What is erectile dysfunction?
Erectile dysfunction (ED), sometimes called impotence, means difficulty getting or keeping an erection firm enough for satisfying sex. Most men have an occasional problem, especially when tired, stressed or after alcohol. It is usually called erectile dysfunction when the difficulty is persistent or keeps coming back.
An erection depends on healthy blood vessels, nerves, hormones and a relaxed state of mind. A problem with any one of these can cause ED, and often more than one is involved.
Common causes
- Blood vessel disease: the same changes that affect the heart can narrow the arteries of the penis. ED can be an early sign of heart disease.
- Diabetes: affects both blood vessels and nerves.
- High blood pressure, high cholesterol, smoking and being overweight.
- Prostate cancer treatment: surgery or radiotherapy can damage the nerves and blood supply.
- Peyronie's disease: scar tissue in the penis can cause curvature and weaker erections. See Peyronie's disease.
- Hormones: low testosterone, or thyroid problems.
- Medicines: some blood pressure tablets, antidepressants and other drugs. Never stop a prescribed medicine without talking to your doctor.
- Psychological factors: stress, anxiety, depression and relationship difficulties, which can also follow a physical cause.
How it is assessed
A urologist or andrologist will want to understand the whole picture before suggesting treatment. Depending on your situation, the assessment may include:
- A confidential conversation about your symptoms, health, medicines and relationships
- A physical examination
- Blood tests, for example blood sugar, cholesterol and testosterone
- A penile Doppler ultrasound, which looks at blood flow in the penis, when this will change the treatment plan
Because ED can be linked to heart disease and diabetes, it is worth having these checked by your own doctor as well.
Treatment options
Treatment usually moves step by step, from the simplest options to the more involved ones. Which option suits you depends on the cause, your health and your preferences.
- First steps
Lifestyle and risk factors
Stopping smoking, more activity, weight loss and good control of diabetes, blood pressure and cholesterol can improve erections and overall health.
- Tablets
PDE5 inhibitors
Medicines such as sildenafil and tadalafil help many men. They are not suitable for everyone, for example men who take nitrate medicines for angina.
- Other options
Injections and vacuum devices
Medicine injected into the side of the penis, or a vacuum pump with a ring, can produce an erection when tablets do not work.
- Psychological support
Sex therapy and counselling
Helpful alone or alongside other treatments, especially when anxiety plays a part.
- Surgery
Penile implant
A device placed inside the penis that allows an erection whenever you want one. Considered when other treatments have not worked well enough or are unsuitable.
Some clinics promote treatments such as shockwave therapy or injections of platelet-rich plasma (PRP) or stem cells. Evidence for these is still limited and they are not suitable for every man. Ask any clinic what the evidence is before you pay for treatment.
When an implant is considered
A penile implant is usually considered when tablets, injections or a vacuum device have not helped enough, have side effects, or are unsuitable. It is a permanent change to the erection tissue, so the decision is made carefully with the surgeon.
Our penile implant service is led by Prof. Dr. Ateş Kadıoğlu. You can read more about his approach to implant surgery, or start with our guide to penile implants and inflatable and malleable devices.
When to see a doctor
See a doctor if erection problems keep coming back or worry you. See a doctor promptly if ED comes with chest pain or breathlessness on exertion, with a new curve or lump in the penis, or with other new symptoms. An erection that lasts more than four hours is an emergency: go to the nearest emergency department.
Questions
Is erectile dysfunction just part of getting older?
It becomes more common with age, but it is not inevitable, and it often has a treatable cause. It is worth being assessed at any age.
Can erectile dysfunction be cured?
Sometimes the cause can be treated, for example by changing a medicine or improving diabetes control. In other cases treatment manages the problem rather than removing its cause. Your doctor can explain which applies to you.
Can I have a consultation before travelling to Istanbul?
Yes. You can send your history and reports in confidence, or book a video consultation. A specialist reviews your case before any plan is suggested.
Which specialist will I see?
Patients are matched to a specialist according to their diagnosis. You can read about our urologists and andrologists.