Scientific Facts: Causes and Treatments of Erectile Dysfunction
By Dr. Zülfü Sertkaya's Team · 6 min read
Summary: Erectile dysfunction can develop due to aging, diabetes, cardiovascular diseases, and psychological factors. In modern medicine, there is a wide range of evidence-based, reliable treatment options from drug treatments to penile prostheses.
What is Erectile Dysfunction?
Erectile dysfunction is the inability to achieve or maintain a penile erection sufficient to initiate or complete sexual intercourse. According to European Association of Urology (EAU) data, a significant proportion of men over the age of 40 experience mild, moderate, or severe erectile dysfunction.
Main Causes of Erectile Dysfunction
The causes of erectile dysfunction are generally divided into two categories: Organic (Physical) and Psychological.
- Vascular Causes: Decreased blood flow to the penis. Hypertension, high cholesterol, and atherosclerosis are the most common causes.
- Neurological Causes: Spinal cord injuries, multiple sclerosis, Parkinson's disease, or nerve damage during prostate cancer surgery (post-radical prostatectomy).
- Endocrine (Hormonal) Causes: Diabetes is one of the biggest factors leading to erectile dysfunction by damaging both the vascular and nerve structures. In addition, low testosterone levels decrease erectile capacity.
- Psychological Causes: Stress, performance anxiety, depression, and relationship problems.
Evidence-Based Treatment Steps
In the treatment of erectile dysfunction, international guidelines recommend a treatment algorithm progressing from the least invasive methods to surgery:
- First-Line (Drug Therapy): PDE5 inhibitors (Sildenafil, Tadalafil, etc.) act by dilating the blood vessels in the penis. However, they are contraindicated in those taking nitrate-group heart medications and may not work in some patients (especially severe diabetics).
- Shock Wave Therapy (ESWT): A treatment aimed at triggering new blood vessel formation (angiogenesis) in the penis using low-intensity shock waves.
- Second-Line (Injection Therapy): Intracavernosal injection (ICI) is a method where the patient injects a vasodilator drug directly into the penis before intercourse.
- Third-Line (Surgery - Penile Prosthesis): For men who do not respond to first- and second-line treatments, or who have severe structural or nerve damage, penile prosthesis surgery is the only definitive solution. The satisfaction rate is higher than all other treatments.
In our center in Istanbul, the patient's clinical condition is evaluated comprehensively with medical tests, and only evidence-based (scientifically proven) treatments are offered.