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Healty Sexual Life

An individual who has a healthy sex life has a well-being in terms of their physical, spiritual, social and other vital needs.

In this part, conditions which might put a healthy sex life into danger, sexual inadequacy of women and men and other systemic diseases making them happen and treatment methods will be explained briefly.


  • Sex discrimination in every period, especially in growing up and developing ages,
  • To obtain inadequate and wrong information in youth and adulthood, therefore not have a satisfactory and safe sex life,
  • To have a sexual intercourse without being sure whether the individuals can take the responsibility and truly want to,
  • Infection factors transmitted sexually due to unprotected intercourse such as HIV/ AIDS, hepatitis B, syphilis, gonorrhea and chlamydia; to not be aware of these diseases and/ or not be treated due to other reasons,
  • To have a child too early or late without being prepared,
  • To not benefit quality health services in conditions such as Sexually Transmitted Infections, contraception, abortion, pregnancy, birth and after-birth.

Sexually transmitted infections may not have any symptoms. Flix sometimes may be the only symptom of sexually transmitted infections. Flix is observed also in healthy women, and its amount, liquidity, color (white or yellow) changes according to menstrual cycle. You should consult a doctor if you are a male having a flix, or a woman having an unusual flix.


Sexually Transmitted Diseases (STD), in which AIDS, hepatitis, gonorrhea, syphilis fall, which are induced due to about thirty factors such as HIV, hepatitis B and chlamydia lead to infertility and even death unless cured. Some STDs can be cured if the patient is treated well. A significant percent of these diseases have no definite treatment. STDs may not have any symptoms. Therefore, these diseases are hard to be diagnosed.

Factors might be found in bodily hormones, some of which can be infected through blood and close contact through skin. It is more likely to be infected through a wounded skin. It can also be transmitted to the baby by its mother through pregnancy, birth and breast-feeding.


  • Do not have a sexual intercourse with somebody whom you know has sexual contact also with others.
  • Keep in mind that this is something confidential and you cannot be sure of it.
  • Use a condom in while having a sexual intercourse to be completely protected. Have a condom with you.
  • Condom is protective against most of the Sexually Transmitted Infections.
  • Keep in mind that there are condoms also for women.
  • Do not use needles and injectors used by someone else no matter for what reason.
  • Be careful to have sterilized devices used while having applications which will violate your bodily integrity such as tattoo, epilation, manicure, pedicure, haircut, ear piercing.
  • Have blood and/ or blood product treatment through safe ways.


Sexually transmitted infections do not cure by themselves. If you think you have a sexually transmitted infection, you must be examined and treated right away. Follow your doctor’s recommendations precisely. Use all your medicine.

Do not start to use a medicine without consulting your doctor.

You should tell your sex partners about your disease and make them be treated as well. Unless they are treated, they might infect the disease to others, even back to you. You shouldn’t have a sexual intercourse until your treatment has been completed.

You might have a disease factor even though you have no symptom.

Sexually Transmitted Infections (HIV/ AIDS, hepatitis B, syphilis, gonorrhea, chlamydia etc…) DO NOT INFECT through sharing your environment (such as toilet and bath), kissing, hank shaking, eating the meal prepared by a ill individual, fly bites or insect bites.


Erection problem is basically a clinical term used by doctors for the sexual performance of their patients who cannot erect enough and/ or maintain the sufficient erection level. We can say that an individual has an erection problem if he cannot erect enough to have a sexual intercourse for more than three months even though he desires. In other words, an individual does not need to ask the help of a doctor if he ever has failed to erect for once. He should consult a doctor if this disorder continues for six months.

Some men believe that erection problems naturally diminish as they age. However, aging does not necessarily lead to erection problems itself. Among other reasons are other health conditions, drugs and life style, which all change the blood flow. Some of these health conditions emerge more frequently as men get older. Men who experience the following conditions can understand they have an erection problem:

  • To not maintain the erection enough to have a sexual intercourse
  • To have a difficulty in maintaining the erection
  • To have a weaker erection than ever
  • To have a weaker confidence that you can erect and maintain the erection

Erection Problems Are More Common Than You Can Imagine!

152 million men have recurrent erection problems worldwide and this number is estimated to increase to 222 million by 2025. It is believed that among the results are many factors such as the changes in nutrition and life style and stress levels.

It is estimated that more than half of the males at the age of 40 have this problem. Unfortunately, only 2 % of these patients are diagnosed truly and treated, and 98 % are diagnosed wrong or lack proper treatment.

Studies in Turkey indicate that sexual function disorder in males above 40 years old is up to 70 percent as light, medium and hard ones.


1. “It is only an imaginative problem of yours.”
In the last 25 years, it has been clarified that erection problems occur due to medical conditions. Despite the fact that erection problems emerge principally because of psychological conditions such as depression, anxiety and stress, there is always a physical reason as well.

2. “Erection problem is observed only in old men.”
This condition can be observed in men of every age, especially those who are above 40 years old. A study indicated that almost the half of the males between 40 and 70 have difficulty in erecting and/ or maintaining erection from time to time. Despite the fact that the level of erection problems increase by age, aging is not the only reason. The reason why erection problems can be observed in old men more frequently is age-related diseases such as high blood pressure.

