Urologist
What is ANDROLOGY?
Erkek cinsel organlarının (penis, testis, meni kanalları) hastalıkları ile ilgilenen bilim dalıdır
What is erectile dysfunction?
Erectile dysfunction is commonly known as impotence or erectile disorder. Its medical definition is the inability to achieve sufficient firmness in the penis for sexual intercourse or the inability to maintain an erection long enough to complete the sexual activity.
Is erectile dysfunction a condition of older men?
Erectile dysfunction (ED) is not just a condition seen in older men, but its prevalence does increase with age. ED is the inability to achieve or maintain an erection, and it can be caused by a variety of factors. These include psychological, physical, and hormonal causes.
While ED is more common in older men, younger men can also experience it. Psychological factors, stress, anxiety, depression, lifestyle factors (such as smoking, alcohol, obesity), and certain health issues (diabetes, hypertension, heart disease, hormonal imbalances) can also contribute to ED in younger individuals.
In summary, erectile dysfunction is not exclusive to older men, but it becomes more common with aging.
How does erection occur?
Erection is a function that occurs through the expansion of blood vessels, controlled by the brain via nerves. While it is under the brain's control, it is not entirely under the individual's control, like the movement of limbs. The centers in the brain that control erection are relatively autonomous, meaning they operate independently to some extent. Sometimes, they can be activated involuntarily, while at other times, they may remain passive despite the individual's conscious intent.
There are two cylindrical organs (corpus cavernosum) in the penis, each encased by a thick membrane (tunica albuginea), which can stretch up to a certain point. The interior of these cylinders are lined with spongy tissue. Upon sexual stimulation, the arteries leading to the penis dilate, increasing blood flow to the spongy tissue. The cylinders begin to expand both in length and girth. Once the stretching capacity of the surrounding membrane is reached, the veins just beneath it become compressed by the engorged spongy tissue, almost halting blood flow, and the erect penis remains firm until the end of intercourse.
Why does erectile dysfunction occur?
There are three components involved in erection: 1. The centers in the brain (medial preoptic area), 2. The nerves of the penis, and 3. The blood vessels of the penis. A problem in any of these components can lead to erectile dysfunction. The most common issue is related to the blood vessels.
Narrowing of the arteries carrying blood to the penis and/or the inability of the spongy tissue to draw enough blood and expand properly can cause the veins to compress, preventing the blood from being trapped in the penis, resulting in erectile dysfunction.
What changes in the penis blood vessels can cause erectile dysfunction?
As advancing age, high blood pressure, and elevated cholesterol lead to narrowing (atherosclerosis) of the arteries supplying the heart, similar conditions cause narrowing of the penile arteries as well. In fact, since the penile arteries are much thinner than the coronary arteries, men with a predisposition to vascular diseases often experience erectile dysfunction years before cardiovascular issues manifest. Therefore, erectile dysfunction can be considered a precursor to a heart attack if health is neglected. Arterial stiffness reduces blood flow to the penis by narrowing the arteries, and even without significant narrowing of the vessels, it disrupts the functions of the vessel cells. The spongy tissue inside the penis has similar characteristics to the arteries. The structure and layers of the cells inside the pools where the blood accumulates are no different from those in the arteries. In the early stages of arterial stiffness, before any noticeable narrowing in the vessels, the volume of these pools at rest may not decrease, but their ability to expand is reduced, which lowers the intensity and duration of an erection.
All diseases that cause narrowing of the heart arteries can also cause narrowing of the penile arteries. In other words, high blood pressure, diabetes, smoking, and high cholesterol can gradually lead to narrowing of the penile arteries and reduce the expansion capacity of the spongy cylinders called corpus cavernosum, which are composed of vascular sinusoids inside the penis.