{"id":143,"date":"2018-04-06T11:36:56","date_gmt":"2018-04-06T08:36:56","guid":{"rendered":"http:\/\/www.leonsaporta.com\/en\/?p=143"},"modified":"2019-12-13T13:26:14","modified_gmt":"2019-12-13T10:26:14","slug":"description-physiology-diagnosis-treatment","status":"publish","type":"post","link":"https:\/\/www.leonsaporta.com\/en\/description-physiology-diagnosis-treatment\/","title":{"rendered":"Description &#8211; Physiology &#8211; Diagnosis &#8211; Treatment"},"content":{"rendered":"<h3><strong>DEFINITION OF ERECTILE DYSFUNCTION (ED)<\/strong><\/h3>\n<p>Inability to provide and maintain required and sufficient erection for a sexual intercourse.<\/p>\n<ul>\n<li>ED is an important health problem.<\/li>\n<li>There are 30 million men with ED in USA<\/li>\n<li>This problem is present in 70% of men over 40 years in Turkey with different aspects<\/li>\n<li>Effect of ED to social life is very important<\/li>\n<li>The patients do not consult with a physician or delay on consulting because of sexual taboos.<\/li>\n<li>Low diagnosis rates for erectile dysfunction depend on insufficient communication between the Physician and the Patient.<\/li>\n<li>Only 10% of men with ED between 18 and 60 years refer to a physician by suggesting this complaint!<\/li>\n<\/ul>\n<p><img loading=\"lazy\" decoding=\"async\" class=\"alignnone size-full wp-image-646\" src=\"http:\/\/www.leonsaporta.com\/en\/wp-content\/uploads\/2018\/04\/47.jpg\" alt=\"\" width=\"340\" height=\"210\" srcset=\"https:\/\/www.leonsaporta.com\/en\/wp-content\/uploads\/2018\/04\/47.jpg 340w, https:\/\/www.leonsaporta.com\/en\/wp-content\/uploads\/2018\/04\/47-300x185.jpg 300w\" sizes=\"auto, (max-width: 340px) 100vw, 340px\" \/> <img loading=\"lazy\" decoding=\"async\" class=\"alignnone size-full wp-image-647\" src=\"http:\/\/www.leonsaporta.com\/en\/wp-content\/uploads\/2018\/04\/48.jpg\" alt=\"\" width=\"475\" height=\"230\" srcset=\"https:\/\/www.leonsaporta.com\/en\/wp-content\/uploads\/2018\/04\/48.jpg 475w, https:\/\/www.leonsaporta.com\/en\/wp-content\/uploads\/2018\/04\/48-300x145.jpg 300w\" sizes=\"auto, (max-width: 475px) 100vw, 475px\" \/><\/p>\n<p>Physicians may also have prejudices about ED;<\/p>\n<ul>\n<li>They assume that sexual issues are out of professionalism<\/li>\n<li>They think that this damages to the relation with the patient.<\/li>\n<li>The concern about attacking private life<\/li>\n<li>Hesitation to shame the patient<\/li>\n<li>Not having time to allocate for this subject causes delays on diagnosis and treatment.<\/li>\n<\/ul>\n<p>Permanent problem under 40 years: Rare<\/p>\n<p>70 years and over : % 65<\/p>\n<p>* Complaints start earlier in diabetic patients!!!<\/p>\n<h3><strong>CAUSES FOR ED<\/strong><\/h3>\n<ol>\n<li><strong> ORGANIC<\/strong><\/li>\n<\/ol>\n<p>Vascular \u2013 Neurological \u2013 Hormonal \u2013 Due to disorders of the penis nature<\/p>\n<ol start=\"2\">\n<li><strong> PSYCHOGENIC<\/strong><\/li>\n<\/ol>\n<p>Suppression of the erectile mechanism by the brain without any physical disorder.<\/p>\n<p>However, many patients have Organic + Psychogenic problems together.