Erectile Dysfunction: Causes and Treatment Options

Q: Erectile Dysfunction: Causes and Treatment Options

Hello： 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. <br>Now, when I urinate, the stream deviates to the left. <br>I can still achieve an erection even without direct trauma to the pe

Penile erectile tissue erection

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.
Even though I haven't hit my penis directly, I can still achieve an erection.
Previously, my penis was straight, and I am concerned whether blood vessels or nerves were damaged.
I have difficulty exerting force at the right base of the penis during urination, and I need to press on the lower right side of the base of my penis with my fingers to straighten it.
Is the injury related to blood vessels, connective tissue, nerves, veins, arteries, or the corpora cavernosa? Has the corpus spongiosum been affected? The corpora cavernosa might be injured, but I had normal erectile function before the injury, including morning and nocturnal erections.
What treatment options are available? I have visited major hospitals and undergone ultrasound examinations, but the medications prescribed have not been effective.
The doctor prescribed Calcitriol F50 and Changchun Sustained Release Film-Coated Tablets 400mg.
I asked the doctor about performing vascular and nerve imaging, but he said it wasn't necessary.
However, the medications have not worked.
On June 5th, I received an injection of Latanoprost 20mg/vial at Cheng Kung University Hospital, which allowed me to achieve an erection for five hours, but I experienced pain on the right side of the base.
The injection wore off slowly by 4:40 PM.
Without the injection, I cannot achieve an erection, and I also experience pain at the right base during urination.
On June 8th, I was prescribed Pentoxifylline 400mg/tab (Fylin) to take twice daily for a total of 56 tablets, and Acetaminophen 500mg/tab (Societal) to take one tablet three times daily for a total of 9 tablets.
Is there an injury to the erectile tissue, or is there venous leakage? I cannot achieve an erection without the injection.
I plan to have blood tests to check hormone levels and am considering whether medications like Viagra or Cialis would be effective.

Weima, 40~49 year old female. Ask Date: 2023/06/14

Dr. Du Shixi reply Urology

Hello: 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 can still achieve an erection even without direct trauma to the penis, which used to be straight and had blood vessels.
Could there be nerve damage? -- It is possible that the blood vessels were injured, but it is unclear whether the injury is to the deeper structures or the superficial ones.
The inability to exert force at the right base of the penis and the need to apply pressure with my fingers to make it straight may indicate damage to the blood vessels, connective tissue, nerves, veins, arteries, or the corpora cavernosa.
-- It is difficult to determine if the corpus cavernosum is injured, as well as the corpus spongiosum that surrounds the urethra.
The corpus cavernosum may have sustained damage.
Before the injury, my erectile function was normal, and I experienced morning and nocturnal erections.
What treatment options are available? I have visited a major hospital and undergone ultrasound examinations, but the medications prescribed have not been effective.
The doctor prescribed Coenzyme Q10 F50 and Sustained Release Membrane-Coated Tablets 400mg.
I asked the doctor about vascular and nerve imaging, but he said it was unnecessary.
However, the medications have not worked.
On June 5th, I received an injection of Latanoprost 20mg/vial, which allowed me to achieve an erection for five hours, but I experienced pain on the right side of the base.
The injection wore off slowly by 4:40 PM.
Without the injection, I cannot achieve an erection, and I also experience pain at the right base during urination.
On June 8th, I was prescribed Pentoxifylline 400mg/tab (Fylin) twice daily for a total of 56 tablets, and Acetaminophen 500mg/tab (Societal) once per dose, three times daily for a total of 9 tablets.
Is there an injury to the corpora cavernosa, or is there venous leakage? However, I cannot achieve an erection without the injection.
Next, I plan to have blood tests for hormone levels.
I am unsure whether to try Viagra or Cialis for treatment.
-- You can consider trying legal medications; you can also inquire at outpatient clinics.
Since you have already been seen at the hospital, if the results are not satisfactory, you may want to consult another medical center.
Wishing you good health.
Erectile issues can be multifactorial, so it's important to pay attention to lifestyle, exercise, and diet.
Wishing you good health.

Reply Date: 2023/06/14

More Info

Erectile dysfunction (ED) is a complex condition that can stem from various causes, including physical injuries, psychological factors, and underlying health issues. Based on your description, it appears that you have experienced a significant injury to the area surrounding your penis and testicles, which may have led to the current erectile dysfunction and urinary issues you are facing.

Causes of Your Erectile Dysfunction
1. Physical Injury: The trauma you sustained seven years ago could have damaged the blood vessels, nerves, or erectile tissues (corpora cavernosa and corpus spongiosum) in the penis. This type of injury can lead to erectile dysfunction due to impaired blood flow or nerve signaling. If the injury affected the blood vessels, it could result in a condition known as venous leakage, where blood flows into the penis but cannot be retained, leading to difficulties in achieving or maintaining an erection.

2. Nerve Damage: If the injury impacted the nerves that control erections, this could explain why you experience difficulty achieving an erection without manual stimulation. Nerve damage can disrupt the signals necessary for an erection, leading to erectile dysfunction.

3. Structural Changes: The injury may have caused changes in the structural integrity of the penis, such as scarring or fibrosis, which can also contribute to erectile dysfunction. The presence of scar tissue can affect the elasticity and function of the erectile tissues.

4. Psychological Factors: Psychological factors can also play a role in erectile dysfunction. Anxiety about performance, especially following an injury, can exacerbate the condition.

Treatment Options
1. Medications: You mentioned that you have tried medications like tadalafil (often known by the brand name Cialis) and other oral medications. These medications work by increasing blood flow to the penis, but they may not be effective if there is significant nerve or vascular damage. If you find that these medications provide temporary relief but are not a long-term solution, it may be worth discussing alternative treatments with your healthcare provider.

2. Injection Therapy: You have also tried injection therapy with tadalafil, which can be effective for some men. However, if you experience pain during the injection or if the effects are not satisfactory, it may be necessary to explore other options.

3. Hormonal Evaluation: Since you mentioned plans to check hormone levels, this is a crucial step. Low testosterone levels can contribute to erectile dysfunction, and addressing hormonal imbalances may improve your symptoms.

4. Vacuum Erection Devices (VED): These devices can help create an erection by drawing blood into the penis. They can be a non-invasive option to consider.

5. Penile Rehabilitation: In some cases, penile rehabilitation programs that include a combination of medications, vacuum devices, and counseling can help restore erectile function over time.

6. Surgical Options: If conservative treatments fail, surgical options such as penile implants may be considered. This is typically reserved for cases where other treatments have not been effective.

7. Counseling: If psychological factors are contributing to your erectile dysfunction, working with a therapist or counselor who specializes in sexual health can be beneficial.

Conclusion
Given the complexity of your situation, it is essential to have a thorough evaluation by a urologist who specializes in erectile dysfunction. They can assess the extent of any physical damage, recommend appropriate tests (such as imaging studies or nerve conduction studies), and tailor a treatment plan that addresses both the physical and psychological aspects of your condition. It is also important to maintain open communication with your healthcare provider about what treatments you have tried and what your specific concerns are. This collaborative approach will help you find the most effective solution for your erectile dysfunction.

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