It is studied under the title of Sexual Dysfunctions in men and women. It does not refer to any particular disease, rather, it is a general definition with many subtitles.

If a person is dissatisfied with their sexual life as a result of any problems encountered during any of these stages, and the situation persists, then sexual dysfunction comes into question. A lack of desire, not being able to have sexual intercourse for any reason, experiencing pain during sex, ejaculation problems, anorgasmia, etc. are all generally named as sexual dysfunction.

Many psychological factors can lead to sexual dysfunction, including trauma experienced in childhood, unsuccessful first sexual intercourse; also feelings of guilt, or performance anxiety. Apart from these, conditions and diseases, or surgical operations that may physically harm the veins or nerves may also cause problems in sexual functions. Moreover, any change or disorder that may occur in hormones may also disrupt any of the phases mentioned before, causing sexual dysfunctions.

Unfortunately, sex is perceived as a serious taboo in our country and sexual problems cannot be discussed frankly. However, both the mental and physical health of people are closely related to the quality of their sexual life. Therefore, when couples or individuals feel any problem regarding their sexual life, they must seek help from a specialist.

Organic reasons for sexual dysfunctions occur as a result of physical problems in the body functions. This group includes the effects of diseases that affect the entire body, such as diabetes, obesity, damage to vessels and nerves after previous surgeries, congenital or acquired anatomical problems, and disorders that may occur in the body’s hormonal system. Patients in this group are frequently followed up by a urologist or a gynecologist, or by an endocrinologist if there are hormonal problems.

Psychological reasons of sexual dysfunctions covers a broader field. Many situations such as childhood trauma, misinformation, or biases due to not having an adequate and right sex education, unsuccessful first sexual experience, and poor family relationships may cause problems in both women’s and men’s sexual functions. In addition to these, obsessions about penis size or performance concerns arising from the mission (potency) imposed on men, masculinity, and the penis can be included in the primary psychological reasons experienced by men. On the other hand, even if the problems in sexual functions stem from organic reasons, these problems often bring psychological problems with them, turning the situation into a knotty problem. The treatment of sexual dysfunctions caused by psychological reasons is often carried out by a psychologist or a psychiatrist trained in this field.

Sexual problems may arise from many reasons, which may be organic or psychological. And, each of these problems is treated by specialist doctors using different methods. However, the problem is that the person experiencing sexual problems is not likely to know the reasons for their problems. The person may lack desire for sex, have problems having an orgasm, ejaculate early, have pain during sex, or experience erectile dysfunction. As the person is not likely to know whether these problems result from hormones, veins, or psychological reasons, and sex is considered a taboo and talking about sex is not that easy, having so many appointments for sexual problems mostly makes the person spend their time and money on unnecessary tests.

A holistic approach to sexual dysfunctions, on the other hand, is a treatment approach that can be applied by urologists and gynecologists that are trained in sex therapy for treating sexual dysfunctions, completed their training in the diagnosis and treatment of hormonal disorders affecting sexual functions, and also developed themselves in these fields. This approach is based on diagnosing the primary reason causing problems, among many other reasons mentioned above, and treating these problems appropriately in only one treatment center.

In other words, a holistic approach to sexual dysfunctions is a treatment approach according to which the problem is treated using methods of sex therapy if the problem is occurring due to psychological reasons, or problems stemming from physical reasons are treated by administering medicine or hormone treatments, making lifestyle changes, by making the patient lose weight (if necessary), and by performing surgical operations.

Sexual dysfunctions due to drug use

Penis size problems

Sexual dysfunctions due to drug use

Sexual dysfunctions caused by the general state of health

Sexual dysfunctions seen in women may also result from organic or psychological reasons, as in male sexual dysfunction. However, vaginismus and orgasm disorders, the most common sexual dysfunctions seen in women, are mostly psychogenic, and the patients in this group greatly benefit from sex therapy.

