Erection Problems and Treatment
Erectile dysfunction — the most common male sexual function disorder after premature ejaculation — can be defined as the inability of the penis to reach sufficient rigidity for satisfying intercourse, or to maintain that rigidity until intercourse is complete.
Erection problems can arise from physical and/or psychological causes. They become more frequent with advancing age, but they can affect young men too. The problem may be permanent or temporary; indeed, for a diagnosis to be made, the requirement that it occurs repeatedly is an important variable.
Closely identified in our society with the notion of “manhood”, this disorder can cause men psychological difficulty, problems in their sex life, dissatisfaction for their partner, and barriers to communication between couples. Beyond all that, erection is a complex process, and a disruption within it can point to other health problems.
The subject is a sensitive one, and women as much as men are left facing the consequences of erection problems. Understanding what erectile dysfunction is matters if the necessary precautions are to be taken and treatment options assessed.
Before going into the details of erection problems, I would like to give some information about the anatomy of the penis, so that the delicate and complex nature of this disorder can be understood more clearly.
How Does an Erection Occur?
Behind the question “how does an erection happen?” lies a series of chemical and physical processes. Nerves, blood vessels, hormones, muscles and much else come into play. A chain of consecutive events results in different centres of the body working in concert. Let us explore the details together.
There are three separate channels within the penis. Two of them are cylindrical, tube-like structures called the corpora cavernosa. Outside these lies a protective capsule known as the tunica albuginea. The last channel is known as the corpus spongiosum, and within it runs the duct that allows urine and semen to be expelled.
These tubes — which allow the penis to become erect before intercourse and to stay erect during it — contain millions of tiny blood vessels. When sexual arousal occurs as a result of stimuli such as smell, touch, sound and sight, the central nervous system, hormones, blood vessels, nerves and the smooth muscle tissue within the penis all act together to increase blood flow into the vessels inside the tubes.
As the tubes begin to fill with blood they expand and lengthen. The protective capsule, the tunica albuginea, then compresses the veins so that the blood remains in the tubes and rigidity is maintained, trapping the blood within both tube structures. Once sexual satisfaction has been reached the process reverses and the blood drains back out of the tubes.
So what exactly is an erection problem? Let us answer from a different perspective.
What Is Erectile Dysfunction?
Erectile dysfunction is either the failure of the tube structures within the penis to fill with blood on arousal — in other words, the penis not receiving blood — or, where blood does flow in and the tubes do fill, the return of that blood to the body through the veins before intercourse is complete.
From this we can speak of two distinct physiological processes behind erection problems. Either not enough blood reaches the tubes despite arousal and they do not fill (a state we call arterial insufficiency), or blood does reach the tubes but the veins cannot perform their task of holding it there (which we call venous insufficiency).
With arterial insufficiency the penis cannot reach sufficient rigidity for intercourse; with venous insufficiency it cannot maintain rigidity until intercourse is complete. Patients who report “I can have intercourse but I lose rigidity before intercourse has finished” must be assessed for venous insufficiency, because the treatment applied to patients whose dysfunction stems from arterial insufficiency does not work for those with venous insufficiency. I will come to these differences in more detail when discussing treatment.
Now let us examine the causes behind erection problems.
What Causes Erection Problems?
Erection problems, like other sexual function disorders, can arise from physical and psychological causes. Assessing the two separately is the better approach.
Physical Causes of Erection Problems
- Insufficient blood reaching the penis: many different and serious health problems can reduce blood flow to the penis. Risk factors such as hardening of the arteries, cardiovascular disease, smoking, high cholesterol, obesity, hypertension, advancing age and a sedentary life can all reduce blood supply to the penis.
- Blood not being retained in the penis during intercourse: the reasons rigidity is not maintained throughout intercourse run parallel to the causes of venous insufficiency. Having undergone cancer treatment such as for prostate cancer, diabetes, cardiovascular disease, smoking and high cholesterol can unfortunately affect the veins of the penis and so cause erection problems.
- Central nervous system problems: multiple sclerosis, spinal cord injuries, antidepressant use and operations in the pelvic region can damage the communication between the brain, the spinal cord and the penis, resulting in erectile dysfunction.
