Erectile Dysfunction: When to See a Urologist for Help

If there are fluctuations in erectile function but blood tests indicate normal kidney function, which specialty should be consulted first?

Recently, when I was about to have intercourse with my girlfriend, I initially had an erection, but it suddenly went soft when we were about to engage in sexual activity.
Even when I managed to get hard again, I experienced premature ejaculation.
After a few days, I noticed that my genital area became somewhat sensitive, but then it returned to normal.
A few weeks later, when my girlfriend wanted to be intimate again, the same situation occurred.
The next day, I noticed that I hadn't had morning erections for several days, although I have started to experience them again recently.
Generally, when I am excited, I would get an erection, but now I may need to touch myself to achieve an erection.
I have been undergoing blood tests at a clinic to check my kidney function, which showed no issues.
I would like to know if my situation is psychological.
I have a condition where my bladder has a remnant of the umbilical cord that did not fully regress, leading to overactive bladder symptoms, including urgency and frequency.
I have been prescribed medication for this, as I often experience sudden urges to urinate, sometimes so severe that I feel the need to go again immediately after using the restroom.
The doctor mentioned that they could try to surgically remove the remnant, but they prefer to have me try medication first.
It seems the doctor is hesitant to perform surgery, as it would involve removing the bladder and then suturing it back.
I am also quite apprehensive about this.
I have been taking medication for about five to six years, and typically, after a period of medication, I can maintain normalcy for several months to half a year without urgency or frequency, needing only one to two pills.
However, recently, even when taking up to three pills, I still experience frequent urination.
I would like to know if this could be affecting my sexual function and whether I should consider having the remnant of the umbilical cord removed from my bladder.

Wu, 20~29 year old female. Ask Date: 2020/12/01

Dr. Lin Wenxu reply Urology

Dear Mr.
Wu,
1.
Based on your description, it is indeed more likely to be psychogenic erectile dysfunction.
2.
According to your description, it may be a remnant of the urachus, possibly a urachal diverticulum, which could lead to infection or even cancer.
If your symptoms of frequent urination are indeed related to the urachus, surgical removal may be considered.
However, it should not be directly related to your erectile dysfunction.
Dr.
Lin Wen-Hsu, Urology Department, Nantou Hospital

Reply Date: 2020/12/01

More Info

Erectile dysfunction (ED) is a common issue that can affect men of all ages, and it can be caused by a variety of factors, including psychological, hormonal, and physical conditions. Based on your description, it seems that you have experienced episodes of erectile difficulties, including sudden loss of erection during sexual activity and early ejaculation, which can understandably be concerning.

Understanding Your Symptoms
1. Erectile Dysfunction: The inability to maintain an erection sufficient for sexual intercourse can be influenced by psychological factors such as anxiety or stress, particularly if the episodes occur in specific situations (e.g., with your girlfriend). Physical factors, including hormonal imbalances or nerve damage, can also contribute.

2. Morning Erections: The absence of morning erections can be a sign of a physical issue, but it can also fluctuate based on stress levels, fatigue, or other temporary factors. The return of morning erections is a positive sign, indicating that there may not be a permanent physical issue.

3. Sensitivity Changes: Changes in sensitivity can occur for various reasons, including anxiety or even changes in blood flow. This can be a temporary response to stress or anxiety about sexual performance.

4. Frequent Urination and Bladder Issues: The presence of an undeveloped umbilical cord remnant affecting your bladder could potentially contribute to urinary urgency and frequency. Medications for overactive bladder can sometimes have side effects that may influence sexual function, including erectile difficulties.

When to See a Urologist
Given your symptoms, it would be advisable to consult a urologist for a thorough evaluation. Here are some reasons to seek help:
- Persistent Symptoms: If you continue to experience erectile dysfunction or changes in sexual function, it’s important to get a professional assessment.

- Psychological Factors: If you suspect that anxiety or stress is contributing to your symptoms, a urologist can help determine if psychological counseling or therapy might be beneficial alongside medical treatment.

- Underlying Conditions: Since you have a history of bladder issues and are on medication, it’s essential to rule out any underlying physical conditions that could be contributing to your erectile dysfunction.

- Medication Review: Discussing your current medications with a urologist can help determine if they might be affecting your sexual function. Adjustments or alternatives may be necessary.

Possible Treatment Options
1. Lifestyle Changes: Regular exercise, a healthy diet, and avoiding smoking and excessive alcohol can improve erectile function.

2. Psychological Counseling: If anxiety or stress is a significant factor, therapy can be beneficial.

3. Medications: There are various medications available for ED, such as phosphodiesterase type 5 inhibitors (e.g., Viagra, Cialis), which can help improve blood flow to the penis.

4. Surgical Options: If conservative treatments fail and if the undeveloped umbilical remnant is confirmed to be causing significant issues, surgical options may be considered. However, this should be discussed thoroughly with your urologist to weigh the risks and benefits.

Conclusion
In summary, your symptoms warrant a comprehensive evaluation by a urologist. They can help determine whether your erectile dysfunction is primarily psychological, physical, or a combination of both. Additionally, addressing your bladder issues and reviewing your medications will be crucial in managing your overall health. Don’t hesitate to seek help; many men experience similar issues, and effective treatments are available.

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