Genital warts are lesions caused by Human Papillomavirus (HPV) that generally form in genital areas; they may look like skin-colored or dark-colored small bumps or have a cauliflower-like appearance. They are also known as genital condyloma or condyloma acuminatum. Today, genital warts are accepted as the most common sexually transmitted disease all over the world. They can be seen both in men and women. They can be often seen on the penis skin, scrotum, inguinal region, or around the anus in men while seen on the vulva, vaginal wall, or around the anus in women.

HPV is the abbreviation for a virus family called Human Papillomavirus. There are more than 170 types of HPV identified so far. Around 40 of them cause diseases in human beings when sexually transmitted.

Most HPV infections do not show any symptoms and disappear from the body in around two years. However, sometimes genital warts occur due to HPV infection and these warts need treatment, and sometimes lesions may occur, which may turn into cancer later.

HPV is mostly transmitted due to close skin-to-skin touching. As it is often seen in genital areas, it is also accepted as a sexually transmitted disease.

There are very limited publications on that a person may rarely be infected with HPV due to indirect contact in places such as around the pools or showers used by many people. It is generally known that HPV is a tenuous virus and cannot survive for long outside the body.

A part of the body may be infected by another part of the body. Especially while shaving the genital area, existing lesions may spread. That is why it is significant to avoid methods that can harm the skin such as razor blades, depilatory cream, and wax.

If you have one or more of these, you need to consult a sexual health clinic.

You can wipe out your warts with proper treatment and get help to get rid of HPV infection.

HPV is a general term that refers to a virus family with lots of subtypes. While some HPV types cause warts on the body, some others lead to cancer by disrupting the structure of the cells over time. HPV infection most commonly causes cervical cancer. Besides, anal cancers, penile cancer, and some oral and throat cancers are also related to HPV.

Today, there is no medicine effective in treating HPV in daily use. Warts caused by HPV can be treated by burning off, freezing, or with various creams. Treatments that could support the immune system are also crucial for the treatment of HPV.

In the past, it was asserted that once a person was infected with HPV, the virus would stay in the body permanently. However, approximately 60% to 80% of individuals with active sex life encounter this virus some time in their lives, and they get over it thanks to their own body resistance. HPV mostly clears up from the body within two to three years. But, sometimes this becomes impossible and HPV stays in the body permanently. And, it may lead to cancer based on the changes it causes on the cells over the years.

No. However, every new arising wart should be immediately treated to prevent them from reappearing; you should eat food and food supplements that boost the body’s resistance and avoid methods that can harm the skin such as razor blades, depilatory cream, and wax.

After all genital warts are treated, the infection rate substantially decreases. However, if there are warts in the cervix in women and the urinary canal in men, HPV continues infecting. The existence of such a situation can be understood by testing the swab sample taken from the inside of the urinary canal.

It is possible to define the virus type by looking at the existent warts in men. Also, if there is no active virus, it is possible to look for the viruses by taking a swab sample from the inside of the urethra (urinary canal).

HPV is a family of viruses with more than 150 defined types. Available vaccines do not protect all of these types, however, they are widely used as they are protective against the most common virus types, and they have an important place in controlling diseases associated with HPV. Now, there are three types of HPV vaccine in use. The bivalent HPV vaccine is protective against HPV types 16 and 18 that cause most HPV cancers. HPV types 16 and 18 account for 70% of cervical cancers. The quadrivalent HPV vaccine is protective against HPV types 6 and 11, which are held responsible for around 90% of genital warts, and also HPV types 16 and 18. The nine-valent HPV vaccine is not available in Turkey yet, but it protects against nine HPV types 6, 11, 16, 18, as well as 31, 33, 45, 52, and 58.

HPV vaccine is not effective for the virus type present in the body. However, it protects against common types of HPV, which has many types. Also, there are some opinions that it prevents existing warts from spreading.

In the vaccine programs of many countries, the HPV vaccine is given to girls under 12 in two doses. Although this vaccine is not available in our national vaccination program yet, we recommend it to be given to children under age 15 in months 0 and 6; and to those above the age of 15 in three doses in months 0, 2, and 6.