<\/p>\n<p>Psychological\u00a0\u00a0\u00a0\u00a0 Vascular\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Neurogenic\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Hormonal\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Drugs<\/p>\n<p>Anxiety \u00a0\u00a0\u00a0 Atherosclerosis\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Trauma Androgen deficiency\u00a0\u00a0\u00a0\u00a0\u00a0 Anxiolytic drugs<\/p>\n<p>Depression\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Hyperlipidemia Surgical Hyperprolactinemia\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Antidepressants<\/p>\n<p>Intercourse problems\u00a0 Smoking MULTIPLE SCLEROSIS\u00a0\u00a0\u00a0 Thyroid diseases\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Antihypertensives<\/p>\n<p>Diabetes\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Herniated disc\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Antiandrogenic drugs<\/p>\n<p>Hypertension\u00a0\u00a0\u00a0 Diabetes\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Digoxin<\/p>\n<p>Alcohol\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Cimetidine<\/p>\n<p>Most common findings in men with ED<\/p>\n<p>Hypertension in 45%; hyperlipidemia in 50%<\/p>\n<p><strong>DM (diabetes = afflicted with diabetes) and %50-60 of men above 50 years of age have ED<\/strong><\/p>\n<p>Erection types<\/p>\n<ol>\n<li>Psychogenic erection<\/li>\n<li>Reflex erection<\/li>\n<li>Nocturnal erection (while sleeping at night)<\/li>\n<\/ol>\n<p>Erections are provided with combination of psychogenic and reflex path in general!<\/p>\n<p>Penile Erection mechanism<\/p>\n<p>Erection is a complex vascular chain of events controlled by nervous, hormonal and psychogenic mechanisms.<\/p>\n<p>Once sexual stimulation starts (visual \/ tactile \/ spiritual), arteries entering into the penis dilates and blood flow coming is increased. Penis enlarges and extends, stores the blood within spongy structure and enters into erection. Vein system is closed to maintain erected position of the penis.<\/p>\n<p>When sexual stimulus is discontinued or ejaculation occurs, system becomes reversed.<\/p>\n<p><img loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-649 aligncenter\" src=\"http:\/\/www.leonsaporta.com\/en\/wp-content\/uploads\/2018\/04\/49.jpg\" alt=\"\" width=\"475\" height=\"355\" srcset=\"https:\/\/www.leonsaporta.com\/en\/wp-content\/uploads\/2018\/04\/49.jpg 475w, https:\/\/www.leonsaporta.com\/en\/wp-content\/uploads\/2018\/04\/49-300x224.jpg 300w\" sizes=\"auto, (max-width: 475px) 100vw, 475px\" \/><\/p>\n<p><strong>Penis Anatomy<\/strong><\/p>\n<p>Penis consists of 2 cavernous corpus (CC) on the top, 1 spongious corpus (CS) on the nottom and glans (head).<\/p>\n<p>CCs include trabecules surrounded by smooth muscle and sinusoids.<\/p>\n<p>Urethra passes along CC.<\/p>\n<p>CCs are covered by tunica albuginea which is poor in elsatic fibers, rich in collagen fibers with limited distensibility (enlargement capacity).<\/p>\n<p>Tunica albuginea prevents venous return by compressing emissary veins which pass along during the erection as it has a limited enlargement capacity.<\/p>\n<p>Contraction of ischiocavernous and bulbocavernous muscles increase the hardness, helps ejaculation.<\/p>\n<p><img loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-650 aligncenter\" src=\"http:\/\/www.leonsaporta.com\/en\/wp-content\/uploads\/2018\/04\/50.jpg\" alt=\"\" width=\"380\" height=\"310\" srcset=\"https:\/\/www.leonsaporta.com\/en\/wp-content\/uploads\/2018\/04\/50.jpg 380w, https:\/\/www.leonsaporta.com\/en\/wp-content\/uploads\/2018\/04\/50-300x245.jpg 300w\" sizes=\"auto, (max-width: 380px) 100vw, 380px\" \/><\/p>\n<p><strong>CAUSES FOR ED<\/strong><\/p>\n<p>Erection problems will be experienced in case of presence of one or more