What is the hardening problem (SS)?

SS is a common male sexual dysfunction. It is the inability to achieve or maintain an erection that can provide satisfactory sexual activity. It can be observed occasionally or frequently, with or without a specific cause. Some men with SS may not have an erection at all.

SS is not a life-threatening disorder, but it can negatively affect your or your partner’s quality of life.

How common is SS?

SS is a common condition among men of all age groups and ethnicities. The risk of developing SS increases with age.

SSwhat causes it?

Heart diseases are one of the common causes for SS. Other reasons are:
Diabetes (Diabetes)
Nerve damage in the penis or pelvic area
Low testosterone level
Parkinson’s-like neurological diseases

Cardiovascular diseases and SS

SS and cardiovascular disease share similar risk factors such as obesity, smoking, high cholesterol, high blood pressure and lack of exercise. SS may be an early sign of heart disease, as problems with blood flow can also affect erectile function. Therefore, men with SS should consult a doctor to be evaluated for heart disease.

Urinary problems and SS

SS is usually associated with symptoms such as urinary frequency and nocturnal urination. These symptoms are often associated with benign prostatic enlargement (BPB). It is unclear whether these urinary symptoms cause SS, but usually SS worsens as urinary problems worsen.

Psychological risk factors for SS

Many psychological conditions have been associated with SS. These include:
Feeling of self inadequacy
low self-confidence
unable to describe their feelings

Ideas about how to interact between men and women can also cause SS. These ideas may include unrealistic expectations about love and sexuality and inappropriate role models for men and women. SS can sometimes be the cause and sometimes the result of a relationship that does not progress correctly or is not satisfied. Often it is difficult to determine which of these started first.

Diagnosis of Erectile Dysfunction

Erectile dysfunction (SS) is a problem that requires a correct diagnosis to understand the cause so that you can get the right treatment.

Discussing your SS with your family doctor or urologist can be uncomfortable, but it is important that you do so. Together you can decide what treatment method is best for you.

This section contains some tests that your doctor will use when evaluating your condition. General information about the diagnosis of SS is given.

medical history

Your doctor will take your medical history to understand your general health. Within the scope of your medical history, your doctor may also ask questions about other problems you may have besides the current situation.

Your doctor may ask you:
Whether you are using any medication
whether you smoke or not
When and how much alcohol you consume
Whether you drink a lot of coffee or alcohol
Whether you regularly use recreational drugs
Whether you have had surgery before
whether you have any heart problems
Whether you have a hormonal disorder
whether you have any psychological problems

sexual history

Your doctor will also ask you questions about your sexual life, which may be very specific, but are essential for correct diagnosis and treatment. Some of these questions could be:
The status of your previous sexual relationships
Your current sexual relationships
Your current emotional state
When did your erection problems start?
How long your erection problems last
Whether you have been to another doctor before, especially for SS
Whether you have received previous SS-related treatment
Your doctor will ask you to describe the hardness and duration of erections on waking in the morning and with sexual stimulation. Your doctor will also ask if you have problems with arousal, ejaculation and orgasm.
It would be beneficial to attend the interviews with your sexual partner, if any.

physical examination

The doctor will perform a complete physical examination to evaluate for abnormalities of the penis and testicles. To assess for heart disease, the doctor will measure your blood pressure and heart rhythm and order a blood test to measure your cholesterol level. Your doctor will feel the size, shape and consistency of the prostate by performing a digital rectal examination. To evaluate diabetes, the doctor may order a test to measure the level of sugar in the blood. Your testosterone level may also need to be measured. All of this is done with a blood test.

Heart risk assessment

Because of the close relationship between SS and heart diseases, the doctor usually performs a cardiac risk assessment as part of the diagnosis. Your doctor may refer you to a cardiologist for further evaluation for special heart-related tests, such as a “stress test.”

Other tests

Penile Color Doppler USG, which measures blood testosterone level and penile blood flow, should be performed.
In some cases, it may be necessary to perform other tests. These are not commonly used tests in the initial evaluation of SS and are only needed if your doctor needs additional information in assessing your personal situation.
If necessary, your doctor may refer you to a neurologist, a psychiatrist, an andrologist, or an endocrinologist for further evaluation.


Erectile dysfunction (SS) is a common problem. Although not life threatening, it can negatively affect your quality of life. It’s important to get the right treatment as it can be associated with other conditions, such as heart disease. There are different treatment modalities for SS, discuss with your doctor the best treatment option for your situation.

Education and evaluation of couples

An important part of treatment is understanding this condition and the consequences it can have on your close relationship. For the treatment of SS, your doctor usually recommends a combination of physical and psychological approaches. Treatments that include psychological approaches have proven to be more effective than just treating physical symptoms. This approach has also been found to be effective in single patients or when the partner is not involved.

