the Differences Between Organic and Psychogenic Erectile Dysfunction

The distinction between organic and psychogenic erectile dysfunction lies in their underlying causes. Organic erectile dysfunction is primarily due to physical factors such as vascular issues, hormonal imbalances, or neurological disorders. In contrast, psychogenic erectile dysfunction is

Hello, doctor.
I used to have a habit of masturbation, at least once a day, and sometimes 3 to 4 times on weekends.
After engaging in actual sexual intercourse (which has only happened three times), I noticed that I experienced erectile difficulties.
During foreplay, I was somewhat hard, but after putting on a condom and inserting, I lost my erection shortly after.
Recently, I haven't been masturbating much—only once every week or two.
My morning erections are quite firm, but it seems like once my brain wakes up, the erection quickly fades.
I do have some response during sexual fantasies, but it also fades quickly once I get distracted.
I don't feel like I can achieve an erection as quickly or maintain it as long as I used to.
After more than five years of frequent masturbation, my mental state has worsened, and my memory has also declined.

I would like to ask you, doctor:
1.
What are the symptoms of organic erectile dysfunction? Do I have it, or is it simply psychological tension, unfamiliarity, or just fatigue?
2.
I realize that I may have indulged excessively.
Will quitting masturbation and starting to exercise lead to improvement?
3.
Additionally, when I was younger, I had a bit of a long foreskin, but after development, I didn't have phimosis and didn't undergo circumcision.
When not erect, I need to pull the foreskin down to fully expose the glans.
There is a slightly raised ring of tissue below the corona of the penis; is this a normal structure? It doesn't hurt, and it seems like it has always been there.

Niming, 20~29 year old female. Ask Date: 2016/12/20

Dr. Xu Wencang reply Urology

You can visit the outpatient clinic for evaluation and assessment.

Reply Date: 2016/12/20

More Info

Understanding the differences between organic and psychogenic erectile dysfunction (ED) is crucial for diagnosing and treating this condition effectively. Erectile dysfunction can stem from various causes, and distinguishing between these causes can help determine the appropriate treatment.

1. Organic Erectile Dysfunction: Symptoms and Causes
Organic erectile dysfunction is primarily caused by physiological factors. This can include vascular issues, hormonal imbalances, neurological disorders, or anatomical problems. Common symptoms of organic ED include:
- Difficulty achieving an erection consistently.

- Trouble maintaining an erection during sexual activity.

- Reduced sexual desire or libido, though this can vary.

Some common causes of organic ED include:
- Cardiovascular diseases: Conditions that affect blood flow, such as atherosclerosis, can impede the ability to achieve or maintain an erection.

- Diabetes: This can lead to nerve damage and poor blood circulation, both of which can contribute to erectile dysfunction.

- Hormonal imbalances: Low testosterone levels can significantly impact sexual function.

- Neurological conditions: Disorders such as multiple sclerosis or Parkinson's disease can affect nerve signals involved in erections.

- Medications: Certain medications can have side effects that include erectile dysfunction.

Given your description of experiencing difficulty maintaining an erection during sexual intercourse, it is possible that you may be experiencing organic ED, particularly if there are underlying health issues. However, it is essential to consider psychogenic factors as well.

2. Psychogenic Erectile Dysfunction: Symptoms and Causes
Psychogenic erectile dysfunction is primarily related to psychological factors. This can include anxiety, stress, depression, or relationship issues. Symptoms may include:
- Erection difficulties primarily occurring in specific situations (e.g., with a partner but not during masturbation).

- Anxiety about sexual performance, which can create a cycle of fear and further erectile dysfunction.

In your case, the fact that you experience morning erections and some response to sexual fantasies suggests that there may be a psychological component at play. The transition from frequent masturbation to sexual intercourse can also introduce performance anxiety, especially if you are feeling pressure to perform.

3. Impact of Excessive Masturbation and Lifestyle Changes
Excessive masturbation can lead to temporary changes in sexual function, including desensitization or altered expectations regarding sexual performance. Reducing the frequency of masturbation, as you mentioned, may help in regaining sensitivity and improving your overall sexual experience. Engaging in regular physical activity can also enhance blood flow and improve mood, which may positively affect erectile function.

4. Concerns About Anatomy
Regarding your anatomical concerns, having a slightly longer foreskin that requires adjustment during an erection is not uncommon. The presence of a ring or slight swelling around the base of the penis is typically normal anatomical variation. However, if you experience pain or discomfort, it would be advisable to consult a healthcare professional for further evaluation.

Conclusion
In summary, distinguishing between organic and psychogenic erectile dysfunction is essential for effective treatment. Given your symptoms and history, it may be beneficial to consult a healthcare provider who can conduct a thorough evaluation, including physical examinations and possibly blood tests, to rule out any underlying organic causes. Additionally, addressing psychological factors through counseling or therapy may also be beneficial. Lifestyle changes, such as reducing masturbation frequency and increasing physical activity, can contribute to improvements in erectile function.

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