Sexual dysfunction in men: erectile dysfunction ( ed )

ED is the inability of a man to create and/or maintain a permanent or recurrent penile erection sufficient for sexual intercourse for at least 3 months. Another important point is not to see erection insufficiency as a natural consequence of aging and not to express it as a problem, especially in the aging process. Although sexual activity seems to decrease with age, sexual desire continues. Studies have shown that while the incidence of ED is 8% in men aged 55, it increases to 25% at the age of 65 and to 55% at the age of 75. It has been reported that the rate of ED among married men is close to 40%.
The risk factors that cause ED are;

DM, diabetes is the main cause in approximately 50% of patients with ED. It has been shown that ED is seen 3 times more in diabetic men compared to non-diabetic men. The main cause in diabetics is neuropathy and microangiopathies.
In cardiovascular diseases and HT, they cause ED by causing deterioration of vascular endothelium.
Chronic renal failures as well as lower urinary tract symptoms (LUTS) can impair sexual function with adverse effects on both ejaculation and erection.
Neurological chronic diseases such as Parkinson’s disease, MS, epilepsy are known to cause ED with the effect of polyneuropathy.
Surgical traumas, especially radical surgeries for prostate cancer and rectal cancer, can cause ED with nerve damage. Radiotherapy and spinal cord injuries can also cause ED.
Sedating or depressing drugs in the CNS, beta-blockers, thiazide group, diuretics, digoxin-like heart drugs can cause ED.
Problems such as psychoses, intense stress and depression negatively affect sexual function. Performance anxiety is an important psychogenic condition that causes erection problems in men.
Smoking and tobacco use, chronic drug use, and chronic alcoholism also cause ED.
Hormonal causes make up a 5% portion.
Diagnosis starts with the story taken from the patient, fm color Doppler USG, and/or intracavernosal injection. Sometimes it can be sufficiently instructive in terms of the history treatment option. Today, the most widely used as a symptom scale is the International Index Erectile Function (IIEF).
In the treatment of erectile dysfunction, firstly taking into account the expectations of the patients and even deciding the treatment decision together with the patient and sometimes with the partner will positively affect the success of the treatment. The treatment is also oral pharmacotherapy, after the causes are revealed. With PDE 5 inhibitors, which have become very popular today, the quality and duration of erection can be increased, and success can be achieved at a rate of 55-80%.

The most commonly used drugs in this group are sildenafil, the blue drug known as viagra, vardenafil, which has a more tissue effect, and tadalafil, which is known as a weekend pill with 24-36 hours of effect. Since this group of drugs has an effect on all vascular tissues, it should not be used together with drugs that contain nitrates and decrease blood pressure by vasodilation. Apart from this, it should be used under the supervision of a cardiologist or with his recommendation in severe heart failures and recent heart attacks. Apart from oral treatments, it is combined with intra-vernosal injections as a single drug or in 2-to-3 mixtures. In long-term use, there are also side effects such as fibrosis or prolonged erection. The method, which is used more frequently in Europe and the USA, but which is not adopted by the patients in our country, is vacuum devices. It is a method applied with the aim of blocking venous return by creating negative pressure in the cylinder with the help of a cylinder in which the penis is inserted and a pump connected to it. Successes over 50% have been reported.

Penile prostheses are the most commonly used surgical treatment in patients who cannot be successful with these treatments. PPs are usually silicone-shaped rods and are inserted into the cavernous tissues by dilation and appropriate measurement. There are different types of single and multi-part types. It is a radical surgeon with success rates of up to 95% and there is no reversal. Patients should be informed about this issue and their expectations should be shared.

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