WHAT IS THE FREQUENCY OF ERECTILE DYSFUNCTION? WHAT IS THE AGE DEPENDENT DISTRIBUTION?

This problem is present in 70% of men over 40 years in Turkey with different aspects

Permanent problem under 40 years: Rare

It is observed by 65% in 70 years and older.

WHAT ARE CAUSES FOR ERECTILE DYSFUNCTION?

1. ORGANIC

Vascular – Neurological – Hormonal – Due to disorders of the penis nature

2. PSYCHOGENIC

Suppression of the erectile mechanism by the brain without any physical disorder.

However, many patients have Organic + Psychogenic problems together.

WHAT ARE THE MOST COMMON FINDINGS DETECTED IN MEN WITH ED?

Hypertension in 45%; hyperlipidemia in 50%

DM ( diabet = şeker hastalığı ) ve 50 yaşın üstündeki erkeklerin % 50 – 60 ‘ında ED vardır !!!

WHAT ARE RISK FACTORS THAT MAY CAUSE ED?

* Aging

* Chronic Diseases (Atherosclerosis – Diabetes – Cardiac Diseases – renal Diseases – Liver Diseases)

* Operations and Traumas

* Drugs

* Smoking and other modifying factors

WHAT ARE THE TESTS USED TO DIAGNOSE ORGANIC ED?

Laboratory Tests

Complete Blood Count – Urea – Creatinine – Liver function tests – Blood Fats (Cholesterol- Lipids) – fasting Blood Glucose (FBG) – Total and free testosterone – Prolactin Hormone (PRL)

* Intracavernous Pharmacological Testing All agents used cause dilatation in arteries and closing in veins and blood is restrained within the penis and erection occurs. It provides information about vascular bearing of the penis.

Color Doppler Ultrasonography Of Penis

It is useful to perform with pharmacological tests. It provides an opinion about penis anatomy and vascular bearing.

Nocturnal Penile Tumescence (NPTR)

Rigiscan Monitor:

It is a tool to obtain information about nocturnal erection count and quality. We obtain such information in some graphics.

Pharmacological cavernosometry – graphy

It is used to determina the location of venous leakage. It is useful to perform if operation is planned.

Angiography

It is important especially to detect the arterial disorder out of the penis and to determine the further operation.

WHAT ARE APPLIED FOR THE TREATMENT OF ED?

Non-invasive methods

Elimination of risk factors

Consultancy – Psychotherapy

Oral and topical drugs

Vacuum tools

* Invasive methods

Transurethral drug applications

Alprotadyl use is especially common in USA. A drug is loaded into the urethra with its special device just before the intercourse.

Intracavernous Drug Applications (Intra Cavernous Injection ICI)

Papaverine and/or prostaglandin derivates may be used single or in combination with different doses just like diagnosis step before the intercourse. A special training should be given to the person to apply this injection by himself.

Penile Prosthesis

Although it is a gold standard for ED treatment, treatment should progress from the least invasive to the most invasive.

Prosthesis use is a irreversible decision!

Vascular surgery:

Vascular by-passes may be applied to increase the blood flow into the penis with some microscopic techniques.

WHAT IS PREMATURE EJACULATION? HOW IS IT TREATED?

Premature ejaculation may be defined as occurrence of the ejaculation within a short period so that parties can not obtain the required pleasure from sexual intercourse.

The basic cause depends on habits and/or psychogenic factors.

TREATMENT:

CONDOM USE

ANESTHETIC POMADES

SEX THERAPY

SQUEEZING TECHNIQUE (MASTER & JOHNSON)

MEDICAL SUPPORT

Sertraline – Fluoxetine – Clomipramine – Trazadone