In addition to all of these, Peyronie’s disease — characterised by the formation of scar tissue within the penis — alcohol and substance dependency, sleep disorders and low levels of male hormone can also lead to this disorder.
Psychological Causes of Erection Problems
As I always say, mind and body need to act together for a healthy sexual experience. Where a man has emotional problems, erection difficulties may both appear and become progressive.
- Depression and anxiety,
- problems within the relationship,
- stress, and
- performance anxiety are psychological causes that can lead to erection problems.
Because erection problems have different causes, treatment must differ too — which makes correct diagnosis critically important, and brings us to our next subject.
How Are Erection Problems Diagnosed?
People experiencing erection problems should not overlook the fact that various health conditions may be causing them. Although frequency increases with age, young men can experience erection problems too, and a range of conditions — including diabetes and cardiovascular disease — may lie behind them.
In the light of all this, comprehensive investigation is essential if patients presenting with erection problems are to be diagnosed with complete accuracy. A history is of course taken first, covering how long the complaint has been present, its extent, how often it occurs, whether there is any chronic illness, whether the patient smokes or drinks, and details of their lifestyle.
Completing the physical examination of the penis and testicles and gathering information on nerve sensitivity both matter. Blood tests and hormone tests make it possible to establish the level of male hormone and to investigate the presence of chronic illness. Urinalysis may also become necessary alongside blood tests.
Investigating whether blood flow in the penis is healthy is also important. Penile colour Doppler ultrasound may be needed to assess whether blood is flowing into the tubes within the penis, and to evaluate the function of the arteries supplying it and of the veins that keep blood within the tube structures throughout intercourse. This imaging technology makes it possible to identify vascular causes of erection problems.
I always emphasise that because erection problems can arise from many different organic causes, the diagnostic process must be comprehensive.
Where no organic cause can be found, psychological support is recommended, with the partner or spouse attending therapy too where possible.
The accuracy of the diagnosis is one of the most fundamental foundations for determining the most appropriate treatment. The causes that emerge can be quite varied, which raises the question of whether erection problems can be prevented. Let us find the answer together.
Can Erection Problems Be Prevented?
Whether erection problems can be prevented depends on their cause. While some causes cannot be prevented, measures that protect and/or improve cardiovascular health can prevent or postpone this disorder. The recommendations that help are:
- Excessive alcohol and smoking should be avoided.
- A healthy diet and regular exercise are needed to prevent conditions that damage vascular health, such as diabetes, high blood pressure and high cholesterol. This reduces the risk of two important contributors to erection problems: heart disease and obesity.
- Where chronic illnesses are present, they should be kept under control.
- A lifestyle free of stress should be adopted where possible.
Ultimately, preventing erection problems may not always be possible despite every precaution. People experiencing them should first consult urology and andrology specialists and go through a comprehensive diagnostic process. The results obtained are critically important for determining and planning treatment correctly.
Erection problems ARE TREATABLE. When planning treatment, the patient’s age, general health, the cause of the problem and how far it has progressed must all be taken into account. So which treatment methods can resolve erection problems?
How Are Erection Problems Treated?
Treatment methods for erectile dysfunction can be examined in two main groups, according to whether the dysfunction stems from arterial or venous insufficiency.
Treatment for Erection Problems Caused by Arterial Insufficiency
Where there is arterial insufficiency — characterised by the tubes not filling with the necessary volume of blood for sufficient rigidity, in other words the penis not receiving blood — treatment methods such as medication, shockwave therapy (ESWT), SVF stem cell therapy and penile implant surgery may be applied.
At AndroKLİNİK, shockwave therapy and SVF stem cell therapy are used for erection problems caused by arterial insufficiency.
As with all our treatments, the methods we apply for erection problems are determined for each individual patient, with the aim of choosing those that will deliver the most effective results in the shortest time.
All treatments are carried out in a clinical setting, and our patients are given detailed information about the requirements both before and after treatment.
Treatment for Erection Problems Caused by Venous Insufficiency
At AndroKLİNİK, venous insufficiency is treated with dorsal vein ligation surgery. For patients who reach sufficient rigidity for intercourse but cannot maintain it to the end, penile colour Doppler ultrasound technology is used to diagnose venous insufficiency. If the results indicate leakage in the veins and the patient’s general health presents no obstacle to an operation, surgery can be planned.