3. “You are too old to have a sexual intercourse.”
Every couple of every age are fond of sexual intercourse. Sex is an important part of a healthy relation. As a matter of fact, many studies indicate that active sexual life ages as a very normal part of life.

4. “To have a sexual intercourse might lead to a heart attack if you have a heart disease.”
Hearth diseases are important medical conditions, however it does not necessarily mean you cannot take pleasure from sex. Erection problems in males who have been treated for their hearth diseases can be treated safely and efficiently. You should consult your doctor to learn whether your heart is strong enough to provide the physical needs in sexual activity before commencing any treatment of erection problems.


Your brain sends signals in order to start a process when you are stimulated. Blood veins in the penis become loose and broaden so that the blood flow into the penis gets faster. Besides, the spongy formations in the penis named corpora cavernosa swell and make pressure upon venous blood vessel and limit the blood flow out of the penis. The penis gets bigger as the blood flowing in is more than the blood flowing out. It should be noted that even though this process is quite simple, the process itself is the result of a perfect balance of the brain, blood vessels, nerves and hormones working together. Unless even a single piece of this process does not work properly, the erection ability of the man might be affected adversely.

Truth: Smoking, fatness, drinking habits or drug use might deteriorate normal circulation or nervous functions and contribute to erection problems.


If you have an erection problem, the erection process might have been deteriorated. The blood flow required for maintaining the erection might have been weakened due to a medical condition arising because of high blood pressure, high cholesterol, diabetes or arteriosclerosis. The connection between the brain and the penis can be prevented due to nervous injuries because of spinal cord injuries, multiple sclerosis, paralysis, prostate surgery or colectomy. Among other factors preventing the maintaining the erection process are liver and kidney diseases, depression, stress and several medicines.


To maintain a healthy life is probably the best way to decrease the development risk of erection problems. Smoking, consuming too much fat and overusing alcohol might have a role in the emergence of the conditions which considerably increase the development chance of erection problems. To avoid these habits is important in terms of decreasing the risk. Your doctor can diagnose your diseases, during your regular visits, such as diabetes or high blood pressure which might lead to erection problems.

Truth: To concern about erection problems might perpetuate or worsen the condition. That you share your problems with your spouse can ease your concerns.

It is important to know that men give different responses to sexual stimulation as they age: To erect and reach orgasm can take a longer time, the need of direct stimulation increases much more and the individual might need longer times between erections. However, it is a wrong belief that individuals take less pleasure from sex as they age. According to many studies, it has been proven that the ability to take pleasure from sex of active sexual life does not diminish in none of the age groups. The percentage of erection problems increase in those above 40 years old, the erection problems should not be regarded as a direct problem of aging. It should be understood that the number and volume of some conditions such as high blood pressure and diabetes increase the frequency and volume of erection problems as men age.


Many men still believe they can deal with erection problems by changing their behaviors on their own. Even worse, some men evade the issue and blame themselves, which makes a pressure on their performance. Such pressured inevitably increase the amount of stress, which weakens the performance. It is important to keep in mind that erection problem is a medical condition generally caused by the physical disorders of circulation and/ or nervous system. To attempt to resolve the problem alone or making a pressure on oneself does not remove the problem. Since erection problem is a medical condition, the best response is obtained with the medical treatments recommended by your doctor. Therefore, it is vital to speak to your doctor about your problem.


Most of the patients who have erection problems have a light or medium difficulty in providing or maintaining erection. On the other hand, functions such as orgasm and ejaculation abilities are normal. The symptoms of erection problems are as the following:

  • To not provide or maintain erection
  • To not provide erection enough for sexual intercourse
  • To not maintain erection during sexual intercourse
  • To not maintain erection enough for a complete sexual intercourse
  • To not have a satisfying sexual intercourse


Many men who have erection problems cannot see what negative effects the condition itself has on themselves and their relationships with their partners, since they are too busy with their conditions. For instance, males who have erection problems can see that they grow apart from their partners emotionally. While males struggle with disappointment, fear, anger, obedience and evasion, their partners can have similar destructive emotions and feel like they are neglected, unattractive and disliked.

To consider the erection problem of a partner related to work stress or exogenous factors such as tiredness will surely worsen the condition. Partners might not be able to recognize the erection problem is a medical condition which leads to some symptoms in the first place. The entire relation might be under stress as a consequence. You partner might want to help you, however it is common that partners are not willing to discuss their erection problems. Such individuals stay quiet on purpose not to make an extra burden and wait for you to start the conversation.

It is important to establish a communication with your partner in order to maintain an intimacy and a healthy relation. You should speak to them about the reasons and possible treatments of your erection problem, which will surely decrease the amount of concern and stress the erection problem might create.


If you think you have an erection problem, to contribute your doctor is the fundamental step for treatment. Today’s doctors deal with this problem routinely and attempt to resolve the erection problem of many other patients. Your doctor may perform a physical treatment and ask questions about your past in order to make a definite diagnosis. Keep in mind that the key to resolve the problems is to answer these questions frankly. You can request your doctor to have the presence of your wife in the appointment with your doctor if it will comfort you.

