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    No matter what the reason for the erection disorders you have is, make sure that you are not alone. More than 150 millions of men experience the same symptoms. Erection disorders can be treated. The number of treatment methods applied gradually increase. These include such new methods which are both effective for most men an which can be applied easily. First of all a man's problem with erection should never be exaggerated by himself or by his spouse.

    For a correct treatment, first of all, the problem should be assessed by a specialist urologist doctor. Following the urological assessment performed, if there is any physical (organic) problem or disease, it should be treated as a priority. If there is no physical obstacle, namely if the origin of the problem is merely psychological, the problem can easily be solved using the sexual therapy techniques applied by a specialist sexual therapist.
    One having his penis erected when he wakes up in the morning (existence of morning erections) indicates that the problem mostly arises from a physical (organic) disorder, namely it has a psychological origin.

 

TREATMENT IN PROBLEM WITH ERECTION ARISING FROM PSYCHOLOGICAL REASONS
Many sexual problems in men arise from performance anxiety. For this reason it is very significant to relax the person and give him his self confidence again through information provided after starting treatment. When persons direct their attention to receiving sexual pleasure rather than their performance, when they learn how to control themselves in the manner to succeed this, the problem shall disappear. Spouses should be encouraged to concentrate their interest on the feelings and to fill their brains with those feelings rather than thoughts. Performance anxiety may be eliminated by "forbidding" spouses to have sexual relation temporarily. Spouses may have all sorts of foreplay experience excluding coitus. Forbidding coitus eliminates anxiety about having erection. When spouses leave thought and anxiety and concentrate on each other and themselves erection will come automatically.
Problems of impotency arising from psychological reasons are generally solved in 5-6 séances using sexual therapy techniques. In sexual therapies applied due to failure to erect, cognitive-behavioral sexual therapy techniques are used in general. In some cases dynamic therapies may be required as well. In such cases treatment period extends.

TARGETS OF SEXUAL THERAPY
• Extricating oneself from oppression of sexual performance
• Creating confidence in the person for his own sexual feelings and spontaneous development of erection
• Overcoming with the fear of losing erection and sexual failure
• Struggling with false sexual beliefs
• Developing sexual life field, rediscovering sexual life
• Restructuring relation
This problem can easily be solved owing to performing the exercises or homework given by the therapist carefully and in the feeling of trust to and proper communication with the therapist.

TREATMENT IN PROBLEM WITH ERECTION ARISING FROM PHYSICAL (ORGANIC) REASONS

CONSULTANCY: Each individual with sexual problem has the right to be treated. A patient having a problem with erection for organic reasons may come with problems including fear, stress or the problem with erection he has may have led to psychological problems. For this reason it shall be proper to provide psychological consultancy for those patients at first sight.

MEDICAL DRUGS: Today certain medical drugs are used as well for treatment of the problem with erection in men (erectile dysfunction, impotency). Those medical drugs are generally drugs of 5 PDE inhibitors group. They are such medical drugs effective for problem with erection (impotency) by inhibiting destruction of substances in the body which are effective for erection and increasing quality and duration of erection. In order those medical drugs to be effective, the person should have his own erection as well though it may be low. Success rate can reach up to 75% in patients selected properly. Complaints including headache, hot flush or the feeling of fullness in the nose may occur depending on widening of blood vessels. Problems with seeing may occur.

 


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    SILDENAFIL CITRATE (VIAGRA): Sildenafil is the inhibitor of phosphodiesterase type 5 enzyme and provide erection by rising the levels of cyclic Guanozin Mono Phosphate (cGMP).Increase in,cGMP level leads to relaxation in smooth muscles and thus erection. It has doses of 25, 50 and 100 mg. It should be taken on an empty stomach 1 hour before relation. The duration of effect is approximately 6-8 hours.

    VARDENAFIL HCL (LEVITRA): Vardenafıl is more authentic than phosphodiesterase type 5 enzyme and inhibits phosphodiesterase type 6 enzyme less than sildenafil. It has doses of 5, 10 and 20 mg. It should be taken on an empty or full stomach 30 minutes before relation. The duration of effect is approximately 6-8 hours.