The HPV vaccine is protective against HPV types causing cancer, as well as other HPV types responsible for genital warts. We recommend HPV vaccination to avoid HPV warts commonly seen in men.

Basically, there are two methods for the treatment of genital warts. The first one is to destroy the warty tissue. The warty area can be burned off using electrocautery, destroyed by freezing, or by burning off with a laser. Sometimes medicine with acid contents can be used to chemically burn off the warty area. As burning off warts with electrocautery can eradicate all warts in only one session, it is more advantageous than the freezing method.

Another method for the treatment of warts is to use medicine applied locally on the wart to trigger the immune system in the warty area. However, the problem with this medicine is that the treatment process takes longer and the treatment may fail if the medicine is not applied correctly.

Genital wart is a disease that may often reappear. If the treatment is applied properly, new warts mostly appear on other areas of the skin, not in the same place as previous ones. You must avoid bleeding of the warts. This is because bleeding warts spread so many viruses around, and this may cause the wart to spread to other parts of the skin. The viruses are mostly spread from the irritated skin areas. That is why you must avoid using razor blades, depilatory cream, and wax for cleaning your genital area. The most suitable method is to cut the hair by using a specially designed tool without irritating the skin.

Moreover, each new appearing wart should be immediately treated and the risk of spreading must be decreased. Apart from these, the immune system of the body has a major role in preventing warts from reappearing. To keep the immune system strong, you should avoid smoking, and use immune system boosters, vitamins, and food supplements.

There are many HPV types. The HPV types that cause warts are different from those causing cancer. However, it is possible to be infected by different types of viruses, thus especially women with genital warts must have regular gynecological examinations.

No. In many people infected with the HPV virus, the virus disappears from the body within two years on average thanks to the immune system. Only in a small group of people, the virus stays permanently. This group of patients is under the risk of developing cancer. However, thanks to close follow-up and controls, it is possible to diagnose the cancers at an early stage and completely clear them.

Penis is an anatomically porous organ. These pores are filled with blood with sexual stimulation, and the penis enlarges and gets hardened. For the penis to get hardened with the sexual stimulation, depending on the signals sent from the central nervous system through the nerves, arteries expand and carry blood to the penis. Meanwhile, the veins narrow and do not carry the blood coming to the penis back and ensure that it is trapped in the penis. In other words, for a healthy erection, firstly the nerves and the vessels need to function healthily. Also, hormones play important roles during erection process.

The hardening of the penis (erection) is a complicated process in which hormones, nerves, vessels, and also psychological factors play a role. Erectile dysfunction may arise due to any problem in any stage of this process. Therefore, erectile dysfunction may result from biological/organic problems related to hormones, or from completely psychological problems.

Sometimes the psychological problems are added on the biological problems, causing the situation to get more complicated. To solve the problem in the right way, the underlying reason or reasons must be analyzed well.

Sexuality in people is a process consisting of biological, psychological, and social factors. Being biologically healthy is not sufficient for the penis to get erected. Psychological factors are as effective as biological and organic factors in the erection mechanism. Since sexuality in men is mostly focused on performance and score, the fear of not being able to show the same performance all the time is called performance anxiety and is one of the common causes of erectile dysfunction.

Obsessions about penis size can also cause erectile dysfunction in men. In addition, conditions that affect psychological health such as anxiety disorders, depression, substance abuse, alcoholism, and childhood traumas are the main causes of erectile dysfunction.

Erectile dysfunction can be treated more successfully thanks to the recent technological developments. Today, it is possible to solve this problem by determining the source of the problem, together with a better understanding of the anatomy of the penis and a better understanding of the mechanisms that cause an erection. We can now successfully identify problems in the vascular structures of the penis, hormonal problems, or psychological problems that may cause erectile dysfunction and produce solutions aimed at the source of the problem.

