Erectile Dysfunction: Insights and Doppler Ultrasound in Taichung - Urology

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Erectile dysfunction (ED) is a complex condition that can stem from various physical and psychological factors. Your symptoms, including the unusual appearance of your penis when flaccid and the inconsistent ability to maintain an erection, warrant a thorough evaluation. It’s important to address your concerns systematically.

Firstly, the description of your penis being "thin and soft" when not erect, and the "hourglass" shape during attempts at erection, suggests that there may be an issue with blood flow or structural integrity. The fact that you can achieve an erection in the morning but struggle in the evening could indicate a psychological component, but it also raises the possibility of vascular issues, particularly since you mentioned that you do not have hypertension, diabetes, or hyperlipidemia (the "three highs").
Vascular erectile dysfunction can occur even in younger individuals, especially if there are underlying issues such as hormonal imbalances, psychological stress, or lifestyle factors. While you have had normal hormone levels, it is essential to consider other potential causes. For instance, conditions like Peyronie's disease, which involves the development of fibrous scar tissue inside the penis, can lead to deformities and erectile issues. Although you initially suspected Peyronie's disease, the inability to perform an ultrasound due to equipment issues may have left this diagnosis unresolved.

Regarding your question about excessive masturbation, while it is generally not considered a direct cause of ED, excessive or aggressive techniques can lead to trauma or injury to the penile tissues, potentially affecting erectile function. However, this is less common and usually reversible with time and proper care.

As for your inquiry about Doppler ultrasound, this test is indeed a valuable diagnostic tool for assessing blood flow to the penis. It can help determine if there are vascular issues contributing to your ED. In Taichung, many hospitals and urology clinics should offer this service, but it may not always be explicitly listed on their websites. It’s advisable to contact the urology department directly to inquire about the availability of Doppler ultrasound and other erectile function tests, such as intracavernosal injection tests, which can provide further insights into your condition.

In summary, your symptoms suggest that a thorough evaluation is necessary to rule out vascular causes of ED. It would be beneficial to seek a second opinion from a urologist who specializes in erectile dysfunction. They may recommend a Doppler ultrasound to assess blood flow and possibly other tests to evaluate the structural integrity of the penis. Addressing psychological factors through counseling or therapy may also be beneficial, especially if stress or anxiety is contributing to your symptoms. Remember, ED is a common issue, and seeking help is the first step towards finding a solution.