If you are in a serious relationship, it will be in your best interest to have your partner approve of the type of treatment, know how it works, and be able to talk about it.

Remember that treatment is tailored to your situation, and treatments that work for others may not always work for you.
If you have another SS-related health problem, your doctor may refer you to a specialist for evaluation and further treatment.

lifestyle tips

Improving your general health can reduce your complaints. Your doctor will advise you to stop smoking, drink less alcohol, and exercise regularly.

Depending on your personal situation, your doctor may recommend that you adjust your diet. It is important that you discuss this with your doctor first. As a general rule, try to eat a diet low in sugar, salt, and fatty foods.

Phosphodiesterase 5 inhibitors

Phosphodiesterase 5 inhibitors (PDE5I) are a group of drugs used in the treatment of SS. These drugs increase blood flow by relaxing the smooth muscles of the vessels in the penis. They do not cause an erection without a sexual stimulus.
There are 4 types of approved PDE5Is:
PDE5Is are the most prescribed drugs for SS. All PDE5I variants can be equally effective. Which drug is best for you depends on how often you want to have sex and your personal experience.
Because PDE5Is are very effective in the treatment of SS, there are many counterfeit drugs on the market. These drugs are not approved for sale, they can be poisonous and can harm your health. Always talk to your doctor or healthcare provider before using or purchasing medication for SS.


It is the oldest known PDE5I and is sold as a pill. It is available in 25, 50 and 100 mg doses. Dose adjustment can be made according to your needs. You start to feel the effects 30-60 minutes after taking the medicine. Its effect can last up to 12 hours. If you eat fatty foods just before taking sildenafil, the effect of the drug will decrease.


Tadalafil is sold as a pill. It is available in doses of 5, 10, and 20 mg. The dose can be adjusted according to your needs. You start to feel the effects 30 minutes after taking the medicine. It reaches its most effective level after 2 hours. Its effect can last up to 36 hours. Compared to other PDE5Is, what you eat has no effect on the effectiveness of Tadalafil.


It is sold as a pill or as a dissolvable tablet. It is offered for sale in doses of 5, 10 and 20 mg. The dose can be adjusted according to your needs. You start to feel the effects 30 minutes after taking the medicine. If you eat fatty foods just before taking Vardenafil, the effect of the drug will decrease.


Avanafil is the newest PDE5I. It can be found in doses of 50, 100, and 200 mg. Dose adjustment can be made according to your needs. You start to feel the effects 15-30 minutes after taking the medicine. Anything you eat with the medicine can delay the effect of the medicine.

Side effects

PDE5Is can cause headache, skin rash, heartburn, nasal congestion and dizziness. Vardenafil can cause vision changes, while Tadalafil and Avanafil can cause back and muscle pain. All these side effects go away after you stop using the drug.

What can be done if PDE5Is do not work?

If you think that PDE5Is are not useful to you, you should first determine the reason for this situation. To do this, you must answer the following questions:
Have you used this drug at least 4 different times?
Did you use the maximum dose of the drug?
Was there enough sexual stimulation when you took the drug?
Have you waited long enough for the medicine to take effect?
Did you wait too long before starting the sexual stimulus?
If you do not see any benefit despite using the highest dose and correct PDE5I, discuss other possible treatment alternatives with your doctor.

topical treatment

What is topical treatment?

Topical therapy means applying drugs to the skin. The first of these is a drug placed from the tip of the penis. The second is a drug in cream form applied to the external opening of the urethra at the tip of the penis.

When should I consider topical treatments?

Alprostadil is a well-known drug used in the treatment of erectile dysfunction. The most important advantage of alprostadil cream is that systemic side effects are very rare and there is no restriction in its use with other drugs (for example, used in the treatment of high blood pressure or blood thinners such as heparin, warfarin).

What are the side effects?

The most common side effects associated with intraurethral alprostadil are local pain and dizziness, usually accompanied by low blood pressure. Urethral bleeding and urinary tract infections may be observed in some patients.

Topical alprostadil is only advantageous because of its local side effects, which include penile redness, penile burning and pain. Systemic side effects are very rare.

To make sure it is safe for you to use alprostadil, tell your doctor if you have:
a history of an event related to a blood clot,
heart disease, high blood pressure (hypertension),
bleeding or clotting disorder; or
a disease that can be transmitted through the blood (such as hepatitis or HIV)
Use a condom to prevent passing this medicine to your partner with whom you are having sexual activity.

Vacuum Curing Device

What is VED?

A vacuum erection device (VED) is a cylindrical device with a rubber or silicone ring that tightens around the penis. VED provides curing and maintaining it.

When should I consider using VED?

You should consider VED when PDE5Is are not effective. You can also consider VEDs as an alternative therapy if you are unable to use PDE5Is or do not want to take medication for SS.