of the following conditions:<\/p>\n<ol>\n<li>problems preventing dilatation in arteries<\/li>\n<li>Spongy structures that will restrain the blood within the penis<\/li>\n<\/ol>\n<p>III. Problems of connective tissue and vein that prevent blood return<\/p>\n<p><img loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-651 aligncenter\" src=\"http:\/\/www.leonsaporta.com\/en\/wp-content\/uploads\/2018\/04\/51.jpg\" alt=\"\" width=\"340\" height=\"395\" srcset=\"https:\/\/www.leonsaporta.com\/en\/wp-content\/uploads\/2018\/04\/51.jpg 340w, https:\/\/www.leonsaporta.com\/en\/wp-content\/uploads\/2018\/04\/51-258x300.jpg 258w\" sizes=\"auto, (max-width: 340px) 100vw, 340px\" \/><\/p>\n<p><strong>RISK FACTORS that may cause ED<\/strong><\/p>\n<ul>\n<li>Aging<\/li>\n<li>Chronic Diseases (Atherosclerosis \u2013 Diabetes \u2013 Cardiac Diseases \u2013 renal Diseases \u2013 Liver Diseases)<\/li>\n<li>Operations and Traumas<\/li>\n<li>Drugs<\/li>\n<li>Smoking and other modifying factors<\/li>\n<\/ul>\n<p><strong>DIAGNOSIS: PATIENT EVALUATION<\/strong><\/p>\n<ul>\n<li>Medical History<\/li>\n<li>Sexual history<\/li>\n<li>Physical Examination<\/li>\n<li>Psychological evaluation<\/li>\n<li>Laboratory tests<\/li>\n<\/ul>\n<p>For an individual who refers by \u201cerection difficulty\u201d complaint, the following should be asked for the past 6 months period.<\/p>\n<p>Status of the sexual desire<\/p>\n<p>Depression \u2013 stress \u2013 anxiety disorders<\/p>\n<p>Marriage problems<\/p>\n<p>Work and life problems<\/p>\n<p>The evaluation of the patient must be done by a specially designed questionare. The scoring system is used in evaluation of the severty of ED and later the result of the treatment. Ed can be classified as no ED, mild, mild-moderate, moderate, severe.<\/p>\n<p><strong>TO OBTAIN A GOOD ANAMNESIS<\/strong><\/p>\n<p>If the person;<\/p>\n<p>Has spontaneous erections,<\/p>\n<p>Morning erections,<\/p>\n<p>Sufficient erection by masturbation,<\/p>\n<p>Erection except his usual partner,<\/p>\n<p>ORGANIC causes may be excluded roughly, PSYCHOGENIC cause is highly possible!!!<\/p>\n<p><strong>DIAGNOSIS FOR ORGANIC ED<\/strong><\/p>\n<p>Laboratory Tests<\/p>\n<p>Complete Blood Count \u2013 Urea \u2013 Creatinine \u2013 Liver function tests \u2013 Blood Fats (Cholesterol- Lipids) \u2013 fasting Blood Glucose (FBG) \u2013 Total and free testosterone \u2013 Prolactin Hormone (PRL)<\/p>\n<p>Intracavernous Pharmacological Testing<\/p>\n<p><img loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-652 aligncenter\" src=\"http:\/\/www.leonsaporta.com\/en\/wp-content\/uploads\/2018\/04\/52.jpg\" alt=\"\" width=\"310\" height=\"250\" srcset=\"https:\/\/www.leonsaporta.com\/en\/wp-content\/uploads\/2018\/04\/52.jpg 310w, https:\/\/www.leonsaporta.com\/en\/wp-content\/uploads\/2018\/04\/52-300x242.jpg 300w\" sizes=\"auto, (max-width: 310px) 100vw, 310px\" \/><\/p>\n<p>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. Negative response is not diagnostic. However, if almost complete erection develops within first 12 minutes following the injection and such erection continues for 30 minutes , it may be deemed that such person does not have any vascular problem.<\/p>\n<p>Drugs used During Intracavernous Pharmacological Testing:<\/p>\n<ul>\n<li>Papaverine 15 \u2013 60 mg<\/li>\n<li>Papaverine 30 mg\/ml + Phentolamine 1 mg\/ml : 0.2 \u2013 1 ml<\/li>\n<li>Prostoglandin E1 5 \u2013 15 microgr.