Erectile Dysfunction: Causes, Symptoms, and Solutions

Erectile dysfunction

I had been masturbating approximately once a day for about a year to a year and a half.
My morning erections have not been firm enough (I have been experiencing very poor sleep quality for nearly three months, typically falling asleep around 2 to 3 AM and waking up naturally around 7 to 8 AM).
Previously, I consulted a sleep specialist who advised me to relax and manage my stress, as I was concerned about potential dependency on medication.
Sometimes I do not experience morning erections; I can get aroused while watching videos, but I do not achieve full erection without manual stimulation.
The angle of my erections has decreased, and I feel much more fatigued after masturbation than I used to.
I visited a urologist on July 3rd, where I underwent a test for testicular cortisol immunoassay, which yielded a result of 4.550.
During my follow-up appointment, the doctor stated that this was within the normal range and prescribed me 20 mg of Cialis to see if the issue was neurological or vascular.
There was a slight improvement in firmness and sensitivity, but the angle of erection did not improve.
About three to four days after starting the medication, I resumed exercising, but the level of erection was slightly weaker than the effect from the medication.
However, on July 17, I began to experience a recurrence of lower back pain (I had previously seen an orthopedic doctor for a sports injury, and it had improved for about two weeks before I started exercising again).
Now, I am hesitant to exercise.
Four days ago, I tested my erection firmness; I masturbated once in the morning with a firmness level of about three, and in the evening, the firmness was about two (I had intentionally refrained from masturbation for three days prior to testing).
I am quite anxious about this situation, especially since I am relatively young to be experiencing these issues.
I worry that it may worsen as I age.
I am 175 cm tall and weigh around 65 kg.
I would like to ask the doctor if it is possible that prolonged overstimulation of the parasympathetic nervous system or chronic fatigue of the penile muscle tissue could be contributing to these problems?

Xiansheng, 20~29 year old female. Ask Date: 2021/07/22

Dr. Cai Zhuorong reply Urology

The causes of erectile dysfunction can generally be categorized into vascular, neurological, and psychological factors.
It is recommended that you do not use masturbation as a test; if you experience difficulties during sexual intercourse, it is advisable to seek medical treatment.

Reply Date: 2021/07/22

More Info

Erectile dysfunction (ED) is a complex condition that can arise from a variety of physical and psychological factors. Understanding its causes, symptoms, and potential solutions is crucial for effective management. Based on your description, it seems you are experiencing a combination of physical and psychological factors that may be contributing to your ED.

Causes of Erectile Dysfunction
1. Physical Factors:
- Hormonal Imbalances: Low testosterone levels can significantly impact sexual function. Your test results for testosterone levels were within normal ranges, which is a positive sign.

- Blood Flow Issues: Conditions affecting blood flow, such as vascular diseases, can lead to ED. Factors like high blood pressure, high cholesterol, and diabetes can contribute to this.

- Nerve Damage: Neurological conditions or injuries can affect the nerves responsible for erections. You mentioned a potential nerve issue, which could be a contributing factor.

- Medication Side Effects: Some medications can interfere with erectile function. If you are taking other medications, it’s worth discussing with your doctor.

2. Psychological Factors:
- Anxiety and Stress: Your anxiety about ED and its implications can create a cycle of performance anxiety, which can exacerbate the issue. Stress from work, relationships, or other life factors can also play a significant role.

- Sleep Disorders: Poor sleep quality, as you described, can lead to fatigue and decreased libido, further complicating ED. Sleep is crucial for hormonal balance and overall health.

- Depression: Mental health issues can significantly impact sexual function. If you are feeling depressed or anxious, it may be beneficial to seek support from a mental health professional.

Symptoms of Erectile Dysfunction
The symptoms of ED can vary but typically include:
- Difficulty achieving or maintaining an erection.

- Reduced sexual desire.

- Changes in the quality of erections, such as decreased hardness or angle of erection.

- Fatigue after sexual activity, which you noted.

Solutions and Management
1. Lifestyle Changes:
- Exercise: Regular physical activity can improve blood flow, reduce stress, and enhance mood. However, be cautious with exercise if you have a history of back pain. Consider low-impact activities like walking or swimming.

- Diet: A balanced diet rich in fruits, vegetables, whole grains, and lean proteins can improve overall health and potentially enhance erectile function.

- Sleep Hygiene: Improving your sleep quality is essential. Establish a regular sleep schedule, create a restful environment, and consider relaxation techniques before bedtime.

2. Medical Treatments:
- Medications: You mentioned trying sildenafil (Viagra). These medications can help improve blood flow to the penis, but they may not address underlying psychological issues. If you find that the medication helps but does not fully resolve the issue, it may be worth discussing with your doctor about adjusting the dosage or trying a different medication.

- Counseling: If anxiety or stress is a significant factor, consider speaking with a therapist or counselor who specializes in sexual health. Cognitive-behavioral therapy (CBT) can be particularly effective.

3. Further Evaluation:
- If symptoms persist, further evaluation may be necessary. This could include tests to assess blood flow, nerve function, or hormonal levels. A urologist specializing in sexual health can provide more targeted assessments.

Conclusion
In summary, your experience with ED may stem from a combination of physical and psychological factors, including anxiety, sleep issues, and possibly nerve-related concerns. It’s essential to address both the physical and emotional aspects of this condition. Continue to work closely with your healthcare provider to monitor your symptoms and explore various treatment options. Remember, ED is a common issue, and seeking help is a positive step towards improving your sexual health and overall well-being.

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I'm sorry, but I can't assist with that.

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