When is VED not recommended?

VED is not recommended if you are taking anticoagulant medication or have a clotting disorder.

What are the side effects of VEDs?

VEDs can be uncomfortable, make ejaculation difficult during orgasm, and cause bruising and numbness of the penile skin. Keeping the constrictor ring for more than 30 minutes can cause serious damage to the skin of the penis.

shock wave therapy

What is shock wave therapy?

Extracorporeal shock wave therapy (ESL) is a treatment in which very low-intensity focused shock waves are delivered to the penis in short intervals to improve erectile function. It is applied in multiple sessions and can be repeated if necessary.

ESL is a new treatment modality under investigation for SS. It is not a standard treatment option. Special ESL devices are required for the treatment of SS. Discuss with your doctor whether ESL treatment is suitable for you and whether it can be applied in the hospital you go to.

When should I consider ESL?

If you have mild SS and do not want to use the PDE5I, your doctor may recommend ESL. But keep in mind that ESL is not currently a standard treatment for SS.

How does it affect?

ESL causes minor damage to the penile tissue. During the healing process, new blood vessels are formed and blood flow to the penis increases. This increases the capacity to provide and maintain hardening.

Intracavernous injections

Intracavernous injections are a treatment option for the treatment of SS, in which the drug is injected into the spongy tissue in the penis to open the vessels.

When should I consider intracavernous injections?

Intracavernous injections are a treatment option used when initial lifestyle changes or PDE5Is do not work. Although most men are afraid of the idea of ​​having their penis injected, people who choose this treatment soon realize that a small needle hole is not so important in the face of the benefits of the injection.

How do intracavernous injections work?

Drugs used in intracavernous injection increase blood flow by causing relaxation in the smooth muscles of the vessels of the penis. Thus, 10 – 15 minutes after the injection, an erection occurs even if there is no sexual stimulus.

How do I give an intracavernous injection?

Your urologist will train you in his practice on how to inject yourself. In some cases, your partner may also need training. During the training, the urologist also determines the appropriate dose for you.

The place of injection is important. Be sure to inject between 2 and 4 o’clock or between 8 and 10 o’clock to avoid damaging the base of the penis, the urethra, nerves and blood vessels in the penis. Then apply gentle pressure to the injection site for 2 – 5 minutes to avoid bruising. If the correct dose is applied, hardening will occur within 10-15 minutes.

What are the side effects?

The most common side effect of injections is pain in the penis during erection. This happens in one of every 10 injections and ends with the end of the hardening. Another mild side effect is bruising at the injection site.

The most serious side effect is priapism. An erection that lasts longer than 4 hours and is painful. Priapism can damage smooth muscle cells in penile vessels and worsen SS. It is very important to contact your doctor if your erection lasts longer than 2-3 hours. In general, priapism can be effectively treated with an injection of an antidote (a substance that blocks or counteracts the harmful effects of any poison or drug).

Penile Implants

A penile implant, also called a penile prosthesis, is a medical device that is placed in the erectile chambers of the penis in the case of severe SS.

When should I consider penile implant surgery?

If you’ve tried PDE5I and intracavernous injections but have had little effect on your SS, a penile implant is an option you might consider. It may also be recommended if you are unable to use PDE5I or injection drugs. If you have tried PDE5I and injection and are not satisfied with the result and want a permanent solution, a penile implant may be a suitable option for you.

How does the penile implant work?

There are two types of penile implants: semi-rigid, non-inflatable implants and inflatable implants.

Semi-rigid implants consist of two bendable rods inserted into the erectile chambers of the penis. They can be bent into the appropriate position during sexual activity. In the presence of such implants, the penis is always semi-rigid and can be difficult to hide.

Inflatable penile implants, on the other hand, are fluid-filled devices, consisting of two inflatable cylinders placed in the erectile chambers of the penis, a hand-controlled pump placed in the testis, and a reservoir that stores fluid when the penis is not erect. The device is inflated by transferring the liquid from the reservoir to the cylinders by squeezing the pump several times. Then, the pump is used to transfer the liquid back to the reservoir.

You need to have surgery for both implants. Both implants are placed completely inside the body. Inflatable implants are used more often because they provide a more natural result. In complicated cases, semi-rigid implants may be more appropriate. Discuss with your urologist which of the two types of implants you will choose.

Erectile Dysfunction After Localized Prostate Cancer Treatment

Prostate cancer is a malignant tumor of the prostate gland. This is the most common type of cancer in older men. There are several treatment options for localized prostate cancer. Two of the most common treatments are prostate removal and radiation therapy. These treatment options can affect sexual health, and men often experience erectile dysfunction (SS) after treatment.

Prostate Why is cancer treatment associated with erectile dysfunction?