  • Treatments do not directly increase your sexual desire.
  • The treatment selection of you and your doctor might not always and instantly give results. Call your doctor if you do not have the results you have wanted. You can set the optimum treatment and dose together.
  • The treatment will not resolve other problems of your relation.
  • You should be open to communicate with your partner and doctor, which will help the treatment be permanent. Keep in mind that speaking to your doctor about your erection problem is the main step in its treatment.


It is known that most of the Erection Problems (75%) occur due to physical reasons but psychological ones. While psychological erection disorder depends on success concern and inner conflicts, physical erection disorder depends on anatomic, nervous, endocrinological, medicine related and vascular system related complications. Vascular problems are the most frequent reason of erection disorders. Erection Problem can occur due to a series of diseases such as coroner artery disease, high level of cholesterol, high tension and diabetes aside from aging. In case of diabetes, changes in small veins carrying blood to arteries and penis, and harms in nerves taking a role in erection function make 50 – 70 % of men inclined to erection disorder.



Impotency in males is the foremost reason why some men lack sexual appetite towards women. Diabetes is considered a common risk factor in erection problems and many men who have this problem are diabetic. Erection problems in diabetic males emerge much before than those who are not diabetic. Additionally, erection problem is three times more likely to occur in diabetic males than those who are not diabetic. Half of the diabetic males have erection problems after they have been diagnosed diabetes. The disease itself deteriorates the formation of the penis vessels and leads to erection problems.

Fat Metabolism Disorders:

High level of lipids such as triglyceride and cholesterol in blood and fatness might lead to impotency.

Nitrogen Metabolism Disorders:

High levels of urea and uric acid in blood and long term albumin loss via urine might lead to impotency. Patients who are regularly subjected to dialysis treatment are naturally impotent. However, this condition disappears as soon as a kidney has been transferred.


Impotency might be caused by incretion system. The greatness of suppressor hormones, especially prolactin, and the fewness of testosterone hormone might rarely lead to impotency. However, the reason is internal secretion system only in 5 percent of hormone related erection problems.

Androgen hormone deficiency might also lead to erection problems. This condition can be treated with androgen (testosterone) addition.

Thyroid glands have even a little effect on erection mechanism. Thyroxin, which is produced in these glands, influences globulin production binding testosterone.


Among the most frequent nervous system related reasons of impotency are (paraplegia, paralyses affecting from the waist down, surgical approaches disabling on waist level and hip fractures leading to urethra rupture or not. Furthermore, contusion, frostbite and neuritis-related deterioration of nerves enabling erection and reproductive organs’ internal nerves or their exit points and branches lead to impotency.


Disorders related to nicotine in nerve conduction due to smoking. Behavioral disorders, neuritis and hormone metabolism disorders due to overuse of alcohol. Drugs such as opium, heroin and cocaine. Sexual stimulators. Despite the fact that such substances do not lead to behavioral disorders like drugs do, they cause an addiction and make prevent the patient from being successful without drugs in long term depression periods.

Overuse of Hormones:

Estrogen toxicity can be observed in transsexuals. These hormones lead to loss of erection, penis and testicles shrinkage, mammary duct ectasia in overdose, increase in subcutaneous fat tissue and hairing. Progesterone is reported to have no effect on males.

Long Term Treatments:

The below mentioned treatments are important in terms of impotency. Treatment of high tension with chlorothiazides and beta blockers. Medicines having an influence on the brain and preventing psychological breakdown.


Disorders in arteries which carry the blood necessary for erection to areolar and spongy tissues might prevent erection. If a particular disorder related to vascular system is being searched as a consequence of impotency, special arteriographic techniques should be used. For such a long while, erection problem was not thought to be related to vascular disorders. On the other hand, every one of four erection problem is related to vascular disorders without age restriction, and this condition might be the initial symptom of Buerger disease (occlusive vasculitis).

Hardening Tissues’ Lesions:

Tissues in this group are in the body of the penis and have wide gaps. Two perous corpus cavernosums on each side and spongy corpus spongiosum which is on a above level enables the penis erect via the blood flowing in. The below mentioned conditions might lead to impotency related to hardening tissues. Permanent impotency due to the rupture of the perous object with force and the deterioration in blood flow. Scar tissue and loss of elasticity making the penis look like a bow and preventing it from erecting again after permanent and painful erection (priapism). Penis stiffness due to calcium accumulation in porous cases and even in internal gaps.

Venous Lesions:

Clot plugs observed in the back, and the area between anus and external productive organs.

Blood Diseases:

Chronic leukemia (blood cancer), Polyglobia (polycythemia)


Primary diseases and disorders which might lead to impotency in this group are; Urinary and reproductive system tumors. Painful erection and impotency in reproductive organs, and infections such as epididymis, prostate and urethra inflammation in reproductive organs.


A temporary impotency is observed in long-term inflammatory diseases, microbic diseases and all diseases which generally decrease the resistance and strength of the body. Sexual desire is the sign that these diseases are being treated gradually.

High Blood Pressure:

High blood pressure might make your blood vessels stiffen and shrink, which limits the blood flow into the penis and causes erection problems. Additionally, several drugs used in order to cure high blood pressure can lead to erection problems.

