Erectile Issues: Causes and Solutions for Young Men

Not hard enough to penetrate?

Hello, doctor! I would like to ask for your assessment on my situation and what would be the best course of action.
I have no prior sexual experience (due to phimosis, which caused pain during intercourse, and I later underwent a circumcision).
After that, when I attempted to have intercourse with my girlfriend, I often found it difficult to penetrate.
I have managed to penetrate twice; once, when I tried to change positions, I couldn't penetrate again, and the other time, I was on medication and did not change positions.
On other occasions, when I wasn't on medication, I found that I couldn't penetrate due to insufficient rigidity two or three times.

My physical condition is as follows: I do not smoke or drink, I do not stay up late, and I sleep for about seven and a half hours.
I went to a urologist, and my urine test showed that my testosterone levels are normal but slightly elevated.
I experience nocturnal erections (I know this because after my circumcision, I often woke up in pain from erections).
I also have noticeable morning erections when I wake up or get out of bed quickly, although sometimes if I linger in bed for too long, I may not have an erection.
I can also masturbate normally.

I really don't understand why I am experiencing issues with insufficient rigidity.
Could you please help me determine whether this is psychogenic or organic erectile dysfunction based on my description? This situation is causing me a lot of stress, and I think about it every day.
Would it be suitable to engage in more jogging and weight training, along with a small amount of Cialis to boost my confidence before stopping the medication?

Lin, 20~29 year old female. Ask Date: 2017/09/26

Dr. Du Shixi reply Urology

There have been too many similar questions; please refer to our frequently asked questions.
Hello: Exercise does not need to be excessive or prolonged; just half an hour a day is sufficient.
If you experience frequent morning erections that are firm (like the hardness of a cucumber), it is less likely to be of organic origin.
Nutrition should also be balanced, and it is advisable to avoid overly oily foods.
If there is masturbation, it may lead to habitual or psychological effects; it is recommended that you consult a physician specializing in sexual function at a medical center for a thorough examination.
Wishing you good health.

Reply Date: 2017/09/26

More Info

Erectile dysfunction (ED) in young men can be a complex issue, often stemming from a combination of psychological and physiological factors. Based on your description, it seems you have experienced challenges with erections and penetration, which can be distressing and impact your confidence and relationship. Let's break down the potential causes and solutions.

Understanding the Causes
1. Psychological Factors: Anxiety, stress, and performance pressure can significantly affect sexual function. Given that you mentioned feeling pressure regarding your erectile issues, it’s possible that anxiety is playing a role. The fear of not being able to perform can create a cycle of anxiety that further exacerbates the problem.

2. Physiological Factors: You mentioned that you have normal hormone levels and experience nocturnal erections, which are good signs of physiological health. However, issues like insufficient blood flow or nerve function can still contribute to erectile difficulties. The fact that you had a circumcision may also have psychological implications, as it can alter the perception of sexual function and sensitivity.

3. Physical Health: While you maintain a healthy lifestyle (non-smoker, moderate sleep, and exercise), it’s essential to consider other health factors. Conditions such as diabetes, cardiovascular issues, or hormonal imbalances can affect erectile function, even in young men.

Solutions and Recommendations
1. Consult a Specialist: Since you have already seen a urologist, it may be beneficial to consult a psychologist or sex therapist who specializes in sexual health. They can help address any underlying anxiety or performance issues that may be contributing to your erectile difficulties.

2. Communication with Your Partner: Open communication with your girlfriend about your concerns and experiences can alleviate some pressure. Understanding and support from a partner can significantly reduce anxiety during intimate moments.

3. Gradual Exposure: Instead of focusing solely on penetration, consider exploring other forms of intimacy that can help build confidence and reduce performance pressure. This can include kissing, touching, or other forms of sexual activity that do not involve penetration.

4. Physical Fitness: Continuing with your running and weight training is beneficial for overall health and can improve circulation, which is crucial for erectile function. Regular exercise can also help reduce anxiety and improve mood.

5. Medication: While you mentioned considering medications like sildenafil (commonly known as Viagra), it’s essential to use these under the guidance of a healthcare professional. They can help you understand how to use them effectively and safely, and whether they are appropriate for your situation.

6. Mindfulness and Relaxation Techniques: Incorporating mindfulness practices, such as meditation or deep breathing exercises, can help manage anxiety and improve your overall mental health. This can be particularly helpful before intimate moments.

7. Avoiding Substance Use: While you do not smoke or drink, it’s important to avoid any substances that could impair sexual function, including excessive alcohol or recreational drugs.

Conclusion
Erectile issues can be challenging, especially for young men, but understanding the potential causes and exploring various solutions can lead to improvement. It’s crucial to approach this situation holistically, considering both psychological and physiological aspects. Seeking professional help, maintaining open communication with your partner, and focusing on overall health can significantly enhance your sexual well-being. Remember, you are not alone in this, and many young men experience similar challenges. With the right support and strategies, you can work towards overcoming these difficulties.

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