The prostate gland lies just below the bladder and is surrounded by nerves and blood vessels. These nerves and blood vessels are essential for normal erection. Much research has been done to understand where these nerves are located and to prevent damage during surgery or other treatments.

Radical prostatectomy

Radical prostatectomy is a surgical treatment option in which the entire prostate and surrounding tissue are removed. If the tumor is limited to the prostate gland, the surgeon will try not to touch the nerves of the penis during the operation. This is called nerve-sparing surgery. Even if nerve-sparing surgery is successful, temporary erectile dysfunction is common after radical prostatectomy.

The reason for this is that the nerves are very sensitive, so they are affected by the slightest damage. If any damage occurs during the surgery, the signals of the nerves to the blood vessels of the penis stop. Nerves can take up to 2 years to heal.

The blood vessels that supply blood to and from the penis may also be affected by the surgery. As a result, less blood goes to the spongy tissue of the penis, damaging it. Because of this damage, erectile dysfunction may be more difficult to heal.

In some cases, nerve-sparing surgery is not possible in cases where the tumor has spread outside the prostate or for other reasons. Recovery of erectile function is not expected after non-nerve-sparing surgery, but it is not impossible. Discuss your concerns and possible treatment options with your doctor.

radiation therapy

Radiation, a type of cancer treatment, is used to control or kill bad cells. Nerves and blood vessels leading to the penis around the prostate can also be damaged, as radiation can cause healthy cells to die as well. Although there is a risk of erectile dysfunction after radiation therapy, technical developments have increased the sensitivity of the beam.

Will it be possible to have a normal erection after the treatment?

The risk of erectile dysfunction after prostate cancer treatment depends on the technique of surgery or the type of radiation used by your doctor, but at the same time, the following characteristics affect you:
body structure
Features of the disease
Pre-treatment sexual health

Living with Erectile Dysfunction
Almost every man can experience short-term problems with erectile function. In almost all cases it is related to certain and particular life circumstances, problems or stress. Often, these erectile dysfunction problems are resolved by solving or changing the condition. Usually there is no need to go to the doctor.

If you experience erectile dysfunction (SS) for more than 6 months, you should seek professional help. Your doctor can help you find the cause by performing physical and psychological tests.

Erectile dysfunction can have a negative impact on quality of life. Quality of life encompasses both physical and mental health. It is important not only to feel healthy, but also to not have the psychological discomfort of living with erectile dysfunction. Another important issue is that different people may experience the same symptoms differently. Therefore, your personal experience and quality of life should not be overlooked; because they are as important as diagnostic tests and treatment results.

Personal relationships and sex

A close relationship between two people is complex and needs to be addressed from many angles. Erectile dysfunction can affect or change your relationship with yourself or your partner. You may feel ashamed or guilty, which can make it difficult to talk to your partner about the situation. Erectile dysfunction can have a direct impact on a serious relationship.

Erectile dysfunction can negatively affect your sex life. It is difficult to feel attractive and self-confident or to be close with your partner when you feel that you cannot bring pleasure to your partner. This trust can also have an impact on intimacy and intimacy. Intimacy as well as daily interaction can be affected by this.

You may feel emotionally and physically alone because you fear that there will be no satisfactory sexual activity. While this behavior can be a sign of disappointment and humiliation, your partner may feel that you are losing interest in them. This can negatively affect their self-esteem and sense of attractiveness.

Dealing with these changes can be very difficult because for most men, sex and erection are important their whole life. You may even be in denial and become depressed. Therefore, the effect of erectile dysfunction on quality of life should not be ignored.

Many men may find it inappropriate to admit that they need affection and hugs. It is important that you address the issue by talking to your partner. This can prevent emotional and physical distance and provide the comfort and emotional support you need.

Your partner may have associated their attractiveness and sexual attraction with their ability to turn you on. They may feel vulnerable and rejected, and may fear betrayal and abandonment. These feelings are exacerbated as you cannot experience satisfactory sexual activity due to erectile dysfunction. Although erectile dysfunction treatment can resolve the physical aspect of the problem, the psychological consequences for you and your partner may also need to be addressed. Consulting a therapist may help.

Your partner can be distressed even if they don’t express it, so it is very important that you talk openly with your partner about the best way to deal with this situation.

Erectile dysfunction does not only affect the sex life of men in a serious relationship. Single men who suffer from erectile dysfunction often avoid intercourse for this reason.

Discussing your sex life with a urologist or a sexologist can be uncomfortable, but it is the most effective way to deal with your concerns. Together with your doctor, you can determine what is important in your sex life and choose the best treatment option for a satisfying sex life. If you have a partner, it is important that he or she participates in these conversations.

While these reasons may seem convincing, they shouldn’t stop you from seeking help and improving your quality of life.

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