Erectile Dysfunction: Causes, Treatments, and Concerns

Erectile dysfunction

Hello Doctor: I have had a long-term habit of masturbation, averaging once a day for about ten years.
Recently, I have noticed significant issues with my erectile function.
The hardness is insufficient, especially at the base, which remains flaccid even after engorgement.
When I achieve an erection, the angle is about 80 degrees, and the firmness is poor.
I find that I need to contract my pelvic floor muscles to achieve any rigidity, but this only lasts for a few seconds before it gradually softens.
Without continuous manual stimulation, it becomes flaccid again.
In a kneeling position, it softens even faster.
Currently, if I continue to stimulate myself, I can maintain a firmer erection due to the sustained contraction of the pelvic floor muscles, but once I stop, it softens within a minute.
Recently, when having intercourse with my girlfriend, I struggle to penetrate because the base is too soft.
When I attempt to enter, I can only get about one-third in before it feels like it might bend or break, and without continued stimulation, it quickly becomes flaccid, making penetration impossible.
This has been very frustrating.
My current situation is that I cannot achieve an erection just by watching adult films or seeing my girlfriend naked; I need manual stimulation to get hard, and it immediately goes soft once stimulation stops.
I have seen a doctor and have been prescribed medication to take before bed and another for use before sexual activity (I am unsure what it is), but there has been no improvement.
Blood tests showed normal results: PSA at 3.7 and testosterone at 7.3.
When I masturbate for too long (continuous stimulation), I experience significant soreness above the testicles and in the groin area, which can be painful with exertion, usually requiring a day of rest to feel better.
Over the past few years, I have also experienced frequent urination, slow urinary flow, and a feeling of fullness in the bladder, groin, and above the testicles.
I would like to ask what might be causing my current issues with achieving an erection that requires muscle contraction to maintain for only a few seconds, the softness at the base, the inability to penetrate during intercourse, and what treatments might improve these conditions (medication? surgery? exercise? or further tests?).
What are the approximate costs, and what is the success rate? I am very worried about this situation, especially since I am still young.
Could my long-term excessive masturbation and exposure to adult films be contributing factors? Or could it be chronic prostatitis or venous leakage, or is there a possibility of some organic abnormality? I would greatly appreciate your detailed advice, as I am genuinely very concerned.
Thank you.

You Xiao Xu, 20~29 year old female. Ask Date: 2018/12/30

Dr. Du Mingyi reply Urology

First, changing the habit of excessive masturbation and watching pornography usually leads to recovery.
If there are still issues, then seeking consultation at a urology clinic is advisable.

Reply Date: 2018/12/30

More Info

Erectile dysfunction (ED) is a complex condition that can significantly impact a man's quality of life and emotional well-being. Understanding the causes, treatments, and concerns surrounding ED is crucial for effective management. Based on your description, it appears that you are experiencing several symptoms that may be related to both psychological and physiological factors.

Causes of Erectile Dysfunction
1. Psychological Factors: Anxiety, depression, and stress can contribute to ED. The pressure to perform sexually can create a cycle of anxiety that exacerbates the problem. Your reliance on manual stimulation to achieve an erection suggests that psychological factors may play a role in your condition.

2. Physiological Factors: ED can also stem from physical issues, including:
- Hormonal Imbalances: Although your testosterone levels appear normal, hormonal fluctuations can still affect erectile function.

- Vascular Issues: Poor blood flow to the penis can result from atherosclerosis or other cardiovascular problems. This could explain the difficulty in achieving and maintaining an erection.

- Nerve Damage: Conditions like diabetes or pelvic surgeries can damage nerves that are crucial for erection.

- Chronic Conditions: Conditions such as prostatitis (inflammation of the prostate) can lead to discomfort and affect sexual function.

3. Lifestyle Factors: Long-term habits such as excessive masturbation, especially if it leads to desensitization, can impact sexual performance. Additionally, lifestyle choices such as smoking, excessive alcohol consumption, and lack of exercise can contribute to ED.

Treatment Options
1. Medications: Oral medications like phosphodiesterase type 5 inhibitors (e.g., Viagra, Cialis) are commonly prescribed for ED. If you have already tried medications without success, it may be worth discussing alternative options with your healthcare provider.

2. Psychological Counseling: If psychological factors are contributing to your ED, therapy with a psychologist or sex therapist can be beneficial. Cognitive-behavioral therapy (CBT) can help address anxiety and improve sexual confidence.

3. Lifestyle Modifications: Improving your overall health can have a positive impact on erectile function. This includes:
- Regular exercise
- A balanced diet
- Reducing alcohol intake
- Quitting smoking
- Managing stress through relaxation techniques or mindfulness
4. Pelvic Floor Exercises: Strengthening the pelvic floor muscles through Kegel exercises may help improve erectile function and control.

5. Further Testing: Given your symptoms, additional tests may be warranted to rule out underlying conditions. This could include:
- A penile Doppler ultrasound to assess blood flow
- Hormonal testing beyond testosterone, including prolactin and thyroid hormones
- A urodynamic study if urinary symptoms persist
6. Surgical Options: In cases where other treatments fail, surgical options such as penile implants may be considered. This is typically a last resort and should be discussed thoroughly with a urologist.

Concerns and Considerations
- Cost and Insurance: The cost of treatments can vary widely. Oral medications may be covered by insurance, while therapy and surgical options may have different coverage levels. It's essential to discuss these aspects with your healthcare provider and insurance company.

- Success Rates: The success of treatment depends on the underlying cause of ED. Many men respond well to medications and lifestyle changes, while others may require more intensive interventions.

- Long-Term Effects: Chronic conditions like prostatitis or vascular issues should be managed to prevent further complications. Regular follow-ups with your healthcare provider are essential.

Conclusion
Your concerns about erectile dysfunction are valid, and it's important to approach this issue holistically. A combination of medical treatment, lifestyle changes, and psychological support can often lead to significant improvements. I recommend scheduling a follow-up appointment with your healthcare provider to discuss your symptoms in detail, explore further testing, and develop a tailored treatment plan. Remember, you are not alone in this, and many men experience similar challenges. Seeking help is the first step toward regaining confidence and improving your sexual health.

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