<\/li>\n<li>Papaverine 12 mg + Phentolamin 1 mg + PGE1 9 micrgr : 0.1 \u2013 0.5 ml<\/li>\n<\/ul>\n<p><strong>Color Doppler Ultrasonography Of Penis<\/strong><\/p>\n<p>It is useful to perform with pharmacological tests. It provides an opinion about penis anatomy and vascular bearing.<\/p>\n<p><strong>Nocturnal Penile Tumescence (NPTR) Rigiscan Monitor:<\/strong><\/p>\n<p><img loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-653 alignleft\" src=\"http:\/\/www.leonsaporta.com\/en\/wp-content\/uploads\/2018\/04\/53.jpg\" alt=\"\" width=\"150\" height=\"180\" \/>Erektil Disfonksiyon The safest test for differentiation of organic and psychogenic ED<\/p>\n<p>It is a tool to obtain information about nocturnal erection count and quality. We obtain such information in some graphics.<\/p>\n<p>(Positive response without any neurogenic or hormonal pathology (Multiple erections which may occur 3 to 6 times per night, reach to 70% hardness of normal erection and last for 10 to 15 minutes are measured) = Psychogenic)<\/p>\n<p><img loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-654 aligncenter\" src=\"http:\/\/www.leonsaporta.com\/en\/wp-content\/uploads\/2018\/04\/54.jpg\" alt=\"\" width=\"360\" height=\"220\" srcset=\"https:\/\/www.leonsaporta.com\/en\/wp-content\/uploads\/2018\/04\/54.jpg 360w, https:\/\/www.leonsaporta.com\/en\/wp-content\/uploads\/2018\/04\/54-300x183.jpg 300w\" sizes=\"auto, (max-width: 360px) 100vw, 360px\" \/><\/p>\n<p><strong>Pharmacological cavernosometry \u2013 graphy<\/strong><\/p>\n<p>It is used to determina the location of venous leakage. It is useful to perform if operation is planned.<\/p>\n<p><strong>Angiography<\/strong><\/p>\n<p>It is important especially to detect the arterial disorder out of the penis and to determine the further operation.<\/p>\n<p>It may be diagnosed with specific neurological tests.<\/p>\n<p><strong>CURRENT METHODS FOR ED TREATMENT<\/strong><\/p>\n<p>Non-invasive methods<\/p>\n<p>Elimination of risk factors<\/p>\n<p>Consultancy \u2013 Psychotherapy<\/p>\n<p>Oral and topical drugs<\/p>\n<p>Vacuum tools<\/p>\n<p><img loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-655 aligncenter\" src=\"http:\/\/www.leonsaporta.com\/en\/wp-content\/uploads\/2018\/04\/55.jpg\" alt=\"\" width=\"340\" height=\"220\" srcset=\"https:\/\/www.leonsaporta.com\/en\/wp-content\/uploads\/2018\/04\/55.jpg 340w, https:\/\/www.leonsaporta.com\/en\/wp-content\/uploads\/2018\/04\/55-300x194.jpg 300w\" sizes=\"auto, (max-width: 340px) 100vw, 340px\" \/><\/p>\n<p>It is an ideal and cheap method for the patients who do not consider any drug or invasive treatment. Penis is placed into a plexyglass lantern and blood flows into the penile vessels by effect of the negative pressure while the air inside is discharged. Penis enlarges and extends. A plastic ring is places into the bottom of the penis to maintain the erection and lantern is removed. The person may have an intercourse as he desires for about thirty minutes.<\/p>\n<p><strong>LI EDSWT:<\/strong><\/p>\n<p>Low Intensity Shockwave Therapy for Erectile Dysfuntion<\/p>\n<p>The ED-SWT \u00a0is designed to deliver extracorporeal, focused, low-intensity shockwave therapy to the penile area of patients suffering of vascular related Erectile Dysfunction (ED).<\/p>\n<p>The ED1000 system is a device for Extracorporeal Shockwave therapy. It non-invasively delivers low-intensity shockwaves to specific areas in the patient penile shaft and crus consequently improving local blood perfusion in this area and improving erectile function.