Improving Erectile Function and Ejaculation Issues: A Urology Guide

Erectile dysfunction, etc?

In the morning, there are times when I have an erection and times when I do not.
During intercourse, I often experience insufficient erection hardness, making penetration difficult.
Previously, I would ejaculate with a large volume and a strong jet, but recently the volume has decreased, and I now experience a "dribbling" discharge.
I engage in sexual intercourse once a week or once every two weeks.
There is no prostate enlargement, and recently I have been able to completely empty my bladder while standing.
When urinating while sitting (for bowel movements), I often find that I can urinate a little more (about 80-100 cc) after cleaning the anal area.
I do not have hypertension, diabetes, or hyperlipidemia, and I usually take Centrum, Adderall, or Ginkgo Biloba with Vitamin F50.
What treatments can improve erection hardness and address the issues of decreased ejaculate volume and "dribbling" discharge?

Xiao Jun, 60~69 year old female. Ask Date: 2023/06/25

Dr. Xu Wencang reply Urology

You can visit the outpatient clinic for evaluation, examination, and treatment.
Medications and low-energy shockwave therapy can be used.

Reply Date: 2023/06/25

More Info

Improving erectile function and addressing ejaculation issues can be a complex process, often requiring a multifaceted approach. Based on your description, it seems you are experiencing fluctuations in erectile firmness, reduced ejaculate volume, and a change in the nature of your ejaculation. Here’s a comprehensive guide to understanding and potentially improving these issues.

Understanding Erectile Dysfunction and Ejaculation Issues
Erectile dysfunction (ED) is characterized by the inability to achieve or maintain an erection sufficient for satisfactory sexual performance. Various factors can contribute to ED, including psychological issues (such as anxiety or depression), physical conditions (like diabetes or cardiovascular disease), hormonal imbalances, and side effects from medications.

Ejaculation issues, such as reduced volume and changes in the ejaculation process (e.g., a "flow" rather than a "splash"), can also stem from similar causes. Medications, particularly those affecting the nervous system or hormonal levels, can lead to these changes. For instance, medications like Urief (used for urinary issues) can cause retrograde ejaculation, where semen enters the bladder instead of exiting through the penis.

Potential Causes of Your Symptoms
1. Psychological Factors: Stress, anxiety, and depression can significantly affect sexual performance. If you are experiencing stress related to sexual performance, it may contribute to your erectile issues.

2. Physical Health: Although you mentioned no history of hypertension, diabetes, or prostate enlargement, it’s essential to consider other health factors. Conditions such as obesity, hormonal imbalances (like low testosterone), or vascular issues can impact erectile function.

3. Medication Side Effects: The medications you are taking, including multivitamins and herbal supplements, may have side effects that influence sexual function. It's crucial to review these with your healthcare provider.

4. Age-Related Changes: As men age, changes in hormone levels and blood flow can naturally lead to variations in erectile function and ejaculation.

Recommendations for Improvement
1. Consult a Urologist: Since you are experiencing specific symptoms related to erectile function and ejaculation, it is advisable to consult a urologist. They can perform a thorough evaluation, including blood tests to check hormone levels and assess overall health.

2. Lifestyle Modifications:
- Diet and Exercise: A balanced diet and regular exercise can improve overall health and blood circulation, which is vital for erectile function. Consider incorporating cardiovascular exercises, strength training, and a diet rich in fruits, vegetables, whole grains, and lean proteins.

- Weight Management: If you are overweight, losing weight can improve erectile function and overall health.

3. Psychological Support: If psychological factors are contributing to your symptoms, consider speaking with a therapist or counselor specializing in sexual health. Cognitive-behavioral therapy (CBT) can be beneficial in addressing anxiety and performance issues.

4. Medication Review: Discuss your current medications with your healthcare provider. They may adjust dosages or switch medications to minimize side effects impacting your sexual health.

5. Pelvic Floor Exercises: Kegel exercises can strengthen the pelvic floor muscles, potentially improving erectile function and ejaculatory control. These exercises involve repeatedly contracting and relaxing the muscles used to stop urination.

6. Consider Medical Treatments: If lifestyle changes and counseling do not yield improvements, medications such as phosphodiesterase type 5 inhibitors (e.g., Viagra, Cialis) may be prescribed to enhance erectile function. Discuss this option with your urologist.

7. Stay Informed: Educate yourself about sexual health. Understanding the physiological aspects of erectile function and ejaculation can alleviate anxiety and help you communicate better with your partner and healthcare provider.

Conclusion
Improving erectile function and addressing ejaculation issues requires a comprehensive approach that considers psychological, physical, and lifestyle factors. By consulting with a urologist, making lifestyle changes, and possibly exploring medical treatments, you can work towards enhancing your sexual health. Remember that open communication with your healthcare provider is key to finding the most effective solutions tailored to your individual needs.

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