    • TADALAFIL (CIALIS):  Tadalafil shows its effect by inhibiting phosphodiesterase type 5 enzyme as well. Tadalafıl mixes with the blood slower than sildenafil and vardenafil. It has doses of 5, 10 and 20 mg. It should be taken on an empty stomach 1 hour before relation. The duration of effect is approximately 36 hours.


 

Can cardiac patients use Phosphodiesterase Type 5 inhibitor?
The medical drugs that cardiac patients will use for their sexual lives should be regulated after detailed cardiologic and urological examinations. Cardiac patients should not use Phosphodiesterase Type 5 inhibitor group drugs without doctor's recommendation. Those drugs should never be used together with nitrates. Cardiac patients can use Phosphodiesterase Type 5 inhibitor group drugs as well strictly provided to be under a doctor's control.

CONSTRICTION RING and VACUUM PUMP:
It is a mechanical pump system. Vacuum devices and constriction rings make vacuum to the penis and provide blood to fill in the penis. Its effect mechanism is increasing blood flow to the penis owing to vacuum device and providing the blood to remain inside through a rubber placed in the root of the penis. It has success of 40-50%. Although it is a device with reliable effect, one should definitely use such tool with safety valve produced by a medical company. The constriction ring should be held for maximum 30 minutes.
The biggest disadvantages of this method include necessity to carry the vacuum device in a bag all he time, the penis being movable under the rubber area since there is no erection there and sometimes the pain felt due to the negative pressure applied.
Although its acceptance by the sexual partner does not differ from other methods, sometimes the patients themselves have difficulty with admitting and applying it.
Side effects including coldness, pain, insensitiveness in the penis, failure of ejaculation or ejaculation with pain and cyanosis may be observed.

TREATMENT OF INJECTION INTO THE PENIS (INJECTION TREATMENT)
Blood vessel expanding drugs are injected into the penis (cavernous substance) using a thin injector. Injecting vasoactive substances including papaverin, prostaglandin E1,fentolamin relaxes penis texture and blood vessels and increases arterial blood flow and thus provides erection. Thus the amount of blood coming to the erection rings increase and erection realizes. Injection into the penis is applied to the group of patients for whom oral drugs have been tried but failed. Its effectiveness at the beginning may be as high as 75%. Satisfaction of the sexual partner is high as well. The most significant side effect known is burning sensation in the penis. Complications including erection for a long time, pain in the penis and testicles, tissue hardening in the penis, disorders in the liver function tests and infection in the penis may be observed. In this method with high probability of success, the person makes injection approximately 15 minutes before having relation and the effect of the drug last for averagely half an hour. Although it is difficult for the patient to make injection into the penis, it is still an effective method used widely in all over the world. This treatment is particularly effective in impotence patients who failed to respond other medical treatments or having impotency due to operation (after radical prostatectomy namely prostate cancer surgery).

INJECTING VASOACTIVE DRUGS INTO THE PENIS (MUSE)
MUSE (Medicated Urethral System for Erections). Substances similar to those used in injection treatment are given from the end of the penis into the urethra. And the substances absorbed from there penetrate into the penis and make effect. Quantity of those substances may not be sufficient sometimes and may be excessive at other times. It is a method not preferred frequently in clinical practice. The most frequently observed side effect is burning sensation in the penis and hematuria.

VASCULAR SURGERY (REVASCULARIZATION)
It is aimed to increase blood flow and blood pressure in this treatment. It is particularly applied for young patients who have an accident preventing normal blood flow. This treatment method is based on the principles of directing a healthy artery to the penis. It is a very rarely used method.