With the advancing of age, erectile dysfunction is more common due to disorders in hormone production and problems in vascular structures. While the reasons for the erectile dysfunction seen at younger ages have psychological origins, problems related to the hormones and the vascular structures come to the fore in older ages.

Surgical treatments can be effective in the erectile dysfunction caused by vascular problems. However, surgical treatments must be considered only after methods such as shock wave therapy (ESWT) and medicinal treatments are tried and failed. The most commonly used surgical treatment method for erectile dysfunction is penile prosthesis implantation surgery. With the penile prostheses, a pleasant sexual life is possible even in older ages.

It is completely normal for men to have a loss of erection after ejaculation and not to have an erection again in a short time. The time between these two intercourses, which is not felt much at young ages, gradually increases with age.

There may be curvatures in the penis that are congenital or appear with age. If this curvature is so advanced that it prevents the penis from penetrating the vagina, it may need to be surgically treated.

Shock waves are sound waves with unique physical properties, which can be produced at different intensities, and have been used for medical purposes for a long time.

In medicine, shock waves were firstly used to break down kidney stones in the 1980s. The shock waves used for this purpose are of high intensity and bear such a high energy that they can shatter a stone. Later, it was observed that the recovery time of the tissues was faster thanks to the shock waves, and shock waves of medium intensity were started to be used for the treatment of various orthopedic diseases.

With low-intensity shock waves, on the other hand, various heart diseases and erectile dysfunction have been treated by stimulating the formation of new vessels (vascularization) in recent years.

Shock Wave Therapy is a term that is used to describe low-intensity shock wave treatment. This therapy method has been used in orthopedics for years to help heal broken bones, injured ligaments, and injured tendons. ESWT has also been used for accelerating the healing of wounds. Targeted high-energy sound waves accelerate tissue regeneration and cell growth.

The hardening of the penis (erection) occurs when the porous tissues inside the penis are filled with blood. In other words, erection depends on the healthy blood flow to the penile tissue. During an erection, the function of the arteries is to expand and carry blood to the penis in a fast way, while the function of the veins is to prevent the discharge of blood that fills the penis by constricting. In cases of advancing age, high cholesterol levels, and diabetes, some disruptions occur in the structure of the blood vessels in the penis, as is the case in the blood vessels in the heart.

Some medicines used for the treatment of erectile dysfunction due to vascular problems aim to increase the blood flow to the penis. Although these medicines are highly effective, the idea of having sex thanks to medicine troubles many men.

Shock Wave Therapy (ESWT) is a treatment that aims to correct the hardening problem permanently by repairing the vessels and increasing the blood flow. As a result of micro-traumas in the penis due to shock waves, some substances are secreted from the cells and stimulate the formation of new vessels. Therefore, new vessels that carry blood to the penis are formed, and the hardening performance is permanently increased.

Shock Wave Therapy is a treatment with almost no side effects when compared to its effectiveness. Sometimes, temporary bruising may occur on the penile skin due to micro-traumas caused by shock waves. These bruises disappear on their own in a week.

Shock Wave Therapy is applied in six sessions, each lasting 15 minutes. Two or three sessions are planned in a week. In total, the treatment takes 2-3 weeks. According to the result of the controls made one month after the completion of the treatment, a second course of treatment of six sessions may be applied.

Testosterone is a hormone that plays important roles in the body. Testicles in men and ovaries in women make testosterone, and small amounts of testosterone are produced in adrenal glands in both sexes. Testosterone is more than a hormone. It has impact on many organs in the body and the general body health.

It regulates the sexual drive (libido) and affects the sexual functions. The erection of the penis is significantly affected by the testosterone levels. It also influences bone mass (density), body fat distribution, muscle mass and strength, red blood cells, and sperm production.

Testosterone is also produced in the ovaries of women. It is considered that testosterone regulates sexual desire in women as well, and has significant impacts on bone density. The amount of testosterone in women are quite less than in men.

The testosterone production in men starts when they are in the mother’s womb, increases during puberty, and reaches the highest levels in the following 10 years. After the ages of 30-40, testosterone levels in men start to gradually decrease. The decrease in testosterone to certain levels may cause various symptoms in the body. This level varies by age and from person to person.