<\/p>\n<p>The ED-SWT \u00a0is intended for use as alternative\/complement treatment of patients with vascular related Erectile Dysfunction.<\/p>\n<p>The treatment with ED-swt \u00a0is painless. In each seance shocks are delivered to 5 different areas of the penis. 300 shocks delivered to each area.<\/p>\n<p>The machine produces 120 shocks per minute. The total amount of shocks per seance are 1500 and lasts about 15 minutes. In mild cases 6-12 \u00a0seances; mild \u2013 moderate cases 12- 36 seances are generally enough for the treatment.<br \/>\n<img loading=\"lazy\" decoding=\"async\" class=\"alignnone size-full wp-image-775\" src=\"http:\/\/www.leonsaporta.com\/en\/wp-content\/uploads\/2018\/04\/jhkljh.jpg\" alt=\"\" width=\"640\" height=\"450\" srcset=\"https:\/\/www.leonsaporta.com\/en\/wp-content\/uploads\/2018\/04\/jhkljh.jpg 640w, https:\/\/www.leonsaporta.com\/en\/wp-content\/uploads\/2018\/04\/jhkljh-300x211.jpg 300w\" sizes=\"auto, (max-width: 640px) 100vw, 640px\" \/><\/p>\n<p><strong>Invasive methods<\/strong><\/p>\n<p><strong>Transurethral drug applications<\/strong><\/p>\n<p><img loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-656 aligncenter\" src=\"http:\/\/www.leonsaporta.com\/en\/wp-content\/uploads\/2018\/04\/57.jpg\" alt=\"\" width=\"200\" height=\"225\" \/><\/p>\n<p>Alprotadyl use is especially common in USA. A drug is loaded into the urethra with its special device just before the intercourse.<\/p>\n<p>Intracavernous Drug Applications (Intra Cavernous Injection ICI)<\/p>\n<p><img loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-657 aligncenter\" src=\"http:\/\/www.leonsaporta.com\/en\/wp-content\/uploads\/2018\/04\/52-1.jpg\" alt=\"\" width=\"310\" height=\"250\" srcset=\"https:\/\/www.leonsaporta.com\/en\/wp-content\/uploads\/2018\/04\/52-1.jpg 310w, https:\/\/www.leonsaporta.com\/en\/wp-content\/uploads\/2018\/04\/52-1-300x242.jpg 300w\" sizes=\"auto, (max-width: 310px) 100vw, 310px\" \/><\/p>\n<p>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.<\/p>\n<p><strong>Penile Prosthesis<\/strong><\/p>\n<p>Although it is a gold standard for ED treatment, treatment should progress from the least invasive to the most invasive.<\/p>\n<p>Prosthesis use is a irreversible decision!<\/p>\n<p>Prosthesis may be with single or multiple pieces.<\/p>\n<p><img loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-658 aligncenter\" src=\"http:\/\/www.leonsaporta.com\/en\/wp-content\/uploads\/2018\/04\/60.jpg\" alt=\"\" width=\"495\" height=\"310\" srcset=\"https:\/\/www.leonsaporta.com\/en\/wp-content\/uploads\/2018\/04\/60.jpg 495w, https:\/\/www.leonsaporta.com\/en\/wp-content\/uploads\/2018\/04\/60-300x188.jpg 300w\" sizes=\"auto, (max-width: 495px) 100vw, 495px\" \/><\/p>\n<p>None of the prosthesis;<\/p>\n<p>provides erection just like normal physiological erection!!!<\/p>\n<p>Models that can not be blown up;<\/p>\n<p>Causes to keep the penis on same size and diameter all the time!<\/p>\n<p><strong>Hydraulic models;<\/strong><\/p>\n<p>Are expensive but more physiologic.<\/p>\n<p>Diameter increase occurs during the erection!<\/p>\n<p><strong>VASCULAR SURGERY<\/strong><\/p>\n<p>Vascular by-passes may be applied to increase the blood flow into the penis with some microscopic techniques.<\/p>\n<p><strong>CHARACTERISTICS OF IDEAL DRUGS<\/strong><\/p>\n<p>Efficient \u2013 Useful \u2013 without side effects \u2013 easy to use \u2013 specific and cheap.