Penis

Prostatitis never causes impotence, and men should not be misled on this point.

The anatomy explains why: the nerves responsible for potency run from the lower side portions of the prostate toward the penis. Prostatitis is an inflammation inside the prostate, and it never affects those nerves. That is why other methods of examination and treatment are needed in such cases. Treating prostatitis is never a treatment for impotence.

Those nerves can be damaged, for example, in prostate cancer, or by a prostate abscess — a collection of pus that damages the nerves; in those cases impotence can occur. Ordinary chronic or acute prostatitis, however, never causes it.

This applies to ordinary acute or chronic prostatitis, which does not directly affect the nerves responsible for potency; prostate cancer and prostate abscess are the exceptions. Sexual function can be impaired in patients with chronic pelvic pain — in that case, the cause is looked for not in the prostate itself but in stress, the nervous system, and vascular and hormonal factors. For this reason, in a patient with long-standing prostate complaints, the two problems are evaluated separately; the real cause can only be determined through an individual examination.

The cause of impotence is often neurological — that is, it is related to the nervous system. Ordinary stress and being on edge can both cause impotence.

In such cases, it may also be necessary to examine the blood vessels leading to the penis and those returning from it, because problems or disease in those vessels can themselves lead to impotence. Age also matters here.

With an individual approach to the patient, this condition can be treated. Sometimes it can be treated with two ordinary medications — but here, too, the approach must be individual.

Treatment given without identifying the cause — for example, based only on a diagnosis of “prostatitis” — does not help with impotence: the cause must be found first, and the treatment chosen to match it.

Treatment with two medications is an example that fits some cases, not a promise that applies to everyone. Erectile dysfunction medications have contraindications and side effects; which medication, at what dose, and whether medication is suitable at all can only be determined after an examination.

The evaluation includes hormone tests, blood sugar and a lipid profile, a vascular assessment, and a review of the medications you take.

When necessary, the blood vessels that bring blood to the penis and carry it away are examined separately, because disease of the vessels themselves can also cause impotence. The patient’s age, other health conditions and how long the complaint has been present are also part of the evaluation.

There is no universal test that “shows everything” — which tests and imaging are needed is decided individually, according to the complaint; an unnecessarily broad package of tests is not recommended.

Erectile dysfunction — commonly known as impotence or “sexual weakness” — is the inability to get an erection or to keep it long enough for intercourse. It is more common in men over 40; stress-related (psychogenic) forms, however, can also occur at a younger age.

In many cases, treatment is possible. Which treatment is used depends on the cause and severity of the erectile dysfunction — which is why treatment is not started before the cause has been identified.

Because erectile dysfunction can sometimes be the first sign of cardiovascular disease, this complaint should not be hidden or left without an examination.

The first step is medication. If medication does not work or is not suitable, methods such as ESWT (low-energy shockwave therapy), vacuum devices and a penile prosthesis may be considered at later stages.

This sequence is a general direction and is not the same for every patient. Which stage to start with and which method to move on to are decided together, depending on the cause, overall health and the patient’s expectations.

Medication should be taken only with a prescription and medical advice: tell your doctor about all other medications you take and about any cardiovascular disease.

The outcome of treatment depends on the cause and on the patient, and it is not promised in advance. A penile prosthesis is a surgical procedure — like any operation, it carries risks, and it is considered when other methods have not worked, after a detailed discussion. No method is suitable for everyone.

Premature ejaculation is also one of the sexual function disorders. It is a different complaint from a weak erection: here an erection may be present, but ejaculation happens sooner than desired.

Both complaints can also occur together in the same patient. At the appointment, a precise description of the complaint — when it started, and whether it happens every time or only in certain situations — determines the right course, and the treatment approach is chosen on that basis.

The treatment approach for premature ejaculation is determined only at the appointment, after the complaint has been evaluated; using medications or other remedies on your own is not recommended.

Yes — medication effects are among the possible causes. That is why the examination includes a review of all the medications you take, including those for blood pressure, the heart, the nervous system and others.

Do not stop a medication you suspect on your own: stopping a prescribed medication can make the underlying condition worse. Switching the medication or adjusting its dose is decided only together with the doctor who prescribed it.

Testosterone deficiency (hypogonadism) can show up as reduced sexual desire, erection problems, persistent fatigue, reduced muscle strength and mood changes; these complaints can also have other causes.

The diagnosis is not made on symptoms alone: a low testosterone level must be confirmed by blood tests taken in the morning on at least two occasions, and its cause must be investigated.

Taking testosterone products without an examination and without medical supervision is not advisable: they can reduce sperm production — which is why they are not recommended for men who are planning to have children — and they can affect how thick the blood is (hematocrit). During treatment, blood tests (including hematocrit and PSA) and symptoms are checked regularly; whether treatment is appropriate is decided by the doctor after an examination.

Congenital or acquired curvature can cause pain and difficulty with intercourse. Treatment depends on the degree of curvature and on how severe the complaints are.

Mild curvature that does not interfere with intercourse and causes no pain does not always require intervention. Because acquired curvature can keep changing for a while, a decision about surgery is usually discussed once the curvature has stabilized.

Surgical correction of curvature is reserved for selected cases; like any surgical procedure, it carries risks, and the result is not promised in advance. The decision is made after an individual examination.