Erectile dysfunction (ED) is the most common type of sexual dysfunction.
It affects half of men over the age of 50.
ED can be an early warning sign for cardiovascular diseases and stroke.
The following conditions are significant causes of ED:
– Obesity
– Smoking
– Excessive alcohol consumption
– Diabetes
– Dyslipidemia
– Hypertension and some antihypertensive medications
– Cardiovascular diseases
– Some antidepressant medications
Initial Evaluation
When a patient first seeks help, the following evaluations are performed:
– Blood tests (hormonal analysis)
– Investigation of sleep apnea
– Doppler ultrasound of the penis after injecting a vasodilator to map the penile blood vessels
Treatment
– Oral medications
– Teaching patients to self-inject the penis to achieve an erection
– Vacuum pump
– Shock wave therapy (ESWT)
– Penile prosthesis surgery
– Stem cell therapy (considered experimental by the European Association of Urology and the American Urological Association)
Botulinum Neurotoxin Injection
– Applied in an office setting without anesthesia into the smooth muscle tissue of the penis to improve blood flow by relaxing the muscles.
– Effects start to show in 2-3 weeks.
– Successful in 70% of patients.
Shock Wave Therapy (ESWT)
– Uses acoustic pressure waves to stimulate the penile smooth muscles, blood vessels, and nerves, promoting tissue regeneration.
– Development of new blood vessels brings more blood to the penis, aiding tissue regeneration and thickening.
– ESWT does not require anesthesia.
– Patients do not feel pain.
– Applied to patients with erectile dysfunction without advanced tissue loss.
– No known side effects.
– Has a success rate of over 75% in treating ED.
– Approved by the FDA and has been used worldwide since 2005.
– Treatment is administered twice a week for a total of 6-8 weeks.
Peyronie’s Disease (Penile Curvature)
– A condition where the penis curves to the side, up, or down during an erection.
– It can be congenital or develop after erections begin.
– Diagnosis is made by inducing an erection with a vasodilator injection during an examination to determine the degree and direction of curvature.
– Patients are asked to provide photos of the erect penis.
– If the curvature interferes with sexual activity, surgical treatment is required.
– Non-congenital types develop due to Peyronie’s disease.
Treating Peyronie’s Disease
– First Stage: This is the painful stage, characterized by pain and a feeling of hardness during and occasionally without an erection. Shock wave therapy (ESWT) is highly beneficial during this period, which can last up to a year. The first stage is considered over when there is no pain for at least three months.
– Second Stage:* This stage involves the development of curvature and palpable hard nodules in the penis. If the curvature exceeds 60 degrees, surgical treatment is necessary.
Premature Ejaculation
– A condition that affects a man’s self-confidence and quality of life, occurring in 5% of men.
– It can lead to psychogenic erectile dysfunction.
– The first line of treatment is medication, though due to planned use and side effects, it is not highly preferred.
– Surgical treatment involves hyaluronic acid (HA) injection into the glans penis.
– Performed under mild sedation.
– Approved by the FDA in 2003.
– Side effects are minor and resolve within 2-3 weeks.
– Extends ejaculation time by 4 to 6 times.
– Effects last for 6 to 9 months.