Key points
- Erectile dysfunction (ED) is not solely an issue of sexual performance; it may be associated with vascular, metabolic, hormonal, neurological, and psychological factors.
- New-onset or persistent ED may be an early indicator of cardiovascular risks in some individuals.
- Diabetes, hypertension, smoking, obesity, sleep disorders, and certain medications can affect erectile function.
- PDE5 inhibitors are among the mainstay treatment options in many patients; however, significant contraindications such as nitrate use exist.
- Studies exist on PRP, low-intensity shockwave therapy, and other regenerative approaches; the extent to which they may contribute in a given patient can vary depending on the method and protocol.
What is erectile dysfunction?
It can be defined as recurrent difficulty in achieving or maintaining an erection sufficient for sexual intercourse. A one-time performance issue does not mean ED; the duration, frequency of recurrence, and the distress it causes the individual are important.
What are the causes?
- Vascular diseases and atherosclerosis
- Diabetes and insulin resistance
- Hypertension and dyslipidemia
- Smoking
- Testosterone deficiency and other hormonal conditions
- Neurological diseases
- Pelvic surgery or trauma
- Depression, anxiety, and performance anxiety
- Sleep disorders and obstructive sleep apnea
- Certain medications
Which evaluations are performed?
History, medications, cardiometabolic risks, physical examination, and, when necessary, laboratory evaluation are the fundamental steps. Testosterone, glucose/HbA1c, lipids, and other tests are selected according to the clinical context. Urology or cardiology evaluations may be added for patients when necessary.
Treatment options
Lifestyle and cardiometabolic risk management is an important part of treatment. PDE5 inhibitors are frequently used options in appropriate patients. If the response is inadequate, proper use, dosage, accompanying diseases, and underlying causes are reviewed. Vacuum devices, injection therapies, or surgical options may also come to the fore in selected patients.
The role of testosterone
Testosterone therapy is not initiated based on the presence of ED alone. Clinical symptoms and repeated, appropriate laboratory results are evaluated together. If true hypogonadism is present, it may contribute to sexual desire and certain areas of sexual function; treatment and monitoring are planned according to individual risks.
Regenerative and complementary approaches
Studies on low-intensity shockwave therapy, PRP, and different regenerative methods are ongoing. Although positive results have been reported in some studies, protocols and long-term data vary. If these options are being considered, their relationship with standard treatments and realistic goals should be discussed clearly.
The role of ozone
Potential effects of ozone via circulatory and redox mechanisms are being investigated. Clinical data for ED remain limited; therefore, if utilized, it is more appropriate to approach it as a complementary option after underlying causes and standard options have been evaluated.
Our approach in our Bodrum clinic
We do not evaluate erectile problems solely with a drug prescription or testosterone level. Vascular health, metabolic risks, sleep, hormones, medications, and psychological factors are addressed together.
Related guides
- Sexual Health and Healthy Aging
- Low Testosterone and Men’s Health
- Insulin Resistance and Metabolic Syndrome
- Nicotine Addiction and Smoking Cessation
- Ozone: Diseases and Clinical Conditions
References
- European Association of Urology. EAU Guidelines on Sexual and Reproductive Health. 2026.
Written and medically reviewed by: Dr. Kerem Çağlayan
Last medical review: September 10, 2026
Disclaimer: This content does not constitute personal diagnosis or treatment advice.
