What is erectile dysfunction?
Erectile dysfunction is the inability to achieve or maintain an erection firm enough for satisfactory sexual intercourse. Occasional difficulty with erections happens to many men and does not, on its own, mean there is a disease. An assessment is needed when the problem becomes recurrent and affects quality of life.
Erectile dysfunction becomes more common with age, but it can occur at any age. Many men are reluctant to talk about it; yet erectile dysfunction is a medical condition, and effective treatment options are available for most patients. The consultation takes place in a setting where privacy is respected.
Causes of erectile dysfunction
A healthy erection requires blood vessels, nerves, hormones and psychological state to work together in harmony. A problem in any of these systems can affect erections.
- Vascular causes: The most common group of causes. Hardening of the arteries, high blood pressure, high cholesterol and smoking reduce blood flow to the penis.
- Diabetes: Can cause erectile dysfunction by affecting both blood vessels and nerves.
- Hormonal causes: Low testosterone, thyroid disorders and raised prolactin can affect sex drive and erections.
- Neurological causes: Spinal cord injuries, multiple sclerosis and nerve damage after pelvic surgery.
- Medications: Some blood pressure medications, antidepressants and hormone treatments can cause erectile dysfunction as a side effect. Medications should not be stopped without consulting a doctor.
- Psychological causes: Performance anxiety, stress, depression and relationship problems; these are particularly prominent in younger men.
- Lifestyle: Smoking, excessive alcohol, inactivity and being overweight.
A warning sign for heart health
Because the blood vessels of the penis are narrower than those of the heart, they can be affected by hardening of the arteries earlier. For this reason, erectile dysfunction can be a warning sign of cardiovascular disease several years in advance. Checking blood pressure, blood sugar and cholesterol in a man with erectile dysfunction is therefore important from this perspective too.
How is it diagnosed?
- Detailed history: When the problem started, whether it developed suddenly or gradually, whether morning erections occur, which medications you take and any other medical conditions.
- IIEF questionnaire: The International Index of Erectile Function is a short questionnaire that helps determine the severity of the problem and monitor the response to treatment.
- Physical examination: The genital area, the prostate and signs of hormone deficiency are assessed.
- Blood tests: Fasting blood sugar or HbA1c, cholesterol levels and a morning testosterone level are checked; other hormones are assessed if needed.
- Penile Doppler ultrasound: Not needed for every patient. It is used to assess blood flow in the penis in patients who do not respond to medication, in whom a vascular problem is suspected, or for whom surgery is planned.
Treatment options
Treatment is planned individually after the examination, according to the underlying cause, the severity of the problem, other medical conditions and the couple’s expectations.
Lifestyle changes and control of risk factors
Stopping smoking, exercising regularly, losing excess weight and limiting alcohol all support erectile function. Good control of diabetes, blood pressure and cholesterol is important for both general and sexual health. In patients with testosterone deficiency, hormone therapy may be considered.
Oral medication (PDE5 inhibitors)
These medications, which increase blood flow to the penis, are the first-line treatment for most patients. They do not cause an erection on their own without sexual stimulation. Because they can cause a dangerous drop in blood pressure, they must never be taken together with nitrate medication for heart disease. For this reason, these medications should only be used after an examination, under medical supervision and at the right dose.
Low-intensity shock wave therapy (Li-ESWT)
This is an outpatient procedure in which low-energy shock waves are applied to the penis. It can be considered as an option in selected patients with vascular and mostly mild erectile dysfunction. However, the devices and protocols used in studies vary, results are variable, and data on long-term effectiveness are limited. It should therefore be planned only after expectations have been clearly explained to the patient.
Penile injection therapy (intracavernosal injection)
For patients who do not respond to oral medication, a medication that widens the blood vessels is injected into the side of the penis with a very fine needle. After the first injections are given in the clinic, the patient learns to do it himself at home. A prolonged, painful erection (priapism) is a rare side effect that requires emergency treatment.
Vacuum devices
An erection is achieved with a cylinder that draws blood into the penis and a ring placed at its base. It is an option particularly for patients who cannot take medication.
Penile prosthesis
For patients who do not respond adequately to other treatments or do not wish to use them, inflatable or semi-rigid prostheses can be implanted inside the penis. The prosthesis is not visible from the outside and generally does not affect urination, ejaculation or sensation. Risks such as infection and mechanical failure are discussed in detail before surgery.
About PRP and stem cell treatments
The effectiveness and safety of PRP (platelet-rich plasma) and stem cell treatments for erectile dysfunction have not yet been demonstrated with sufficient scientific evidence. Current guidelines do not recommend these methods as routine treatment.
Partner support and psychological approach
Erectile dysfunction often affects not only the individual but also the relationship. Involving the partner can help reduce anxiety and contribute to the success of treatment. For patients in whom psychological factors are prominent, sex therapy or psychological support can be planned alongside medical treatment.
When should you see a doctor?
It is advisable to see a urologist if erectile problems have lasted for several months, are getting worse, or are affecting your sex life and relationship. Especially in men with risk factors such as diabetes, high blood pressure, high cholesterol or smoking, an assessment is important not only for sexual health but for general health too.
Bringing a list of all your medications and noting when and how the problem started makes the consultation easier. Obtaining erection medication without a prescription, online or from unofficial sources can pose serious health risks because of products with unknown contents.
Follow-up after treatment
The effectiveness of treatment and any side effects are assessed at follow-up appointments. If the first medication or dose tried is not enough, a different dose, way of taking it or method can be planned; not getting a result on the first attempt does not mean that treatment has failed. Controlling risk factors and maintaining lifestyle changes should continue whichever treatment is chosen.
Erectile dysfunction treatment in Bursa, Turkey
Op. Dr. Mücahit Kabar graduated from Uludağ University Faculty of Medicine and completed his urology residency at the Urology Clinic of Ankara Training and Research Hospital. He has scientific studies in andrology published in international peer-reviewed journals. He sees men with erectile dysfunction in Bursa (Nilüfer), with careful attention to privacy, at Özel Medicabil Nilüfer Hastanesi (weekdays 08:30–12:00) and Özel Jimer Hastanesi (weekdays 13:00–17:00).
Consultations are held in English or Turkish. The hospitals’ international patient departments can arrange interpreters for other languages and help with airport transfers and accommodation. If you are travelling from abroad, you can book your appointment in advance through the online booking page or appointment line of Özel Medicabil Nilüfer Hastanesi (weekdays 08:30–12:00, +90 444 8 112) or Özel Jimer Hastanesi (weekdays 13:00–17:00, +90 444 45 67). You can share any previous test results beforehand via WhatsApp (+90 541 622 54 82). More information is available on the international patients page and the contact page.
