Erection is the filling of the penile tissue with blood as a result of hormonal, vascular (vessels) and neurological (nervous) effects as a result of visual or sensory stimulus, and its readiness for sexual intercourse as a result of the blood being trapped in the penis for a while and erection occurs.
The inability to initiate or maintain sexual intercourse at the desired level as a result of one or more malfunctions in these mechanisms is called erectile dysfunction (impotence). In short, to maintain sexual health; vascular health, nervous and hormonal system should be good.
Scientific studies have shown that erectile dysfunction is also a serious symptom of cardiovascular disease.
After listening to the patient's story and performing a physical examination, first of all, blood tests that must be done for each patient should be studied.
Complete blood count (hemogram),fasting blood sugar, lipid panel (cholesterol, triglyceride),testosterone, liver and kidney function tests are the tests that should be done first. The PSA test and digital examination for the prostate should also be applied, especially in men over the age of 50.
Some patients may require further investigations. Prolactin, FSH, LH, Thyroid function tests, penile doppler ultrasonography and nocturnal penile tumescence test are the main ones.
It is necessary to get rid of the reversible risk factors as much as possible before the treatment of erectile dysfunction (impotence) before drug or other interventional treatment methods.
If the impotence problem cannot be improved by eliminating the risk factors, drug therapy is usually started first. PDE-5 inhibitors (tadalafil, sildenafil, vardanafil) are the most commonly used agents. It acts by increasing the blood flow to the penis.
Long-term use of tadalafil with its daily dose can also provide permanent improvement. Since these drugs are risky to use in some heart diseases and with some drugs, they should be started by a urologist.
The benefit of penile shock wave therapy (ESWT) has now taken its place in the guidelines for those who cannot respond to drug therapy, who cannot use it due to the side effects of drug therapy, or to increase the effectiveness of the drug. Since most of these patients’ main problem is vascular insufficiency, vascular and tissue regeneration is induced by low-intensity sound waves with the ESWT method. It is easy to apply because it is a risk-free, painless and short-term procedure.
Another treatment method is injection treatments, which are applied to the tissues of the penis. It is usually applied to the cavernous tissue of the penis (providing the erection mechanism) with the help of fine-tipped injectors or by the urethral route (through the duct where we urinate). Although it has the disadvantage of being painful, difficult to apply and wounds in the penile tissue, it is an advantage of being highly effective.
Vials consisting of agents called papaverine, alprostadil and phentolamine individually or in combination are licensed. Prolonged unwanted erection side effects (priapism) are less especially with alprostadil and combination therapies. Physicians should inform their patients about this side effect after the application.
Penile prostheses, on the other hand, are generally used as a last-line treatment method in erectile dysfunction (impotence) and have a high success rate. It is the last chance for patients who do not respond to simpler and cheaper treatment methods such as drugs, injections and ESWT. The disadvantage of this method is that it is a surgical procedure and therefore inclined to complications, and its high cost.
Premature ejaculation is defined as involuntary ejaculation before or shortly after penile penetration into the vagina. Although it is wrong to give a specific time, it is used to describe this problem as less than 1 minute as book information.
Regardless of the duration, ejaculation without adequate pleasure for both partners can generally be called premature ejaculation. The main reason has not been fully elucidated and it is thought to be affected by the psychosocial state.
Various neurotransmitters have been implicated in early warning in the pathogenesis, and therefore, this mechanism has been tried to be corrected in the treatment of premature ejaculation (SSRI-derived drugs).
One of the most effective methods of premature ejaculation treatment is drug therapy. However, the expectation in the majority of patients; a permanent effect after using the drugs for a few days, this is unfortunately not possible.
After long-term use of these medical drugs, the problem can be solved by performing behavioral learning. There are medical agents in the form of gel that can be applied orally and directly to the penis. The most frequently applied and the only oral medication approved for this problem in the world is the drugs containing the active ingredient dapoxetine.
Apart from drug therapy, some behavioral models have also been developed and found useful. It is based on the idea of learning to control ejaculation. The most commonly known methods are the 'squeezing' technique, which will give a painful stimulus to the penis head when ejaculation is felt, or the 'stop-start' technique, which is based on the principle of taking a short break when the female partner warns the man in excessive stimulation.
Again, masturbation before sexual intercourse is a behavior model that prevents premature ejaculation.
Injections made to the head of the penis, especially using hyaluronic acid, are also used in the treatment by reducing the hypersensitivity that causes premature ejaculation.
It is applied to patients who do not respond to drug treatments, which are simpler treatment methods, due to various reasons, especially in vascular (vascular) insufficiency. After 6 months to 1 year after surgery, satisfaction rates have been reported above 90%. Penile prostheses, also known as happiness sticks, are available in one-piece and malleable or multi-piece (three pieces) and inflatable varieties.
Although one-piece penile prostheses are always rigid, there is no reason to worry about "would it be obvious from the outside" in patients. Because, thanks to its ability to bend, this appearance is not evident by laying it on the abdominal wall.
Multi-piece, inflatable prostheses are inflated with the help of a pump placed under the skin during sexual intercourse and become ready for erection. The disadvantage of these more ergonomic prostheses is that they are more costly. In the selection of the prosthesis type, the patient and the doctor should decide together. These prostheses can be used for years, usually for a lifetime, except for rare infections or mechanism disorders.
If the semen ducts are not removed due to prostate or bladder cancer, ejaculation is not affected and there is no problem in the satisfaction of the person.
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Note: Page contents are for informational purposes only and a doctor's application is required for your diagnosis and treatment.
Assoc. Prof. Dr. Arif Demirbaş
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