<\/p>\n<p>Some agents effecting on different locations (from the brain or penis vessels etc.) with different mechanism of actions:<\/p>\n<p>papaverine \u2013 nitroglycerine \u2013 verepamil \u2013 alprostadil \u2013 phentolamine \u2013 phenoxbenzamine- yohimbin \u2013 sildenafil \u2013 tadalafil \u2013 vardenafil \u2013 apomorfin \u2013 trazadone etc.<\/p>\n<p>While using these agents, to be under physician control is required. Because some serious side effects may appear. (for example, those using drugs dilating cardiac vessels such as nitrate may have fatal risks.)<\/p>\n<p><strong>DIAGNOSIS AND TREATMENT PRINCIPLE ACCORDING TO TREATMENT EXPECTATION OF THE PATIENT<\/strong><\/p>\n<ul>\n<li>Oral Treatments \/ Transurethral therapies \/ Vacuum device<\/li>\n<li>NO TEST IS NEEDED<\/li>\n<li>ICI : Intracavernous drug injection<\/li>\n<li>ICI Test<\/li>\n<li>Penile Prosthesis<\/li>\n<li>ICI test \/ NPT test \/ Penile doppler US<\/li>\n<li>Venous surgery<\/li>\n<li>ICI test \/ Penile doppler US \/ Cavernosometry \/ Cavernosography<\/li>\n<li>Arterial surgery<\/li>\n<li>ICI test \/ Doppler US \/ cavernosometry \/ cavernosography \/ Pharmacoarteriography<\/li>\n<\/ul>\n<p><strong>TREATMENT FOR PREMATURE EJACULATION (EJECULATIO PRECOX)<\/strong><\/p>\n<p>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.<\/p>\n<p>The basic cause depends on habits and\/or psychogenic factors.<\/p>\n<p><strong>TREATMENT<\/strong><\/p>\n<ul>\n<li>CONDOM USE<\/li>\n<li>ANESTHETIC POMADES<\/li>\n<li>SEX THERAPY<\/li>\n<li>SQUEEZING TECHNIQUE (MASTER &amp; JOHNSON)<\/li>\n<li>MEDICAL SUPPORT<\/li>\n<\/ul>\n<p>Sertraline \u2013 Fluoxetine \u2013 Clomipramine \u2013 Trazadone<\/p>\n","protected":false},"excerpt":{"rendered":"<p>DEFINITION OF ERECTILE DYSFUNCTION (ED) Inability to provide and maintain required and sufficient erection for a sexual intercourse. ED is an important health problem. There are 30 million men with ED in USA This problem is present in 70% of men over 40 years in Turkey with different aspects Effect of ED to social life [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":144,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[12],"tags":[],"class_list":["post-143","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-erectile-dysfunction-andrology"],"_links":{"self":[{"href":"https:\/\/www.leonsaporta.com\/en\/wp-json\/wp\/v2\/posts\/143","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.leonsaporta.com\/en\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.leonsaporta.com\/en\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.leonsaporta.com\/en\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.leonsaporta.com\/en\/wp-json\/wp\/v2\/comments?post=143"}],"version-history":[{"count":10,"href":"https:\/\/www.leonsaporta.com\/en\/wp-json\/wp\/v2\/posts\/143\/revisions"}],"predecessor-version":[{"id":778,"href":"https:\/\/www.leonsaporta.com\/en\/wp-json\/wp\/v2\/posts\/143\/revisions\/778"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.leonsaporta.com\/en\/wp-json\/wp\/v2\/media\/144"}],"wp:attachment":[{"href":"https:\/\/www.leonsaporta.com\/en\/wp-json\/wp\/v2\/media?parent=143"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.leonsaporta.com\/en\/wp-json\/wp\/v2\/categories?post=143"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.leonsaporta.com\/en\/wp-json\/wp\/v2\/tags?post=143"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}