Erectile Dysfunction: Causes and Solutions for Men

Erectile dysfunction during sexual activity?

Hello Doctor, my situation is a bit complicated and I hope you can provide me with a more comprehensive response.
About two years ago, I had phimosis and went to the hospital for an examination.
The doctor suggested circumcision, but I requested to try using steroids first.
After applying the treatment, I can now retract the foreskin, although it is still somewhat tight.
However, during sexual intercourse, the glans can be fully exposed.
Problem 1: My glans is particularly sensitive, and I experience a slight pain sensation.
Therefore, when my girlfriend performs oral sex or touches my glans, I am completely unable to respond.
Problem 2: Since childhood, I have been fascinated by watching pornography and have developed specific preferences.
I used to have strong reactions to certain outfits or adult films, but now I have no response at all.
I still watch pornography and masturbate, but I have to use my hand to achieve an erection rather than experiencing a natural erection.
Additionally, the frequency of morning erections has decreased.
Problem 3: When I want to have sex with my girlfriend, I am currently unable to achieve an erection at all.
If she uses her mouth, I find it too sensitive and uncomfortable.
Using her hand also feels unpleasurable, and I can only achieve an erection through masturbation.
I need to think of more intense imagery to do so.
However, when it comes to penetration, if her hand is not moving, I often lose my erection, or it becomes flaccid after insertion.
I have been taking traditional Chinese medicine to improve my condition, but I hope the doctor can provide me with some advice.

J, 20~29 year old female. Ask Date: 2018/12/22

Dr. Du Mingyi reply Urology

You may still consider circumcision to reduce pain.
As for the issue of erections, it's quite simple; there's no need to keep watching the videos.

Reply Date: 2018/12/22

More Info

Erectile dysfunction (ED) is a complex issue that can stem from various physical, psychological, and lifestyle factors. Based on your description, it seems that you are experiencing a combination of sensitivity issues, psychological barriers, and possibly some physiological changes. Let's break down your concerns and explore potential causes and solutions.

Problem 1: Sensitivity of the Glans
You mentioned that your glans (the head of the penis) is particularly sensitive and that you experience discomfort during oral sex or when touched. This heightened sensitivity can be a result of several factors, including:
1. Physical Changes: After undergoing treatment for phimosis (tight foreskin), the sensitivity of the glans can change. When the glans is exposed, it may react more intensely to stimulation, leading to discomfort or pain.

2. Psychological Factors: Anxiety about sensitivity can create a cycle where the anticipation of discomfort leads to a lack of arousal. This can further exacerbate erectile issues.

Problem 2: Decreased Sexual Arousal
You noted a significant decrease in your sexual arousal compared to the past, where you would respond strongly to visual stimuli. This change can be attributed to:
1. Desensitization: Frequent exposure to pornography can lead to desensitization, where the brain requires more intense stimuli to achieve the same level of arousal. This is often referred to as "porn-induced erectile dysfunction."
2. Psychological Conditioning: If you have conditioned your arousal response to specific types of stimuli (like certain pornographic content), you may find it challenging to respond to real-life sexual encounters, leading to performance anxiety.

Problem 3: Difficulty Achieving and Maintaining an Erection
The inability to achieve or maintain an erection during intercourse, while being able to achieve an erection through masturbation, suggests a psychological component. Here are some potential causes:
1. Performance Anxiety: The pressure to perform during sexual encounters can lead to anxiety, which can inhibit the physiological processes required for an erection.

2. Lack of Stimulation: If you find that you need to rely on strong mental imagery to achieve an erection, it may indicate that the physical sensations during intercourse are not sufficient to maintain arousal.

Recommendations for Improvement
1. Consult a Specialist: It would be beneficial to consult a urologist or a sexual health specialist who can provide a thorough evaluation. They may recommend tests to rule out any underlying medical conditions.

2. Psychosexual Therapy: Engaging in therapy with a professional who specializes in sexual health can help address performance anxiety and desensitization. Cognitive-behavioral therapy (CBT) can be particularly effective in changing negative thought patterns and behaviors.

3. Gradual Desensitization: Consider gradually exposing yourself to sexual situations without the pressure of performance. This could involve intimate activities with your partner that do not focus on penetration, allowing you to build comfort and reduce anxiety.

4. Limit Pornography Use: Reducing or eliminating pornography consumption can help reset your arousal response. This may allow you to regain sensitivity to real-life sexual stimuli.

5. Physical Health: Maintain a healthy lifestyle through regular exercise, a balanced diet, and adequate sleep. These factors can significantly impact sexual health and function.

6. Communication with Your Partner: Openly discussing your concerns with your partner can help alleviate pressure and foster a supportive environment for exploring intimacy without the expectation of performance.

7. Consider Medication: If psychological and lifestyle changes do not yield improvements, discussing the option of medications like PDE5 inhibitors (e.g., Viagra, Cialis) with your healthcare provider may be appropriate.

Conclusion
Erectile dysfunction can be multifaceted, involving both physical and psychological elements. By addressing these issues holistically and seeking professional guidance, you can work towards restoring your sexual health and improving your intimate relationships. Remember, you are not alone in this, and many men experience similar challenges. Taking proactive steps is key to finding a solution.

Similar Q&A

Understanding Erectile Dysfunction: Causes and Solutions for Men

Hello Doctor: Thank you for your response. I do not have any bad habits such as smoking, drinking, or betel nut chewing. I do not engage in exercise, but I remember that during periods of inactivity in the past, my condition was still good. I would like to provide additional info...

Dr. Xu Weikai reply Urology
Xiao Hua: Hello, it should not have any impact. Of course, psychological factors could also be a possibility. For now, let's just observe for a while. If there is no improvement, it is still recommended to seek further detailed treatment (Note: usually only medical centers h...

Understanding Erectile Dysfunction: Causes and Solutions for Young Men

Hello, doctor. Although I am only 26 years old, I have been experiencing erectile dysfunction for many years. During middle school, my erections were consistently strong and normal. However, starting from a certain day in high school, I noticed that my penis appeared significantl...

Dr. Xu Weikai reply Urology
Mr. Li: Hello, it is recommended to undergo a thorough examination, such as a penile erection test and a penile blood flow test. If there are any unclear aspects, feel free to ask again so we can further discuss and research. Online responses can only serve as a reference; if nec...

Addressing Erectile Dysfunction: Causes, Treatments, and Concerns

Hello Doctor, since last August, I have been experiencing issues with insufficient rigidity during sexual intercourse, and the sensitivity during erection has become quite dull. I can still complete the act as long as there is continuous stimulation, but if I get distracted, I lo...

Dr. Xu Wencang reply Urology
The test results are acceptable. You can follow the physician's recommendations for treatment for a period of time, and you should gradually recover.

Understanding and Managing Sexual Desire Issues in Urology

It is common to notice that during daily activities, there may be instances where there is a lack of erection before ejaculation. This can be attributed to various factors, including psychological stress, fatigue, or hormonal imbalances. To address issues related to sexual desire...

Dr. Du Shixi reply Urology
Hello: Your situation is likely not ejaculation, but rather the release of some prostatic fluid. If you do not have a regular partner, then DIY solutions are your only option. Wishing you good health.