Male erection problem (impotence) is also known as ‘erectile dysfunction, ‘impotence’ or ‘erection problem’. Erection means the hardening and erecting of the penis.

Any male individual can experience erection problem due to the reasons such as job and partner problems, economical problems, nervousness, prostration and other problems regarding relationship etc. This is a natural thing to happen. Because expecting a sufficient erection anytime is not possible. However, if the erection problem repeats frequently and prevents sexual intercourse, it requires a treatment.

Impotence is not the same thing with sexual anorexia. It’s different than ejaculation problems. And it should be mixed with premature ejaculation or infertility. A male individual with impotence can have orgasm and have children. This means that a patient with erection problem can have sexual drive and ejaculate without any problems.

Age factor is an important one for the patients with erectile dysfunction. It’s a common problem among the males over 40.

Male individuals can have problematic periods regarding erection at any age, however, permanent erection problem before the age of 40 is rare. This rate increases as the age advances and the rate of erection problem among the males around the age of 70 is 65%.

Although some changes related with aging occur in the advanced ages, these changes don’t always cause erection problem. Many males need more penile stimulation for erection, erection level of the penis decreases while it’s erected and any distraction during sexual intercourse causes the loss of erection. Frequency of sexual intercourse is less, but the intercourse is as much pleasurable as before. And this is very important for the male individual to feel good about himself.

Erection is a natural reflex of a healthy oenis and nervous system. Any problems regarding the anatomical structure of penis or nervous system can damage this reflex.

Penis' Anatomy and Erection ?


Anatomically, there are two spongy cylinders called Corpora Cavernosa parallel to urinary tract in the penis. When the male individual is stimulated sexually, nervous system stimulates the penis to erect. Penis muscle and arteries in the penis loosen to fill the sinusoids in the spongy cylinders with blood. And this results in the erection of the organ. With the blood filled in sinusoids, increasing pressure in the organ and prevention of circulation due to suppression of venes balances the blood flow. Arrangment of blood flow in this way keeps the erection. Brain, spinal cord, nerves, blood venes, penile smooth muscle and hormones work in this process. Muscles of spongy cylinders are controlled by special centers in the brain and spinal cord and this way the erection and softening is maintained. While these centers provide the erection by being effected by sexual contact, erotic stimulations or fantasies; concern, insecurity, excitement, fear and stress affect the erection.

What Are the Reasons for Erection Problem?
Erection problem is caused by various reasons. They can be psychological, physiological or the combination of both. Separationg of psychological and physiological reasons from each other is important in terms of the treatment selection. Reasons of erection problem can be divided into 3 main groups:

1. Psychological reasons
2. Physical reasons
3. Psychological and physical reasons

1-) Psychological reasons:
Psychological problems such as anxiety and depression caused by the reasons such as stress, constant occupations pressure, feeling of failure in business and family life, constant problems between partners, physical antipathy and fear of impregnating the female partner, having wrong information about sexuality, being refused, sadness etc. may cause erection problem.

Male erection problem can also be caused by the problems about marriage, imbalance of roles in the relationship, dominant character of female partner, communication problems, being cheated on or cheating on.

Again, male erection proble can be caused by negative perception regarding sexuality due to male, strict, rule based family structure, being raised with strict religious and moral rules and not getting any sexual education. Sexual traumas during childhood and puberty, harassment, rape, abuse, incest relationships, disappointing first sexual experiene, lack of information and experience can also cause it.

Senseless and intrapsychic conflicts regarding the fact of being a couple may cause this problem as well. It’s possible that these conflicts may arise when the male is about to be involved in the sexual activity. Additionally, most of the erection problems we see in our clinic are simpler and easily treatable ones caused by emotional factors. These include performance anxiety, fear of being refused by the woman, impotence expectation due to difficulty in erecting experienced in the past, excessive focus on the satisfaction of the female partner and culturally induced guilt regarding sexual pleasure.

As a result, impotence due to psychological reasons mentioned above is a common one among the patients of any ageç Since the most important and functional sexual organ is the brain, long-term or newly started phychic traumas or the ones experienced in the pas can cause erection problem.

Males react to erection problem (impotence) with shame, guilt, confusion, loss of confidence, tedium, prostration. Increasing pressure for performance prevents spontaneous erection. Male individual then starts fighting with questions as “what if I can’t get erected?, “will I get erected?”, “will my erection last until the end of intercourse?”, “will my erection go away?”, “what if the erection ends before getting inside the vagina?” consciously or unconsciously instead of focusing on pleasure and sexual conenction with his female partner. This negative thoughts turn into fear of failing and may become a vicious circle by causing loss of motivation and performance during the upcomign sexual intercourse. This means that the most significant psychological factor causing erection problem is the negative expectation and thoughts regarding performance. The person’s expectation of insufficient performance and thoughts about the problems that might arise after insufficient performance would cause anxiety and avoiding sexual intercourse and even depressive symptoms.