Hearth Disease and High Cholesterol:

Like high blood pressure, heart disease and high cholesterol might prevent blood from flowing into your penis and lead to erection problems. Men with erection problems are more likely to have accompanying diseases.

Hearth Disease and Sex Life:

To have a heart disease does not necessarily mean you cannot take pleasure from sex. Despite the fact that it is a common belief that you might have a heart attack or die immediately if you have a heart disease and start a sexual activity, the risk is low. Generally an individual who has been through a hearth surgery or hearth disease can turn back to their sex life once they feel ready. They should share their concerns with their doctor. Concerns about the sensation whether the sexual performance has decreased and the general depression due to the disease might have led to a decrease in sexual capacity. Such a depression can be observed frequently in cardiac patients and is treated within 3 months. This condition might occur by making the sexual problems of partners which have existed for a while bigger.

Doctor’s Role:

Among the most efficient resolutions of the problem is the encouragement of the patient by their doctor. For instance, suggestions towards a cardiac start while the patient is being treated in the hospital. Doctors are aware of the importance of encouragement for the patient and their partner and might carry out some tests in order to understand whether the patient has the capacity to return to their sex life.

Fear Is Not The Only Reason:

On the other hand, fear is not the only reason disrupting sex life. Vascular diseases which accompany hearth diseases make it difficult for the penis to erect. Despite the fact that chest pain, difficulty in breathing and tachycardia’s observed often in cardiac patients generally do not lead to dangerous conditions, they might disrupt sexual activity. Sublingual nitrate tablets or sprays should be recommended to patients who have a pain in the chest 5-15 minutes before the sexual intercourse. All these should be shared with doctor. Some medicines given to cardiac patients might affect sex life. In this case, doctors might give different medicines. The hearth of a cardiac is not suitable to tolerate a sexual intercourse right after the hearth surgery. Sexual intercourse equals to running up a flight of stairs, which increases the speed of the hearth beat and blood pressure. Most patients need 2-4 week in order to start a sex life again. However, the patient needs to talk about this condition with their doctor. Sex positions are not of much importance.

Recommendations to Be Given To A Cardiac About Sexual Activity:

  • Do not start a sexual activity when you are angry or under stress. You should prefer to have a sexual activity when you are relaxed, comfortable and away from daily stress.
  • You should prefer to start a sexual activity not right after you have had your meal. You should wait 1-3 hours.
  • You should choose a comfortable place which shall not interrupt the sexual intercourse.


Aside from stress, anxiety and fear to be unsuccessful; depression can lead to erection problems. Men who have erection problems due to physical reasons might feel themselves depressed, stressed and anxious at the same time.

Prostate Surgery

Prostate surgery – especially prostate cancer surgery – might harm the nerves and veins besides prostate and lead to erection problems.

Other Health Conditions

Other health conditions which might lead to erection problems are as the following:

  • Kidney disease
  • Chronic alcoholism
  • Multiple sclerosis


Some drugs you use for other health conditions such as high blood pressure, hearth disease, depression, anxiety and ulcer might lead to erection problems as side effects

Habits and Life Style

There are many habits which might lead or contribute to erection problems:

  • Sedentary life
  • Smoking harms veins and leads to blood flow problems which will make it difficult for you to erect and maintain erection. Smoking is believed to increase erection problem risk by two times.
  • Overuse of Alcohol: Overuse of alcohol might lead to erection problems.

Using Narcotic or Doping Drugs:

Drugs such as hashish or cocaine have adverse effects on erection, which is also valid for anabolic steroids.

Nutrition Habits and Cholesterol:

Consuming too much fat leads to the embolism and reduction of blood flow, which is the most fundamental reasons of erection problems. High cholesterol levels also increase the erection function reduction risk. However, all cholesterol types are not bad. You can lower the risk of the reduction in your erection function through increasing your good cholesterol (high density lipo-protein or HDL) and decreasing bad cholesterol (low density lipo-protein or LDL). These are some keys to increase HDL and decrease LDL:

  • Consume high fibrous foods.
  • You should prefer to use liquid herbal oil whose oil rate is high such as olive oil.
  • Exercise regularly.
  • Quit smoking.

Psychogenic Erection Loss

It is seen most commonly in those who have premature ejaculation story or acute alcohol intoxication. Furthermore, it might be related to over religious beliefs, oppressive parents, possible homosexuality concerns, or chronic stress. Performance anxiety is the basis in most of these conditions. Generally, organic erection losses begin insidiously. Function loss is permanent and it gradually gets worse and no erection can be provided also in other conditions such as night erections, masturbation, erotic situations, and sexual desire might disappear. Erection losses due to psychological reasons follow a preparatory process on the contrary. Erection becomes temporary and occasional, which does not occur with every partner in every different situation. Despite the fact that erection can be provided in foreplay, the individual cannot maintain the erection, which is rather often. Men with psychogenic erection difficulty can provide erection via masturbation and their erection continues during night.

