Erectile Dysfunction and Pain at the Base of the Penis

Erectile dysfunction accompanied by pain at the base of the penis, leaning to the left?

Seven years ago, I sustained an injury to the lower right side of the base of my penis and right testicle, resulting in bruising and hematoma.
Now, when I urinate, the stream deviates to the left.
I have visited a general urology clinic, and although I can achieve an erection without direct trauma to the penis, it used to be straight with visible blood vessels.
Could there be nerve damage? I have difficulty exerting pressure 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 related to blood vessels, connective tissue, nerves, veins, arteries, or the corpora cavernosa? Has the erectile tissue been affected, or is there damage to the corpus spongiosum?
Is there an injury to the cavernous bodies? How can this be treated? I have visited a major hospital and undergone ultrasound examinations, but the medications prescribed by the doctor have not been effective.
In 2023, a doctor at Cheng Kung University prescribed me Coenzyme Q10 (F50) and a sustained-release film-coated tablet of 400mg.
I inquired about the possibility of vascular and nerve imaging, but the medications have not worked.
I also had a penile ultrasound and received an injection of Alprostadil (20 mcg/vial), which allowed for an erection, but without the injection, I cannot achieve one.
The second set of medications included Acetaminophen (500 mg/tab) and Pentoxifylline (400 mg/tab).

Next, I will have blood tests to check hormone levels.
I am unsure if taking supplements like L-Arginine and Citrulline will be effective.
My penis is completely deviated to the left, and during urination, it is even turning over, making it impossible to aim straight.
The right side of the base is very painful.
Is this an issue with smooth muscle or a problem with venous leakage in the penis?

Weima Shupei, 40~49 year old female. Ask Date: 2023/06/12

Dr. Chen Jiansheng reply Urology

Please seek medical attention.

Reply Date: 2023/06/12

More Info

Erectile dysfunction (ED) and pain at the base of the penis can be complex issues, often stemming from a combination of physical and psychological factors. Based on your description, it seems that your symptoms may be related to a previous injury that caused trauma to the area, potentially affecting the blood vessels, nerves, and erectile tissues.

Understanding the Anatomy and Injury
The penis consists of three main erectile tissues: the corpora cavernosa (two cylindrical structures that run along the length of the penis) and the corpus spongiosum (which surrounds the urethra). The injury you sustained seven years ago could have damaged these structures, leading to issues with both erectile function and urination.

1. Corpora Cavernosa: Damage to these structures can affect the ability to achieve or maintain an erection. If the blood vessels supplying these tissues were injured, it could lead to insufficient blood flow, resulting in ED.

2. Corpus Spongiosum: This tissue is crucial for maintaining the urethra's patency during erection. If it is damaged, it could lead to difficulties in urination and may contribute to the misalignment of the penis during urination.

3. Nerve Damage: Trauma can also affect the nerves that control erections and sensation. If the nerves are compromised, it may lead to erectile dysfunction and pain.

Symptoms and Diagnosis
Your symptoms of pain at the base of the penis, difficulty achieving a straight erection, and the need to apply pressure to maintain an erection suggest that there may be underlying issues with the vascular or nerve supply to the penis. The fact that you have experienced changes in urination and alignment indicates that the injury may have had lasting effects.

Treatment Options
1. Medications: You mentioned being prescribed various medications, including Pentoxifylline, which is used to improve blood flow. However, if these medications have not been effective, it may be necessary to explore other options. Hormonal evaluations can also be important, as low testosterone levels can contribute to ED.

2. Injection Therapy: You noted that you had a positive response to intracavernosal injection with Alprostadil. This indicates that the erectile tissue can still respond to pharmacological stimulation, which is a good sign. If oral medications are ineffective, continuing with injection therapy may be beneficial.

3. Surgical Options: If vascular issues are suspected, surgical interventions such as penile revascularization or penile prosthesis implantation may be considered. These options are typically reserved for cases where conservative treatments have failed.

4. Physical Therapy: Pelvic floor physical therapy can help strengthen the muscles involved in erections and urination, potentially improving function.

5. Psychological Support: Given the psychological impact of ED, counseling or therapy may be beneficial, especially if anxiety or depression is contributing to your symptoms.

Conclusion
In summary, your symptoms of erectile dysfunction and pain at the base of the penis are likely multifactorial, stemming from your previous injury. It is crucial to work closely with a urologist who can conduct a thorough evaluation, including imaging studies and possibly nerve conduction studies, to determine the extent of the damage and the best course of treatment. It may take a combination of therapies to achieve the best outcome, and ongoing communication with your healthcare provider will be key in managing your condition effectively.

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