are addictive." False! PDE5 inhibitors do not cause addiction.

Conclusion

Erectile dysfunction is not a source of shame—it's a treatable medical condition. Between 40-70% of men experience this problem at some point in their lives. What matters is early diagnosis and proper treatment.

Remember: Erectile dysfunction is not just a sexual problem—it can be an early warning sign of serious conditions like heart disease and diabetes. Therefore, consult a urologist without delay.

Thanks to modern medicine, more than 90% of patients can be successfully treated. With proper treatment, you can improve both your sexual life and overall health.