Men at the age of 40 who have experience an erection problem for once in their lifetime choose one of these two patterns of behavior. While some men have some feel sad and sorrowful, others become worried and get into panic thinking there is something wrong which cannot be reversed. While the men in the first group do not think of their former failure, the other group starts to constantly test themselves and question their performances, which we call “becoming audience”. Most of the men and women with sexual function disorder start to watch themselves just like an audience, which gradually prevents them from taking pleasure from sex.

Psychogenic erection loss can be removed with the treatment of performance anxiety, which is actually the basis of the loss. “Becoming audience” can be stopped by completing the process, telling both partners about the adverse effects and encourage them for the disorder be taken under control. In order for the process to be controlled, first of all, partners need to be aware of it. The problem will disappear when the partners manage to pay attention to taking pleasure from sex, not to their performances, and learn to control themselves. Partners need to be encourages to pay their attention to sensations, and fill their brains with these sensations. Performance anxiety can also be treated by prohibiting partners to have a sexual intercourse for some while. Partners can experience any foreplay but coitus. Prohibiting coitus will remove any anxiety about whether the male will have an erection. In such cases, males often have an erection. If you think you have an erection problem, we recommend you to consult a doctor. To better your sexual health and resolve your erection problems will let you gain your self-confidence back. Therefore, many men can establish their private lives with their partners and experience those sensations again. However, it there are several points to consider: Treatments do not directly increase your sexual desire. The treatment selection of you and your doctor might not always and instantly give results. Call your doctor if you do not have the results you have wanted. You can set the optimum treatment and dose together. The treatment will not resolve other problems of your relation. You should be open to communicate with your partner and doctor, which will help the treatment be permanent. Keep in mind that speaking to your doctor about your erection problem is the main step in its treatment.

Psychological Factors:

These reasons might be both alone and along with several physical reasons.

Performance Anxiety:

The erection might be affected if the individual is anxious about their sexual performance.


It might affect sexual performance.


Depression can be observed in individuals with erection problems or Erection Problems might emerge in individuals with depression.

Relationship Problems:
Sexual and economic tensions and problems about the family between partners might affect your sexual performance adversely.


Before You Use the Medicines
Your doctor might recommend you to make some changes in your life style before you start the treatment of your erection problem with medicine or other methods such as:

  • Exercise
  • Blood fat reducing diet
  • Quit smoking
  • Reduce alcohol use
  • Reduce stress and tiredness.

Consult your doctor about the medicines which lead to erection problems such as testosterone deficiency, and which are possible to be removed with supplements, or cause erection problems as a side effect.

The decision about your erection problem is up to you and your sex partner. You should be informed about every treatment method within the bounds of possibility. Below are some questions to consider in order to help you make a decision:

  • How efficient and safe is the treatment?
  • What is the opinion of my partner about this treatment?
  • Can the treatment be performed comfortably and easily?
  • Does it comply with my life style?
  • How much does it cost?

Treatment Options

Oral Treatments:

Oral medicine treatment is receiving medicine (pills) orally in order to provide erection. Receiving medicine is a safe and easy treatment method, which helps blood flow into the penis. The man needs to be stimulated in order for the medicine shows its effect. Among the most frequent side effects of this method are headache, redness in the face, indigestion and blockage of the nasal passage. This method is not applicable to everyone; therefore you should consult your doctor to learn whether this method is applicable to you. Aware of your medical story, your doctor will tell you if you could use such medicines. If you use nitric medicines such as nitroglycerine for chest pain, do not use any medicine for your erection problem even infrequently. You should consult your doctor to learn about the safety of taking any other medicine.

Sexual Consultancy/ Sexual Education:

You can consult a psychiatrist, a psychologist or a sexual therapist to talk about your sexual or other problems affecting providing and maintaining erection.

Penis Injection Treatment:

Injections full of medicines which will help you erect are used in injection treatment, which relaxes muscles and provides an erection between 5 and 10 minutes through enabling blood to flow into the penis. Injection treatment could be rather efficient via providing an erection lasting 30 – 60 minutes.


Vacuum Device:

Vacuum device is made up of a tube placed on your penis (to help erection by vacuuming) and a ring placed on its body (to maintain the erection). Vacuuming brings the blood to the penis and the ring captures the blood so that the penis gets stiff. Vacuum devices are generally safe and efficient, however they are not recommended to be used more than 30 minutes for once. Erection disappears when the ring is removed.

Surgical Methods:

Implant Placement to the Penis: This is a proper option for those who cannot benefit the other options. A device (a stick) is placed surgically in the penis and is being used by pumping when the individual desires to have a sexual intercourse.

There are mainly two types of implants: One, two or three compound pumpable (hydraulic) devices and medium-hard soft prosthesis. This method is preferred for patients who cannot benefit the other options, since the application of these two types of devices require an irreversible surgery.

Herbal Treatment:

A number of herbal products have been produced to enhance sexual desire, sexual pleasure and performance. However, there is no generally accepted scientific evidence that such products are safe and efficient.

Hormone Replacement Treatment:
Decreasing erection quality might occur due to too low testosterone levels (your testosterone level can be measured via blood test). Hormone treatments can increase your testosterone level. The treatment can be applied cutaneously, orally or through regular injection.

