Sudden Erectile Dysfunction: Causes and Solutions

Sudden erectile dysfunction?

Hello Doctor: For the first three weeks, everything was normal during masturbation.
However, on a Sunday (5/10), it seemed that prolonged engorgement (over an hour, with repeated engorgement) led to ejaculation while the penis was in a flaccid state.
Subsequently, I experienced difficulty achieving the previous level of rigidity (originally a 4, now fluctuating between 2-3).
I visited the hospital for an examination, and since I have been experiencing morning erections at least three days a week, the doctor concluded that it was due to penile overexertion.
Recently, I have been taking a medication called Cialix, which has shown slight improvement; although the duration is still short, I can regain hardness to a level of 3-4.
However, after achieving rigidity, I immediately experience soreness in the muscles around the penis and perineum (sometimes the mid-penis feels a bit tense and stiff).
Yesterday, after achieving an erection (for 3 minutes), I suddenly experienced insufficient engorgement.
Although I still had morning erections today with a hardness of around 3 (twice), I am still a bit concerned, so I seek your help.

Questions:
1.
Could prolonged erection on one occasion lead to venous leakage? (Previously, I could maintain a firm erection for about 10-20 minutes without issues.)
2.
I have soreness in the perineum and sides of the penis, but urination is normal.
Is this due to overuse of the penile muscles or prostatitis?
3.
Could this situation be caused by excessive anxiety?
4.
Recently, I have applied slight pressure and used heat therapy during erections; could this have adverse effects?
Notes:
1.
I have been exercising regularly for the past three months, three to four times a week; two days of weight training and jogging, one day practicing fencing for about 2 hours, and jogging plus aerobic exercise for half an hour.
2.
I do not smoke and have abstained from alcohol for the past three months due to competitions.
Recently, I have consumed alcohol twice a week for the past month, about 1 liter each time.
3.
My diet is normal, with occasional fast food, and I usually sleep around 11-12 PM.
I have been going to bed an hour earlier since the penile issues began.
4.
I masturbate about three times a week, and previously, my erections were normal without sudden softening.
I have not masturbated in the past three weeks since the issues arose.
5.
My water intake is normal, with no blood in urine, and the urine color is normal.
Urination is still forceful like a water column.
Thank you, Doctor.

K Zai, 20~29 year old female. Ask Date: 2020/05/27

Dr. Cai Zhuorong reply Urology

1.
Can prolonged erection lead to venous leakage? (Previously, the firmness was normal, and the erection could last around 10-20 minutes.) A: Venous leakage is mostly caused by trauma.
An abnormal erection lasting more than 4 to 6 hours may lead to tissue hypoxia.
2.
There is soreness on the perineum and the sides of the penis, but urination is normal.
Is this due to overuse of the penile muscles or prostatitis? A: Both possibilities exist; chronic prostatitis can also occur without urinary symptoms.
3.
Could this situation be caused by excessive anxiety? A: This possibility cannot be ruled out.
4.
Recently, during an erection, slight pressure was applied, and heat was used.
Could this cause adverse effects? A: There is no medical evidence indicating that this would cause adverse effects.

Reply Date: 2020/05/27

More Info

Erectile dysfunction (ED) can be a distressing condition, and understanding its potential causes and solutions is crucial for effective management. Based on your description, it seems that you have experienced a sudden change in erectile function following an episode of prolonged erection. Let's address your concerns systematically.

1. Prolonged Erection and Venous Leak: Prolonged erections, especially those lasting over an hour, can lead to a condition known as priapism. This occurs when blood becomes trapped in the penis, leading to potential damage to the erectile tissue. While venous leak (the inability to maintain an erection due to blood leaking out of the penis) is a common cause of ED, it is less likely to be caused by a single episode of prolonged erection unless there was significant trauma or injury. However, if you notice persistent difficulties in achieving or maintaining an erection, it may be worth discussing with your healthcare provider to rule out any underlying vascular issues.

2. Pain in the Perineum and Penis: The discomfort you are experiencing in the perineum and sides of the penis could be attributed to muscle strain from overuse, especially if you have been engaging in rigorous physical activities, including weight training and sword fighting. It is also possible that this discomfort could be related to pelvic floor muscle tension or even prostatitis (inflammation of the prostate gland). Given that you are able to urinate normally without pain, it may lean more towards muscle fatigue rather than a prostate issue. However, if the pain persists or worsens, a visit to a urologist would be advisable.

3. Anxiety and Psychological Factors: Anxiety can significantly impact erectile function. The stress of experiencing sudden ED can create a cycle of anxiety that exacerbates the problem. It is essential to recognize that psychological factors can play a substantial role in ED, especially if there is a fear of recurrence. Techniques such as mindfulness, relaxation exercises, or even counseling may help alleviate anxiety and improve sexual function.

4. Self-Care Measures: Applying gentle pressure and heat to the area can sometimes provide relief from discomfort. However, it is essential to be cautious and avoid excessive manipulation, as this could lead to further irritation or injury. If you find that these measures help, they can be continued, but if discomfort persists, it would be wise to consult a healthcare professional.

In summary, while your symptoms may be related to temporary fatigue or anxiety, it is crucial to monitor your condition closely. If you continue to experience difficulties with erections or if the pain persists, seeking a thorough evaluation from a urologist would be beneficial. They may recommend further tests, such as a Doppler ultrasound, to assess blood flow to the penis or other diagnostic measures to rule out underlying conditions.

Additionally, maintaining a healthy lifestyle, including regular exercise, a balanced diet, and adequate sleep, can support overall sexual health. Avoiding excessive alcohol consumption and managing stress through relaxation techniques can also be beneficial. Remember, open communication with your healthcare provider is key to addressing any concerns and finding the right treatment plan for you.

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