Premature ejaculation, orgasm disorders and changes in sexual interest also may cause erection problems interconnectedly.

2-) Physical reasons:
a.) Vascular diseases

• Cardiovascular diseases
• Hypertension (high blood pressure)
• Diabetes Mellitus (diabetes)
• Hyperlipidemia (high cholesterol, triglyceride etc. in blood)
• Smoking
• Having severe operation on pelvic area
• Having radiotherapy on pelvic area

b.) Neurological diseases affecting nervous system
• After strokes
• Trauma, impact, accidents affecting spinal cord and spinal cord diseases
• Diseases related with brain degeneration (Parkinson’s, Multiple Sclerosis etc.)
• Brain tumors
• type 1 or Type 2 Diabetes involving nerves
• Chronic kidney failure
• Nerve section during surgeries on pelvic area

c.) Diseases causing anatomic or structural disorders on penis
• Hypospadias, epispadias
• Micropenis (small penis)
• Peyronie’s disease
• Inherent penis curvatures

d.) Diseases developing due to hormonal disorders
• Hypogonadism (lowness of male hormone called testosterone in blood)
• Hyperprolactinemia (high prolactine hormone in males)
• Hyper-Hypo thyroidism (high or low thyroid hormones)
• Hyper-Hypo cortisoiism (such as cushing’s syndrome)

e.) Erection problems due to medication

• Various medications used for treatment of hypertension
• Various antidepressanst • Antiandrogenic medications (medications suppressing testosterone)
• Alcohol and drug use (heroin, cocaine, marihuana etc)

f.) Traumas (penis ruptures, penis fractures etc.)

What are the risk factors for erection problem?

1. Risk factors are led by cardiovascular diseases. The risk factors stated below are also risk factors for the erection problem:

• Not doing exercises regularly
• Smoking
• Adiposity
• High cholesterol level in blood
• Metabolic Syndrome

2. chronic diseases are important risk factors. The most effective of these diseases are diabetes, hypertension, chronic kidney failure.

3. Constant use of medication for chronic diseases is also among the risk factors.

4. Various surgeries: Having had a surgery that is conducted for the treatment of prostate cancer such as prostatectomy.

5. Having radiotherapy or brachytherapy on the pelvic area and prostate

In order to see the presence of physical (organic, structural) factors, males with erection problems should be examined by a specialist.

How Is Erection Problem Diagnosed?
Examination starts with obtaining the medical history. Risk factors are questioned for this part. Diabetes, hypertension and cardiovascular diseases should definitely be questioned. It’s important to know whether the patient had any durgical procedures and was exposed to any radiotherapies. It’s also important to gather information about the severe accidents, smoking and use of alcohol, medications being used and used in the last year.

The patient should be asked about any possible pain when the penis is erected and about any deformities and curvatures. If these problems exist, Peyronie’s disease might be possible. Psychological reasons should also be questioned. The step after medical history is the physical examination. An emphasis should be put on the genital area. Vascular and nerve functions should be tested. Peyronie’s disease should also be checked. Digital rectal examination may be conducted to know more about the prostate.

Some blood and urine tests would be required. Testosterone and sugar level in the blood should be measured. Level of blood fats should be known. Colored Doppler Ultrasonography is a sensitive test providing information about penile venes through sound waves. Injection of erection providing medications (papaverin) can be conducted and the response can be observed. If there are no problems regarding blood flow, the erection would occur. Some diseases would require further tests. First of these is the neurological test called bulbocavemous reflex measurement. Doctor places one finger in the anus during this test and squeezes the penile glans with other hand. Normally the muscles around the anus would contract. Thanks to another test, information regarding erection during sleep and its level can be obtained. Every male individual gets 3-4 times of erection (nocturnal erection) during sleep. If the problem is physical, frequency and level of erections reduce. In the presence of psychological reasons, patient continues to have these erections. This test provides significant information to the physician for the separation of psychological and physical reasons.

Male erection problem (impotence, erectile dysfunction, erection problems) are treatable today. If the problem has been existing for more than 3 months, Professional help should be sought. Getting information about the treatment of erection problem could help a lot in terms of your treatment.

 

© 2016 - Op. Dr. Cem ÖZLÜK