Another Condition Deteriorating A Healthy Sex Life of Men in the Following Years: ANDROPAUSE

What is Andropause?

Sexual hormone of women disappears after a certain age, and consequently menopause emerges. Hormone levels change also in men after a certain age. Testosterone, the sexual hormone of men, continuously decreases after men are 45-50 years old, however this hormone never dies. Also known as andropause, this condition leads to a regression in sexual desire and mental functions. Moreover, it causes tiredness, sleep problems, emotional changes, impotency, depression, sexual strength loss, osteoporosis, decrease in sperm quality, adverse effects, androgen hormone deficiency, changes in the shape of the body, especially an additional 10-15 kg. fat in the abdominal area.

The treatment methods developed attract attention due to the fact that the average life expectancy grows longer and therefore problems related to aging, for instance andropause, will increase.

It is estimated that 52 percent of the males in Turkey who are between their 40s and 70s have a decrease in sexual performance and desire, however these numbers do not reflect the reality enough since not that many people consult doctors about the mentioned problems.

In short, andropause has turned out to be a clinical table depending upon aging-related physical or mental changes along with the decrease in androgynous hormones.

This Clinical Table Includes The Following Symptoms: 
1. Decrease in sexual function and desire, especially a quality loss in the morning erections,
2. Decrease in intellectual capacity, concentration loss, tiredness, anger and depression,
3. Apparent decrease in muscle mass and power,
4. Decrease in bone mineral density (osteoporosis),
5. Increase in organ fatness.

Despite its common use, andropause is not a proper definition. Although the reproduction features in women completely and acutely disappear with menopause, the reproduction capacity in men can continue in spite of aging. In this context, androgen deficiency is a more proper definition than andrapause for aging men. It has been proven that serum free testosterone levels in men between 39 and 70 years old decrease by 1.2 %.

About 25-50 % of the bio-utilizable testosterone levels of men over 65 years old decreases and symptoms requiring androgen replacement treatment (placing artificial hormones to resolve deficiency) emerge. Genetic disorders, fatness, several hormonal instabilities (growing hormone, thyroid hormone, and insulin), alcohol, stress and chronic diseases can independently lead to a change in blood testosterone levels.


Women experience problems about their sexual desire and relations like men. A recent study indicates that about 40% of women experience some sexual disorders. These women may have not been stimulated or reached orgasm. Many women finds it difficult to speak this problem to their partners or are shy to be treated and afraid to be misunderstood by health personnel. The sexual problems in women occur due to psychological and/ or physical functions just like in men. Recent studies indicate the sexual problems in women occur more physically (biologically) than ever known. Several medical conditions such as diabetes, cardiovascular disorders and MS have been found related to the problem.

Decreased Sexual Desire Disorder

Differentiation in sexual desire is among the most apparent problems leading partners to unhappiness, limitation and even not talking about it. Tiredness, depression, diseases, stress, anxiety, lack of harmony in the relationship, alcohol or drug use affect the level of strength and desire to have sex of the individual. To change oral birth control medicines, periods, treatments, child birth or upcoming menopause is closely related to that women lose their sexual desire. 80 % of the women coming for treatment have decreased sexual desire. The women with such problems have a decrease in their sexual desires, however they tend to approach their partners positively to stimulate or make them reach orgasm. There is no certain physical sign indicating the sexual reluctance in women truly exists. The evaluation of sexual desire is possible only through the evaluation of interest towards men, and determination whether sexual fantasies, thoughts and ideas exist. Sexual desire can easily decrease due to the medicine received and the change in mood such as depression. Since decreased sexual desire can be related to frequently oppressed or decreased orgasm, it is important to question which one comes first.

Sexual Stimulation Disorders

Sexual stimulation disorder is the condition in which an individual cannot continuously or repetitiously respond to sexual stimulations or her vaginal resources cannot be maintained. As a matter of fact, this condition occurs not due to the lack of physical stimulation, but defect in the individual conception of stimulation. Since women with sexual stimulation problems generally attempt to completely stay away from sex, these women are often diagnosed to have lack of sexual desire. In the recent years, some scientists suggested that sexual stimulation disorder can be caused by a physical disorder such as vascular and clitoral inadequacy. Vascular sexual function disorders can both cause sexual stimulation disorder and orgasm problems.

Orgasm Disorders

Orgasm disorder is the condition in which an individual cannot reach orgasm or have late orgasm after normal sexual stimulation continuously or repetitiously. The form and density of the necessary stimulation to make women reach orgasm vary. Therefore, it is up to the decision of the doctor that the woman has received the proper sexual stimulation. On the other hand, this complaint needs to have made the relation between partners difficult and led to misery. Intermittent, situational orgasm deficiencies are believed not to be regarded as disorder due to the fact that the form and density of the necessary stimulation to make women reach orgasm vary in different periods.


