Erectile Dysfunction

Erectile dysfunction is the persistent difficulty in getting or keeping an erection firm enough for sex. It becomes more common with age but is not an inevitable part of ageing, and it affects many men under 50.

It is often a sign of general vascular health. The arteries of the penis are narrow, so erection problems can appear two to five years before symptoms of heart disease, which makes a medical check worthwhile, not just a prescription.

Symptoms

• Erections that are less firm or do not last
• Loss of morning erections, suggesting a physical cause
• Difficulty only in some situations, suggesting a psychological element
• Reduced sexual desire, which may point to low testosterone
• Curvature or pain with erection, suggesting Peyronie's disease

Causes and risk factors

An erection depends on blood flow, nerves, hormones and state of mind, and any of them can be involved. Common physical causes are diabetes, high blood pressure, high cholesterol, smoking, obesity, prostate or pelvic surgery and radiotherapy, spinal injury, multiple sclerosis and low testosterone. Medicines including some blood pressure tablets, antidepressants, finasteride and opioids contribute. Anxiety, depression, relationship difficulty and performance worry can cause it alone or make a physical problem worse. Alcohol and recreational drugs are frequent factors.

How it is diagnosed

• Medical and sexual history: A validated questionnaire such as the IIEF-5, plus a review of medicines and risk factors.
• Blood tests: Fasting glucose or HbA1c, lipids, and a morning testosterone level, with prolactin if testosterone is low.
• Cardiovascular assessment: Blood pressure and heart risk evaluation before starting treatment.
• Penile Doppler ultrasound: Done after an injection to produce an erection. It measures inflow and venous leak, mainly when surgery is considered.

Treatment options

• Lifestyle and risk factor treatment: Exercise, weight loss, stopping smoking and good diabetes control improve erections measurably.
• PDE5 inhibitor tablets: Sildenafil, tadalafil and related drugs work for about two thirds of men. They must never be combined with nitrates.
• Psychosexual therapy: Useful alone or alongside tablets, particularly in younger men.
• Testosterone replacement: Only for confirmed deficiency.
• Vacuum devices and injections: Alprostadil by injection or urethral pellet, or a vacuum pump, when tablets fail.
• Penile implant: An inflatable or malleable prosthesis for men in whom other treatments have failed. Satisfaction is high, and the step is irreversible.
• Shockwave, PRP and stem cell injections: Low-intensity shockwave has modest evidence in mild vascular cases. PRP and stem cells remain experimental and should not be sold as established treatment.

When it is urgent

An erection lasting more than four hours (priapism) is an emergency and needs hospital treatment within hours to avoid permanent damage. Chest pain during sex needs emergency care, and nitrates must not be given if you have taken a PDE5 inhibitor, so tell the ambulance crew.

Travelling to Türkiye for treatment

Most erectile dysfunction is best managed by your own doctor with tablets and risk factor control. Travel makes sense for penile implant surgery (about 7 to 10 days, with the device activated around six weeks later, which can be taught remotely or on a return visit) or for a vascular work-up combined with a cardiology check. Be cautious about clinics selling packages of regenerative injections.

Send your reports, scans and a short history and a Clinic-Y coordinator replies within 24 hours with suitable teams and written, all-inclusive proposals side by side. Reviewing your case is free.

Frequently Asked Questions