Erectile Dysfunction: Causes, Symptoms, and Next Steps

Erectile dysfunction?

Since last year, I have noticed that my erections have become very soft, and I experience discomfort in certain positions due to soreness in the groin area.
I do not have a partner, but I have been watching adult films to try to stimulate myself.
Although I can achieve an erection, it is difficult to reach the firmness of a cucumber, and I no longer feel the same tightness as before, especially at the glans, which feels particularly soft and painful when pressed.
It seems that the hardness of the base and the glans are not coordinated.
Recently, during masturbation, I have found that deep breathing helps me achieve an erection that is closer to the firmness of a cucumber, but it still does not become fully hard.

I previously visited the urology department at National Taiwan University for an examination, where I received injections and other tests.
The doctor mentioned that my erection speed is very slow.
I was then referred to a cardiology specialist and underwent a CT scan, but the results were inconclusive, and the doctor suggested surgery.
However, I did not go to the hospital due to a recent pneumonia diagnosis.
I am considering returning to the hospital for further examination and would like to know which department I should consult for my condition.
I am also seeking clarification on what symptoms I might be experiencing.
I am 30 years old and wish to get married, but this issue is holding me back, and I feel lost about what to do.

Ruan Pa, 30~39 year old female. Ask Date: 2020/05/06

Dr. Fu Shizhang reply Urology

Erectile dysfunction should certainly be addressed in the urology department, and based on the description, it is likely that vascular factors may be involved.

Reply Date: 2020/05/06

More Info

Erectile dysfunction (ED) is a common issue that can significantly affect a person's quality of life, particularly for those who are looking to establish intimate relationships. Understanding the causes, symptoms, and potential next steps is crucial for addressing this condition effectively.

Causes of Erectile Dysfunction
ED can stem from a variety of physical and psychological factors. Common physical causes include:
1. Cardiovascular Issues: Poor blood flow due to conditions like atherosclerosis (hardening of the arteries) can impede the ability to achieve or maintain an erection.

2. Diabetes: This condition can damage blood vessels and nerves, leading to ED.

3. Hormonal Imbalances: Low testosterone levels can affect libido and erectile function.

4. Neurological Disorders: Conditions such as multiple sclerosis or Parkinson's disease can interfere with nerve signals necessary for an erection.

5. Medications: Certain medications can have side effects that contribute to ED.

6. Substance Abuse: Alcohol, tobacco, and recreational drugs can negatively impact erectile function.

Psychological factors also play a significant role in ED. Anxiety, depression, and stress can all contribute to difficulties with erections. Performance anxiety, in particular, can create a cycle of anxiety and ED.

Symptoms of Erectile Dysfunction
The primary symptom of ED is the inability to achieve or maintain an erection sufficient for sexual intercourse. Other related symptoms may include:
- Reduced sexual desire or libido.

- Difficulty achieving an erection during sexual activity.

- Erection that is not firm enough for penetration.

- Pain during erection or ejaculation.

In your case, you mentioned experiencing a softer erection, discomfort in certain positions, and a noticeable difference in hardness between the base and the tip of the penis. These symptoms suggest that there may be both physical and possibly psychological components to your ED.

Next Steps
Given your symptoms and previous medical evaluations, it is important to take a structured approach to further assess and address your condition:
1. Consult a Urologist: Since you have already seen a urologist, it may be beneficial to return for a follow-up. A urologist specializes in male reproductive health and can provide targeted evaluations and treatments for ED.

2. Consider a Comprehensive Evaluation: This may include blood tests to check hormone levels, blood sugar levels, and cholesterol, as well as a physical examination to assess vascular health. A penile Doppler ultrasound may also be performed to evaluate blood flow to the penis.

3. Psychological Assessment: If psychological factors are suspected, consulting a mental health professional or sex therapist can be beneficial. They can help address any underlying anxiety or stress that may be contributing to your ED.

4. Lifestyle Modifications: Consider making lifestyle changes that can improve overall health and potentially alleviate ED. This includes regular exercise, a balanced diet, quitting smoking, and reducing alcohol consumption.

5. Discuss Treatment Options: Depending on the underlying cause of your ED, treatment options may include oral medications (such as PDE5 inhibitors), vacuum erection devices, penile injections, or even surgical options if indicated.

Conclusion
ED can be a complex condition with multiple contributing factors. It is important to approach this issue holistically, considering both physical and psychological aspects. Given your age and desire to establish a relationship, addressing this condition is crucial. Don't hesitate to seek further medical advice and explore treatment options that can help restore your confidence and sexual health. Remember, you are not alone in this, and many men experience similar challenges. Seeking help is the first step towards improvement.

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