Dyspareunia (Painful Sexual Intercourse)

The majority of women may feel pain during sexual intercourse at some point in their lives. But if this problem is recurrent, it disappoints both partners and causes especially the women to react negatively against sexual intercourse and to lose their self confidence in time. Feeling pain during the sexual intercourse is medically called dyspareunia. Frequency of dyspareunia is 10 to 15%. The solution of the pain emerged during or after the sexual intercourse is in fact a very difficult problem. Hymen tightening (due to scar), infection in abdomen and diseases related to labia majora can be listed among the physical causes. Dyspareunia (painful sexual intercourse) may develop depending on many variable factors from a simple anatomic problem to a complex psychosocial and biological phenomenon. The time passed between the doctor’s establishing the true diagnosis among many possible reasons and starting the treatment and the patient’s responding to the treatment may be rather long. In the past, patients used to describe such pain complaints with difficulty and even today, patients have difficulty in expressing their dysoareunia complaints explicitly. For instance, a patient with dysoarenia sees a doctor in order to get rid of her vaginal discharge problem and thinks that if the discharge disappears, she will also overcome painful sexual intercourse. Feeling dysoareunia in vaginal opening, vagina and deep intercourse is related to different reasons. The problem is often in the area where the pain is experienced. However, in some cases, the problem may be in a different area or even in an area other than genitals. Patients should be evaluated in terms of chronic pelvic pain as dyspareunia is a specific kind of chronic pelvic pain.

Apart from the gynecological diseases, digestive system diseases, kidney and urinary tract diseases, musculoskeletal diseases and psychological diseases can be listed among the reasons of chronic pelvic pain. Patients experiencing chronic pelvic pain often consult a gynecologist but as they are not evaluated and directed effectively, they can not find a permanent solution for their problems. In summary, multidisciplinary (different specialties) approach is necessary in the treatment of chronic pelvic pain and dyspareunia which is a special kind of it.


Vaginismus is described as the condition in which vagina is tensed as far as to prevent penis to penetrate. For instance, a woman who is concerned about feeling pain in sexual intercourse again may involuntarily experience muscle spasm as an abstinence behavior. Another reason is composed of anxiety, fear and concern emerged with the revival of the struggles in her psychological world. 12 to 17% of the patients applied to sex therapy clinics are diagnosed as vaginusmis. Sometimes, secondary vaginismus developed following the vaginal pain in consequence of surgeries and chemical substances can also be seen. Situational anxiety, involuntarily muscle spasm, sexual arousal disorders, problems with vaginal lubrication, sexual anorexia and lack of sexual information may cause vaginismus. As well as the control of the physical conditions, psychotherapy helps too.

Reasons of Female Sexual Dysfunction

Sexual dysfunction may arise for a variety of organic and psychological reasons. Female role in sexual activity and female sexual dysfunction is not researched into as detailed as male’s and the problem is only regarded as psychological related. However, studies conducted in recent years have revealed the importance of organic aspect of the problem.

Among the organic reasons;

  • . Systemic diseases and vascular reasons
    Blood flow to the genitals might be disturbed Systemic problems such as diabetes, heart disease, hypertension, high cholesterol levels, problems related to vascular structure such as atherosclerosis and habit of cigarette smoking.
  • . Neurological reasons
    The message sent to genitals by the brain is blocked as a result of nerve injuries caused by neurological diseases or various reasons (such as diabetes, trauma and surgical intervention). Sexual dysfunction may arise due to spinal cord injuries, epilepsy, multiple sclerosis, cerebrovascular diseases, Alzheimer’s and Parkinson’s diseases and infections related to nervous system. Nerve injuries developed during the surgical interventions of genitals such as hysterectomy and operations directed to urinary bladder and intestines may also cause sexual dysfunction.
  • . Hormonal reasons
    Sexual dysfunction can be seen when the hormone levels in the blood is diminished which enables the genitals to develop and various stages of sexual activity to take place. Females mostly suffer from this problem especially after oophorectomy.
  • . Surgical procedures
    Some of the genital surgery procedures may disturb hormonal balance and cause sexual dysfunction due to the produced changes in the body as well as causing nerve injuries. Female’s personalization may be disturbed due to the ostomies opened during the mastectomy or urinary bladder and intestine related operations and her sex life is affected by this.
  • . Treatment and drugs
    Some treatment methods, some drugs and habits of substance use affect sex life in various ways. Some drugs used in the treatments of heart diseases, hypertension, depression, hormonal disorders, cancer and some diuretics and chemotherapy and radiotherapy may disturb menstruation, the structure of genitals and thus the sexual functions.
  • . Advanced age
    As the age advances, smooth muscle and connective tissue rate in clitoris and vagina increases in favor of connective tissue. As a result of this, the ability of clitoris hardening and vaginal enlargement decreases.
  • . Menopause
    The interest in sex diminishes due to the pain during sexual intercourse as a result of reduction in the size of vagina and decrease in the vaginal discharge depending upon the estrogen hormones diminished with menopause.
  • . Psychological reasons
    Childhood, upbringing and life experiences gained in this period, habits and obsessions affect next phases of an individual’s life.

Individuals who grew up in bad family with wrong/insufficient sexual information or who experienced sexual trauma have sexual dysfunction tendency. Sexual dysfunction arises due to reasons such as sexual failures, depression, infidelity, pregnancy and post-partum mental problems, reaction to organic diseases, aging, sexual problems of the partner and exposing sexual violence in the next phases of his life. Loss of attraction for the partner, termination of relationship, loss of self-confidence, fear of sex and failure, stereotyped misconceptions about sex, insufficient foreplay and psychiatric disorders make it difficult to solve the problem. Especially in acquired orgasm disorders, psychological problems may also accompany organic reasons.

