Erectile Dysfunction: Causes and Treatment Options

Erectile dysfunction?

I previously sustained an injury to the lower right side of the base of my penis, resulting in bruising and hematoma in the right testicle.
Now, when I urinate, the stream deviates to the left.
I can still achieve an erection even though I haven't hit the penis directly.
Previously, my penis was straight with visible blood vessels.
Could there be nerve damage? I have difficulty exerting force at the base of the penis during urination, and I need to apply pressure with my fingers on the lower right side of the base to achieve an erection.
Is the injury affecting the blood vessels, connective tissue, nerves, veins, arteries, or could it be related to the soft tissue of the penis? Is there a possibility that the cavernous bodies (corpus cavernosum) or the spongy body surrounding the urethra (corpus spongiosum) are injured? How should this be treated? I have visited a major hospital and had an ultrasound, but the medication prescribed by the doctor, including F50 and Changxun sustained-release film-coated tablets 400mg, has not been effective.
I asked the doctor about vascular and nerve imaging, as well as penile ultrasound, but he said it was unnecessary.
However, the medication has not worked, and I have photos but no files to send.

goog, 40~49 year old female. Ask Date: 2023/05/16

Dr. Sun Hongshun reply Urology

Hello, may I ask how long you have been injured? This will affect the diagnosis.
Additionally, when the penis is erect, do you feel any hard lumps? If so, it is possible that the penile fascia was injured previously, but other causes could also be responsible.
I recommend that you continue to follow up with a urology clinic.
Wishing you a speedy recovery.

Reply Date: 2023/05/16

More Info

Erectile dysfunction (ED) can be a complex condition influenced by various physical and psychological factors. In your case, it appears that a traumatic injury to the area around the penis and testicles has led to symptoms that may include difficulty achieving or maintaining an erection, changes in urination, and potential vascular or nerve damage.

Understanding the Causes
1. Trauma: The injury you described, particularly the bruising and swelling in the area, could have affected the blood vessels, nerves, or the erectile tissue itself (corpus cavernosum and corpus spongiosum). Trauma can lead to conditions such as penile fracture or hematoma, which can disrupt normal erectile function.

2. Vascular Damage: The ability to achieve an erection relies heavily on adequate blood flow to the penis. If the blood vessels (arteries or veins) have been damaged, this could impair blood flow, leading to difficulties in achieving or maintaining an erection.

3. Nerve Injury: The nerves that control erections are located in the pelvic region. If these nerves were injured during the trauma, it could result in erectile dysfunction. Symptoms like needing to apply pressure to the base of the penis to achieve an erection may indicate nerve involvement.

4. Psychological Factors: Trauma can also lead to psychological issues such as anxiety or depression, which can further exacerbate erectile dysfunction.

Treatment Options
1. Medical Evaluation: Since you have already undergone ultrasound imaging, it is essential to follow up with a urologist who specializes in erectile dysfunction. They may recommend further tests, such as a penile Doppler ultrasound, to assess blood flow and vascular integrity.

2. Medications: The medications you mentioned, such as phosphodiesterase type 5 inhibitors (e.g., Viagra, Cialis), are commonly prescribed for ED. However, if these have not been effective, it may be worth discussing alternative treatments with your doctor. Other options include injections directly into the penis or vacuum erection devices.

3. Physical Therapy: In some cases, pelvic floor physical therapy can help strengthen the muscles involved in erections and improve overall function.

4. Surgical Options: If there is significant vascular damage or if conservative treatments fail, surgical options may be considered. This could involve penile implants or vascular surgery to restore blood flow.

5. Psychological Support: If there are psychological components to your ED, therapy or counseling may be beneficial. Addressing anxiety or depression can improve sexual function.

Lifestyle Modifications
- Healthy Lifestyle: Maintaining a healthy diet, regular exercise, and avoiding smoking and excessive alcohol can improve overall vascular health and erectile function.

- Stress Management: Techniques such as mindfulness, meditation, or yoga can help reduce stress and improve psychological well-being.

Conclusion
Erectile dysfunction following trauma can be multifactorial, involving physical, vascular, and psychological components. It is crucial to have a thorough evaluation by a healthcare professional who can tailor a treatment plan specific to your needs. If medications have not been effective, do not hesitate to seek a second opinion or explore other treatment modalities. Open communication with your healthcare provider about your symptoms and concerns is vital for effective management.

Similar Q&A

Addressing Erectile Dysfunction: Causes, Treatments, and Concerns

Hello Doctor, since last August, I have been experiencing issues with insufficient rigidity during sexual intercourse, and the sensitivity during erection has become quite dull. I can still complete the act as long as there is continuous stimulation, but if I get distracted, I lo...

Dr. Xu Wencang reply Urology
The test results are acceptable. You can follow the physician's recommendations for treatment for a period of time, and you should gradually recover.

Understanding Erectile Dysfunction: Causes, Treatments, and Solutions

Although I have reached the age of hearing, my body is still healthy. Friends and family often say I look like I'm in my 40s or 50s. I am still very enthusiastic about my sex life, but in the past six months, I have been experiencing difficulties during intercourse. The main...

Dr. Chen Xiuyi reply Urology
Hello: Erectile dysfunction can be categorized into psychological, organic (which includes three main types: vascular, neurological, and endocrine, with vascular issues being the most common), and medication-related causes. Based on your description, it is likely due to vascular ...

Understanding and Treating Incomplete Erections: A Guide for Better Sexual Health

It sounds like you are experiencing erectile dysfunction and difficulties with sexual performance. This can be caused by a variety of factors, including psychological issues, stress, anxiety, or physical health conditions. Here are some steps you can consider for treatment: 1. *...

Dr. Lin Hexing reply Urology
Hello, based on your description, it seems you are experiencing erectile dysfunction. Since you are not yet married and are still in school without a stable income, it may be too early to seek out pleasurable sexual experiences at your age. Focusing on improving your physical fit...

Understanding Erectile Dysfunction: Causes, Treatments, and Concerns

Hello Doctor: A couple of months ago, I suddenly experienced erectile difficulties. Initially, I could achieve an erection, but often pre-ejaculate fluid would come out first, and then within a minute, I would lose my erection, accompanied by a feeling of rapid heartbeat. Previou...

Dr. Du Shixi reply Urology
Hello, I understand your concerns. It might be helpful to relax a bit. Consider whether your weight is too high, maintain a balanced diet (minimize fried foods), ensure you have adequate sleep, and engage in moderate exercise (like walking or running). Try to avoid sitting for lo...