Erection problem in men is characterized with the inability of firmness of penis or early termination of firmness. It is known as ‘impotence’ among people. In medical terminology, it is referred to ‘erectile dysfunction’ or ‘erection problem’.
Erection is firmness of the penis to become ready for sexual penetration during sexual stimulation and enlargement of the penis in volume (in length and thickness) depending on this firmness.
Before erectile dysfunction, it is useful to know the anatomical structure of erection. There are two ‘cavernous bodies’ (corpora cavernosa) and one ‘spongish body’ (corpora spongiosa) which extend parallel to each other in penis. When sexual stimulation occurs, penis muscles relax and blood flow increases. Increasing NO (Nitric Oxide) in the vein provides important vasodilatation (blood-vessel-relaxing) effect, and the veins in the cavernous body are filled with blood. In this way, erection is achieved. As this filling in the penis exerts pressure, the circulation is fixed and the erection is maintained.
For the realization and maintenance of erection, the sexual warning transmitted to the brain with erotic messages must continue. The most important organs for erection are: penis, spinal canal and brain. In other words, we need to consider the situation both physically and psychologically in order to understand why erection problem occurs.
The inability to get or keep an erection firm enough to have sexual intercourse is called ‘erectile dysfunction’ or ‘impotence’. Sexual satisfaction may not be achieved because there is no penetration in case of erectile dysfunction.
In Turkey, the incidence of erection problems increased in men over the age of 40, but almost every man has this problem in a part of his life. In order to consider the erection problem as a pathological finding, problem must continue for at least six months and this problem should be observed in a monogamous life.
An erection problem is most commonly seen with physiological reasons. To achieve penis firmness, anatomical formations in the penis and blood flow must be healthy. For this reason, the first step to be taken when the erection problem is encountered is to have urological examination. As a result of detailed examinations and tests to be performed by the urologist doctor, it becomes clear whether the problem is organic or not.
Some diseases affect erection problems in the penis. Diabetes, heart disease, prostate disorders, high cholesterol, circulatory and vascular disorders, vascular occlusion, atherosclerosis, depression and antidepressant drugs may cause erection problems.
Age factor should also be taken into consideration in erection problem. It is more commonly seen in men over 40 years of age. If all findings are normal after physical factors are examined, erection problem should be considered as a psychological disorder.
The problem of men with erectile dysfunction may be congenital or acquired.
Among the psychological reasons of erection problem subconscious fears, illiteracy, prejudices and performance anxiety are the most common factors.
As in all sexual dysfunction disorders; the first impressions obtained during the years when sexual identity age starts to develop, perceived first messages, first experiences, cultural aspects of sexuality perception can cause the underlying reasons of erection problems. Together with these factors, the relationship dynamic and balance between couples and marriage problems are also involved.
Erectile dysfunction may also be affected by social changes. Such factors as a job change, financial concerns, death of a relative and depression can be the reason for this disorder.
Morning erections are not observed in organic (physical) erection problems, conversely to psychological erectile failure. There are ‘morning erections’ in psychological erection problems. Morning erections are caused by increased sexual dreams and increased testosterone levels. The problem is inability of erection or short erection time during sexual intercourse.
In addition, if erection is not achieved against spouse but achieved against another partner, it can be understood that problem is situational and psychological. This may be due to interpersonal sexual problems or marital problems.
In organic erectile dysfunction some hormonal tests and penis blood flow tests are abnormal. Even though some of the medications are applied, these patients should also take psychological support.
Hypoactive Sexual Desire Disorder (HSDD) usually depends on psychological reasons. In addition, decreased testosterone hormone level in the blood may cause sexual anorexia. Sexual anorexia problem in men can also be seen as an erection problem. Treatment is reason-oriented.
As in all sexual dysfunctions, erectile dysfunction can be treated with sexual therapy if it has psychological origin. Prior to psychotherapy and sexual therapy, patients should undergo a detailed urological screening. In the absence of any physical findings, the process can be easily overcome with psychotherapy and sexual therapy.
The primary step in the treatment of erectile dysfunction is receiving detailed anamnesis. With the detailed anamnesis, the origin of the problem can be detected and the process is shaped. The process is completed between 10- 12 sessions with sexual and psychotherapies whose content is shaped according to the factors.
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