Among the various psychological factors, loss of attraction for the partner or the fear of rejection by the partner, harm anxiety and feeling of guilt come into prominence.

How Female Sexual Dysfunction is Determined?

Sexual dysfunction is only diagnosed by means of examinations and tests. Therefore, it is best to consult a specialized health team, explain the problem and be in search of treatment. In order not to affect the diagnosis and the treatment, the problem must be expressed explicitly and no information must be hidden. Even though, the patient is can be diagnosed in the light of the information gained from her and physical examination, certain tests may be conducted.

Early Stage Examinations

After conducting the patient a full physical examination and psychosocial evaluation who applied with the sexual dysfunction complaint, firstly the sexual function questionnaire directed to internationally used complaints is conducted and in later stage diagnostic studies are conducted. Urine and full blood analysis (such as blood sugar, creatinin, cholesterol, triglyceride and liver enzymes), hormone levels (such as FSH, LH; estradiol, testosterone) are the firsts to consult. Later on, ultrasonography and vaginal PH-measurement are resorted for further examinations in necessary.

Female Sexual Dysfunction Treatment

It has a wide treatment range from drugs or therapies with vacuum-like devices to psychotherapy determined depending on the reason and the general condition of the patient. Studies are still ongoing for new treatment methods.

Clitoral Vacuum Device

Designed for the treatment of sexual dysfunction related to poor blood circulation in genitals, clitoral vacuum device enables the blood circulation in clitoris and increases smooth muscle rate. It creates a smooth vacuum effect on clitoris and increases sensitivity, vaginal discharge and orgasm. After the use of this device, up to 100%, %80 and %73 increases are determined in sensual sensitivity, orgasm and vaginal discharge relatively.

Psychological Consultation

Various psycho-social problems can be observed in patients with sexual dysfunction as well as their partners. These psycho-social problems sometimes appear to be the cause or the result in sexual dysfunction. Troubles in sex life may cause conflicts among the partners and even terminations of relationships. In partners applied with sexual dysfunction, psychotherapy and sex therapy applications may be necessary in consequence of psychological and social examination. Psychological consultation and therapy support are important in determining the problem and assisting with its solution but are also crucial as they help the patient and partner overcome the problem.

Post-Partum Sexual problems

With the arrival of the new baby, couples think that they overcame all the difficulties experienced during the pregnancy. In fact, alongside the responsibility of the baby, hormonal changes can cause serious problems in sex life for both partners. The long-awaited little baby becomes a turning point in most couples’ lives. Even though this causes excitement and happiness among the couples, there is the other side of the medallion.

Because the baby brings along many problems. Factors such as additional responsibilities of the baby, hormonal and bodily changes may turn the couples’ lives upside down. And as a result of this, sexual problems arise.

It is not completely wrong to say that post-partum changes affect the female the most. Delivery may cause many important problems such as dyspareunia, vaginismus and especially sexual anorexia.

Even though to a lesser extent, in fact, men too are affected by this situation. While struggling to adjust to the new order, they experience problems in their sex lives.


After delivery, sexual anorexia and loss of erection compose the most common problems seen among men. Then, what are the underlying factors of sexual problems arise after delivery and what are the treatment methods? With sleepless nights after delivery, breast-feeding every two to three hours and baby’s frequently being sick, family life may completely turn upside down. In addition, couples only focused on each other up to that day direct almost all the attention to the baby. On the one hand the frustration of adapting a new life, on the other hand annoyance of not getting attention as before results in the sexual anorexia.


“Prolactin” which is secreted more after delivery and plays an important role in breast-feeding causes sexual anorexia and vaginal dryness. During the breast feeding period in which this hormone is excessively secreted, the problem of sexual anorexia arises for the women.

With the arrival of the baby, the family concept adds to the image of sexual partner. Especially women sacralize the role of mother overmuch and may approach sexuality cautiously. When the female is not content with the postpartum body, she cannot receive sexual pleasure as she constantly occupies her mind with it during intercourse. Besides, the partner who does not regard his spouse as well-groomed as before may become estranged from sex life. Breasts and vagina are the most two exciting parts for men in sex life. With the delivery, these parts may lose their effects as elements of excitement. When breasts and vagina which were only regarded as sexual arousal by the man until the delivery suddenly become the parts which provide the baby with food and delivery, man may become estranged from his spouse. Moreover, the arrival of the baby may trigger the inner conflicts man or the woman has suppressed until then and these problems may cause sexual anorexia.


What happens in men’s world after delivery? Which problems do they face other than sexual anorexia?
– Sexual anorexia being in the first place, sexual arousal disorders (erectile dysfunction, premature or delayed ejaculation) arise.
– Pain in penis may occur during sexual intercourse, even if it’s rare.
– Under the sexual problems of men lie factors such as adopting a new life, changes in the female’s body, and the image changes of sexual parts.
However, postpartum sexual problems are seen less in men than in women.