Erectile Dysfunction (ED) Treatment in Turkey

What is Erectile Dysfunction?

Erectile dysfunction is the inability to achieve or maintain sufficient penile hardness for sexual intercourse. Clinically, this condition persists for at least three months and negatively affects both individual quality of life and partner relationships. Approximately 50% of men over the age of 40 worldwide experience some degree of erectile dysfunction. Erectile dysfunction is not only a sexual health problem but can also be an early sign of systemic diseases.

Causes of Erectile Dysfunction

The causes of erectile dysfunction (ED) are generally multifactorial. Diseases that impair vascular health, disorders affecting nerve conduction, hormonal imbalances, psychological stress factors, and side effects of certain medications are among the most common causes. Impaired blood flow prevents adequate accumulation of blood within the penis, while nerve damage disrupts the transmission of sexual stimuli to the brain. A decrease in testosterone levels can lead to reduced sexual desire and performance. Additionally, depression, anxiety, and relationship problems also directly affect erectile function.

The causes of erectile dysfunction are multidimensional and usually result from a combination of vascular, neurogenic, hormonal, anatomical, or psychogenic factors:

• Vascular causes: Conditions such as atherosclerosis, hypertension, and diabetes can block sufficient blood flow to the penis.
• Neurological causes: Spinal cord injuries, Parkinson’s disease, or multiple sclerosis, which affect the nervous system.
• Hormonal imbalances: Testosterone deficiency, hypogonadism, prolactinoma.
• Psychological factors: Depression, anxiety, relationship problems, performance anxiety.
• Iatrogenic causes: Prostate surgeries, certain medications (e.g., antihypertensives, antidepressants).

Risk Factors and Underlying Diseases in Erectile Dysfunction

Erectile dysfunction typically develops due to the accumulation of specific risk factors. Chronic diseases such as diabetes, hypertension, cardiovascular diseases, and obesity significantly increase this risk. Particularly, atherosclerosis blocks blood flow to the penis, leading to erection problems. Smoking, high cholesterol, sedentary lifestyle, and poor nutrition further exacerbate these risks. Additionally, hormonal or metabolic disorders such as testosterone deficiency, thyroid dysfunction, and kidney diseases may be underlying causes. Erectile dysfunction can sometimes be the first sign of serious heart disease.

What Are the Symptoms of Erectile Dysfunction?

The most prominent symptom of erectile dysfunction is insufficient erection or inability to maintain an erection throughout sexual intercourse. Other symptoms that may accompany the condition include decreased sexual desire, loss of morning erections, and reduced sexual satisfaction. Some men may experience this condition occasionally, while for others it may become permanent. Symptoms can affect both physical and psychological well-being and lead to loss of confidence. Regardless of the severity of the symptoms, the possibility of an underlying systemic disease must always be considered.

Symptoms of erectile dysfunction include:

• Insufficient penile hardness during sexual activity
• Inability to maintain an erection throughout intercourse
• Noticeable decrease in morning erections
• May be accompanied by loss of libido (sexual desire)
• Decrease in sexual satisfaction
• If these symptoms become persistent, clinical evaluation is necessary.

How is Erectile Dysfunction Diagnosed?

The diagnosis of erectile dysfunction begins with a detailed patient history. Sexual function, overall health status, lifestyle habits, and psychological condition are evaluated. Physical examination assesses vascular structure, nerve reflexes, and hormonal signs. Laboratory tests and imaging methods are performed when necessary. Short forms and questionnaires used in diagnosis help measure the severity of the condition and its impact on quality of life. Based on these evaluations, the cause and severity of erectile dysfunction are determined, and an appropriate treatment plan is created.

The Importance of Early Diagnosis in Erectile Dysfunction

Erectile dysfunction is often an early sign of a more serious disease. It is closely related to chronic illnesses such as coronary artery disease and diabetes. Early diagnosis not only helps preserve sexual function but also significantly improves quality of life. Additionally, early detection of underlying diseases enhances long-term health outcomes. Therefore, it is very important for individuals experiencing erectile dysfunction to consult a urology specialist without delay.

Tests Used in Erectile Dysfunction

• Total and free testosterone levels: Used to assess hormone levels.
• Lipid profile and fasting blood glucose: Necessary for screening metabolic syndrome and diabetes.
• Penile color Doppler ultrasonography: An imaging method that evaluates blood flow to the penis and venous leakage.
• Nocturnal Penile Tumescence (NPT) test: Determines if spontaneous erections occur during sleep.
• Intracavernosal injection test: Observes vascular and tissue response by injecting medication into the penis.
• Nerve conduction tests and reflex examination: Used to rule out neurological disorders.
• Psychological evaluation: Investigates psychological factors such as anxiety, depression, and performance anxiety.

Erectile Dysfunction (ED) Treatment in Turkey

The treatment of erectile dysfunction in our Ankara clinic is personalized for each individual. Managing underlying diseases often forms the foundation of the treatment.

ED treatment follows a stepwise approach, beginning with non-invasive methods such as lifestyle changes and psychological support. Subsequently, medications, devices, and as a last resort, surgical options are considered.

A multidisciplinary approach yields more successful results, especially in complex or resistant cases. Treatment success is closely linked not only to medications but also to the patient’s motivation and active participation in the process.

1. Medication Treatments for Erectile Dysfunction: PDE5 Inhibitors

Phosphodiesterase type 5 inhibitors (PDE5 inhibitors) are the most commonly used class of drugs for erectile dysfunction. These medications relax the blood vessels in the penis, increasing blood flow and supporting the erection process. Sildenafil, tadalafil, vardenafil, and avanafil belong to this group. Because their onset and duration of action differ, the appropriate agent is selected based on the patient's lifestyle and frequency of sexual activity. These drugs are effective only with sexual stimulation. Caution is advised in patients with heart disease, especially those using nitrate medications.

2. Shock Wave Therapy (ESWT) for Erectile Dysfunction

Low-intensity shock wave therapy (ESWT) has gained attention in recent years as a non-invasive method. This treatment promotes new blood vessel formation through sound waves applied to the penis. Positive results have been reported in patients with mild to moderate vascular erectile dysfunction. Treatment typically consists of 6-12 sessions applied once a week. While the exact mechanism is still under study, some research shows increased vascular elasticity and improved microcirculation. ESWT is an alternative for patients who do not respond to medication or prefer not to use drugs.

3. Vacuum Devices and Penile Prostheses for Erectile Dysfunction

Vacuum erection devices mechanically draw blood into the penis by applying negative pressure externally, producing an erection. These devices can be effective for patients who do not respond to or cannot use medications. Penile prosthesis surgery is considered a last-line treatment. Prostheses are usually designed to be inflatable or malleable and provide a permanent solution. Patient satisfaction after surgery is generally high, but risks such as infection and mechanical failure should be considered.

4. The Importance of Lifestyle Changes in Erectile Dysfunction

A healthy lifestyle plays a fundamental role in both preventing and treating erectile problems. Quitting smoking, limiting alcohol consumption, regular physical activity, balanced nutrition, and weight control positively impact erectile function. Additionally, reducing stress and improving sleep quality can enhance erectile health. Lifestyle changes not only reduce symptoms but also increase the effectiveness of medication treatments.

Which Specialist Should Be Consulted for Erectile Dysfunction?

The primary specialty for individuals experiencing erectile dysfunction is urology. Urologists are qualified to diagnose and plan treatment. Support from other specialties such as endocrinology, cardiology, and psychiatry may be sought when necessary. A multidisciplinary approach is particularly effective in patients with multiple risk factors.