LSWT (Linear Shock Wave Treatment)
Linear Shock Wave Therapy (LSWT) which is a new generation-invasive treatment method for treatment of problem with erection namely erectile dysfunction (ED) is accepted to be a great development for patients with such complaints. Success of this method which is effective in all erection problems with vascular causes is higher than 80% in mild and medium degree patients and higher than 60% in high degree patients. Low density shock waves are used for this process. This technology is the newest method in treatment of patients with erectile dysfunction. The system was developed in the manner to be applied directly from a single point to the concerned area. This new LSWT system provides therapeutic effect in a wide area with a length of 70 mm in one time from a single point of application along the target organ.
Erection problem with vascular reasons make up approximately 70% of the patients with erection problem with organic reasons and the biggest group among them are diabetic patients and patients of coronary disease. 50% of the patients give up using the drug for reasons including risks in patients of coronary disease, necessity to plan in advance and addiction to the medical drug in addition to the known side effects and adverse effects of the medication. Furthermore it has been evidenced that LSWT treatment made the patients with severe erection problem who fail to respond the medical drugs and who were directed to injection and prosthesis treatment be able to respond the medical drugs. Low Density Shock Wave Therapy (LSWT) has been used successfully in ischemic tissue treatment in the field of cardiology since 2000 and increase blooding in the ischemic tissue which has low blooding in the heart. LSW waves which are applied by being reflected firstly and focused then lead to creation of new thin veins in sexual organ of men as it is the case with the heart and increase blooding in the organ, thus successful erection is provided again. Furthermore the same method of treatment is applied for diabetic foot and non-recovering injuries in diabetic patients.
It is applied on 4 areas and provides optimum effect owing to its linear nature. Recovery is achieved in a treatment process applied only in 4 séances for 4 weeks (totally 80 minutes) owing to its state of art technology. The treatment is completely safe, it contains no intervention or attempt. It contains no medication. It has no side effect during or after the treatment reported up to date. The patients can turn back to their daily lives after each séance without waiting. They have no restrictions in their daily lives.
The patients having the treatment tell that they started to feel differently after the second week and reached to the maximum level 1 month after. And the permanent effect realizes from the end of the 4th séance through creation of new veins. It has been evidenced that the success of this LSWT treatment which has been used clinically in the world for the last 2 years has continued for minimum 3 years.

PENIS PROSTHESES (JOYSTICK)
It is the last step and the most successful treatment alternative for persons who fail in the other treatment alternatives or who cannot use the other treatment alternatives.

• It is the process of placement of prostheses which will realize erection in the tubes providing erection in the penis (cavernous substances) through an operation.
• Its level of success is quite high.(95-99%)
• The commonly used prostheses are semi-hard silicon type ones or inflatable or hydrophilic prostheses.
• On the other hand the sexual partner is satisfied more. (Since the necessary level of erection is provided with penis prostheses, both the man and his partner receive higher sexual pleasure.)
• Today 3 piece inflatable penile prostheses are generally preferred in developed countries. Satisfaction of the patient and his partner reaches up to 90% after 3 piece penile prosthesis applications.
• Inflatable prostheses are much more expensive and they are inflated just before sexual relation and can take its original form after relation.
• Operations may be applied under general or regional (spinal/epidural) anesthesia. Those prostheses can be mounted with laceration of approximately 4-5 cm entering though the areas below or above the penis root. It is sufficient for the patient to stay at hospital for one day after the operation. (Trace of laceration is almost invisible in prostheses mounted with under-penis lacerations (scrotal).)
• It can also be applied for patients having erection disorder together with curvature and/or pain in the penis (Peyronie) during penis de-erection.
• One of the most frequently asked questions about penis prostheses is whether the prostheses can be noticed from outside. Penis prostheses cause no problem with the sexual partner during sexual relation. Particularly when pump and twistable type prostheses are selected, it is almost impossible for your partner to notice your prosthesis unless you tell her.
• Penis prostheses are merely a treatment providing sufficient erection for sexual relation. They do not influence ejaculation and insemination.

 PENILE PROSTHESIS APPLICATIONS


                           

© 2016 - Op. Dr. Cem ÖZLÜK