Male Sexual Health and Sexual Dysfunction

Current Diagnostic and Treatment Options

Male sexual health affects not only sexual performance, but also self-confidence, psychological well-being, and partner relationships. Conditions such as erectile dysfunction, premature ejaculation, and decreased libido are common today and are largely treatable.

 

What Is Male Sexual Dysfunction?

Sexual dysfunction refers to problems occurring at any stage of the sexual response cycle. This cycle consists of:

• Sexual desire (libido)

• Erection

• Orgasm

• Ejaculation

Disruption at any of these stages may lead to:

• Erectile dysfunction

• Premature ejaculation

• Low sexual desire

• Delayed ejaculation / inability to reach orgasm

 

Erectile Dysfunction (ED)

Erectile dysfunction is the inability to achieve or maintain sufficient rigidity for satisfactory sexual intercourse.

It is frequently associated with:

• Diabetes

• Hypertension

• Cardiovascular disease

• Obesity

• Smoking

Important: Erectile dysfunction can sometimes be the first sign of underlying cardiovascular disease.

 

Causes of Sexual Problems in Men

Organic (Physical) Causes

• Vascular diseases

• Diabetes

• Low testosterone

• Neurological disorders

• Nerve damage after prostate surgery

• Obesity

• Smoking

Psychological Causes

• Performance anxiety

• Stress

• Depression

• Relationship problems

In many patients, these factors coexist.

 

Diagnostic Process

Accurate treatment requires detailed evaluation. Diagnostic methods include:

• Medical history

• Physical examination

• Blood tests

• Testosterone measurement

When necessary:

• Penile Doppler ultrasound

• Nocturnal erection testing

 

Treatment Options

Treatment typically progresses from simpler to more advanced approaches.

1. Oral Medications

PDE5 inhibitors:

• Sildenafil

• Tadalafil

• Vardenafil

These are first-line treatments.

2. Shockwave Therapy (ESWT)

A non-surgical method aimed at increasing blood flow to the penis.
It is particularly used in vascular-related erectile dysfunction.

3. Intracavernosal Injection Therapy

Used in patients who do not benefit from oral medications.

In this method:

• Medication is injected into the spongy tissue of the penis using a fine needle

Effects:

• Causes vasodilation

• Increases blood flow

• Initiates erection

It has a high success rate and is non-surgical.

 

Regenerative Treatments

Penile Stem Cell Therapy, PRP, and Biological Applications

In recent years, treatments targeting tissue regeneration have gained attention.

The goals are:

• Supporting tissue repair

• Promoting new blood vessel formation

• Increasing blood flow

 

Penile Stem Cell Therapy

Stem cells obtained from the patient’s own body are applied to the penis.

Potential effects:

• Tissue regeneration

• New blood vessel formation

• Support for nerve healing

PRP (Platelet-Rich Plasma)

Obtained from the patient’s own blood. Growth factors within PRP may:

• Support microvascular formation

• Improve blood flow

• Enhance tissue healing

Exosome and Cellular Therapies

New-generation biological approaches aiming to:

• Enhance cellular communication

• Support tissue repair

Scientific Perspective (EAU Approach)

Stem cell and PRP therapies show promising results. However, they are not yet considered standard treatments. They may be used as supportive options in selected patients.

 

Vacuum Devices

Mechanical devices that increase blood flow to the penis.
They are supportive, non-invasive options.

Penile Prosthesis (Penile Implant)

For patients who do not respond to medication or injection therapy, penile prosthesis implantation is the most effective and permanent solution.

These are medical implants placed inside the penis.

 

Types of Penile Prostheses

1. Inflatable (Three-Piece) Prosthesis

• Provides the most natural erection

• Operates with a pump system

• Highest patient satisfaction rates

2. Two-Piece Prosthesis

• Simpler mechanism

• No separate reservoir

3. Malleable (Semi-Rigid) Prosthesis

• Constant semi-rigid structure

• Easy to use

• Low mechanical failure risk

 

Who Is It Suitable For?

• Patients who do not respond to oral medications

• Those who do not wish to use injections

• Diabetic patients

• Individuals seeking a permanent solution

(Patient satisfaction rates exceed 90%.)

 

Conclusion

Today, male sexual dysfunction can be treated with multiple approaches, including:

• Oral medications

• Injection therapies

• Regenerative treatments

• Penile prosthesis surgery

Early evaluation and an individualized treatment plan significantly increase success rates.