While testosterone levels may decrease with age, this situation can also result from the lack of testosterone production in the testicles of men. Sometimes, even if testosterone production is normal, low testosterone levels may occur due to the fast destruction of this hormone. No matter what the reason is, the decrease in testosterone levels causes a decline in bone density and body muscle mass, and an increase in fat mass. Besides, lack of sexual desire and sexual dysfunctions occur. Testosterone does not influence only the sexual desire in men. The desire to live, excitement, and the sense of competition are also affected by testosterone.

Decrease in testosterone levels may result from many reasons. Firstly, as the production of testosterone will decrease with age, testosterone levels in the blood may also decrease. Moreover, testosterone production in the testicles may diminish due to some diseases or medical conditions regardless of age. Also, in situations that cause an increase in the destruction of testosterone, the testosterone levels in the blood will decline. Testosterone in the body is broken down in two main ways. In the first way, an enzyme named 5-alpha reductase converts the testosterone into another form of testosterone called Dihydrotestosterone (DHT).

This new molecule is responsible for the formation of sex characteristics in men, such as pilosity and deepening of the voice. The other way the testosterone may take is a process called aromatization that takes place in the fat tissue. This process is realized by the aromatase enzyme and results in the formation of estrogen. Estrogen is a hormone, also known as the female sex hormone, that helps the formation of feminine characteristics. As can be understood, when the fatty tissue in the body increases, the conversion of testosterone into estrogen also increases, and this process results in situations such as sexual dysfunctions, the lack of sexual desire, and the enlargement and sagging of breast tissue.

Normal testosterone level values written next to the laboratory results cause confusion about this issue. Normal values for a 30-year-old man and normal values for a 70-year-old man cannot be the same. Besides, when it comes to testosterone, the concept of normal also becomes very controversial because the effectiveness of testosterone also differs from person to person. When a patient consults us with the complaints of erectile dysfunction and the lack of sexual desire, we measure the testosterone levels as well as the levels of “sex hormone-binding protein”, the main protein to which the testosterone in the body binds, thus calculating the free testosterone levels that are active.

If there are symptoms caused by low testosterone levels (such as lack of sexual desire, erectile dysfunction, osteoporosis, malaise, fatigue, lack of desire, angriness), testosterone supplementation is required.

Although prostate cancer depends on testosterone, external testosterone supplements do not lead to prostate cancer. The use of testosterone supplements in people diagnosed with prostate cancer is quite controversial and not recommended.

Testosterone is not secreted constantly in the body at all times. The testosterone levels increase especially in the mornings. Similarly, external testosterone supplements are expected to provide higher levels of testosterone during morning hours, but not to cause big changes in the body. Especially orally taken testosterone supplements are now rarely used because they have serious side effects on the liver.

Although testosterone supplements administered through injections at certain intervals are better alternatives in terms of side effects, with injections made every 3-4 weeks, it is not possible to maintain a testosterone level that is stable and that increases during morning hours and slightly decreases towards evening. Natural testosterone supplements, applied to the body in the form of cream or gel during morning hours and absorbed slowly through the day, come to the forefront in terms of both their effectiveness and the rare side effects.

The testosterone is converted into estrogen by getting broken down by the aromatase enzyme, especially found in the adipose tissue in the body. Reducing the amount of fatty tissue in the body by losing weight increases testosterone levels. Moreover, foods and food supplements that reduce the activity of aromatase enzyme breaking down the testosterone in the body also help to reduce testosterone levels in the body.

As exercise generally decreases the fat mass while increasing muscle mass, it raises testosterone levels. Exercises that especially increase testosterone levels are the ones strengthening the large muscle groups like legs, back, and chest. In addition, HIIT workouts that boost explosive strength are also known to increase testosterone levels.

On the other hand, endurance sports like running for a long time and cycling long-distance reduce testosterone levels.