and Overcoming Erectile Dysfunction: Common Concerns and Solutions

Erectile dysfunction

Hello doctor, I would like to ask a few questions:
1.
When I am not erect, I can easily pull back my foreskin for cleaning, but when I am erect, I can only retract it halfway over the glans.
Urination and ejaculation are normal.
If I do not want to undergo circumcision, is that acceptable? Will this affect the size of my erection? If I continue to have phimosis, will my glans shrink?
2.
Regarding my erection issues, last November, after masturbating, I suddenly lost my libido and found it difficult to achieve an erection.
I was very anxious and went to see a urologist who said it was a psychological issue and prescribed me a relaxant.
I later returned to normal, but last month after masturbating, the problem recurred.
However, after a few days, my erections returned to normal.
I am considering abstaining from sexual activity.
Doctor, do you think this is due to psychological factors? Will this situation lead to erectile dysfunction? I have been very worried about this.
3.
Is it normal for my penis to measure 3-4 cm when flaccid and 10-11 cm when erect?
4.
How long does it typically take for a person to ejaculate during masturbation?
5.
How can I increase the hardness of my erections?
6.
My erect penis seems thinner than before.
Is this due to insufficient blood flow? How can I improve this to restore its thickness?
7.
Is there any issue if I ejaculate before achieving an erection?
8.
Sometimes when watching adult films or fantasizing, I find it difficult to achieve an erection on my own and often need to use my hand for stimulation.
How can I improve this? If I get distracted, I become soft, and there was even a time I ejaculated before getting hard, which felt very sensitive.
9.
Can young people experience organic erectile dysfunction or physiological erectile dysfunction?
10.
I have visited both a large hospital and a clinic for urology, and the doctors have all said that these issues are psychological, so no further examinations were conducted.
However, this concern continues to trouble me.
Am I focusing too much on these problems? Could you please explain in detail how to address these issues?

Yundongyuan, 10~19 year old female. Ask Date: 2019/04/21

Dr. Xu Wencang reply Urology

You can follow up with outpatient visits for examinations.

Reply Date: 2019/04/21

More Info

Erectile dysfunction (ED) is a common concern that affects many men, and it can stem from a variety of physical and psychological factors. Let's address your questions one by one, providing insights and potential solutions.

1. Phimosis and Hygiene: It sounds like you may be experiencing a condition known as phimosis, where the foreskin cannot be fully retracted over the glans (head) of the penis when erect. If you prefer not to undergo circumcision, there are non-surgical options available, such as topical steroid creams that can help loosen the foreskin. It's important to maintain good hygiene to prevent infections, which can occur if the foreskin is not retractable. As for the size of the penis, phimosis itself does not typically affect the size of the erect penis, but it can lead to discomfort during erections.

2. Psychological Factors in ED: Your experience of sudden loss of sexual desire and difficulty achieving an erection can indeed be linked to psychological factors, especially if it occurs after a stressful event. Anxiety and stress can significantly impact sexual performance. It’s good that you consulted a urologist, and if the issue persists, consider speaking with a mental health professional who specializes in sexual health. Techniques such as cognitive behavioral therapy (CBT) can be beneficial.

3. Penis Size: The size you mentioned (3-4 cm when flaccid and 10-11 cm when erect) falls within the normal range. Penis size can vary widely among individuals, and what’s most important is functionality and comfort.

4. Masturbation Duration: The time it takes to ejaculate during masturbation varies greatly among individuals. There is no "normal" duration, but if you find that it takes longer than you’d like, consider exploring different techniques or focusing on relaxation to enhance your experience.

5. Increasing Erection Hardness: To improve erection hardness, consider lifestyle changes such as regular exercise, a balanced diet, and avoiding smoking and excessive alcohol consumption. Additionally, managing stress and anxiety through relaxation techniques or therapy can also help.

6. Changes in Size: If you feel that your erections are less firm or the penis appears thinner, it could be due to insufficient blood flow or psychological factors. Engaging in regular cardiovascular exercise can improve blood circulation. If the issue persists, a consultation with a urologist may be warranted to rule out any underlying conditions.

7. Ejaculation Without Erection: Ejaculating without a full erection can happen and is generally not harmful. However, if this occurs frequently, it may indicate underlying issues that should be addressed.

8. Difficulty Achieving Erection: If you find it challenging to achieve an erection even with visual or mental stimulation, this could be a sign of performance anxiety. Techniques such as mindfulness and focusing on sensations rather than performance can help. If distractions lead to loss of erection, consider practicing relaxation techniques to reduce anxiety.

9. Organic vs. Psychological ED: While younger men can experience organic causes of ED, it is more common for psychological factors to play a significant role. Conditions such as hormonal imbalances, vascular issues, or neurological disorders can contribute, but these are less common in younger individuals.

10. Ongoing Concerns: It’s understandable to feel anxious about these issues, especially if they persist. If your healthcare providers have ruled out physical causes, focusing on psychological aspects may be beneficial. Consider seeking therapy or counseling to address anxiety and improve sexual confidence.
In summary, erectile dysfunction can be multifactorial, involving both physical and psychological components. Addressing lifestyle factors, seeking professional help for psychological concerns, and maintaining open communication with healthcare providers can lead to effective management and improvement of symptoms. If issues persist, further evaluation may be necessary to explore any underlying conditions.

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