Erectile Dysfunction: Concerns and Treatment Options for Young Men

Consult a physician?

Hello, doctor.
I am 21 years old.
Previously, I sought medical attention due to prolonged morning erections not occurring and poor erection hardness.
The doctor diagnosed me with "psychogenic" erectile dysfunction and prescribed three medications: trazodone hydrochloride (for depression), dibenyline (to improve peripheral circulation), and vitamin E.
After taking these medications for three weeks (all taken at bedtime), I was able to achieve morning erections, but they disappeared after urination.
During my follow-up visit today, I expressed my concern about the possibility of "venous leakage." The doctor prescribed me one tablet of "Viagra" along with the previous three medications, stating that if the erection is still not firm after taking it, it could indicate "leakage." I would like to ask the doctor: 1.
I know this medication should not be taken casually; should I take it? 2.
Is there any basis for determining whether I have leakage? 3.
For psychogenic erectile dysfunction, how long does it typically take to resolve? Thank you for your response, doctor.
I am genuinely worried because I am only in my twenties.

skate, 20~29 year old female. Ask Date: 2004/12/15

Dr. Xu Weikai reply Urology

Hello, your situation really seems to be influenced by psychological factors.
After taking the medication, your morning erections have returned, and the urinary issues have diminished; this is quite normal.
Morning erections are triggered by bladder distension due to urine.
The three medications you are taking are commonly used, and one of them is a well-known oral medication that was frequently prescribed before the advent of Viagra; this prescription is quite comprehensive.

As for using Viagra as a basis for a venous leak test, I personally do not agree with that approach.
A more objective method would be to conduct a nocturnal penile tumescence test or a penile cavernosography, which can provide a clearer understanding of the underlying issue.
However, these tests are more invasive and uncomfortable, and are typically only available at larger medical centers.

Regarding the use of Viagra, even if it proves ineffective, it cannot be definitively concluded that the issue is due to a venous leak.
Here are my recommendations for you:
1.
Try to relax a bit and pause the medications to see if there are any changes in your morning erections.

2.
When you have an erection, stand up and measure the angle between your erect penis and your thigh; is it 60 degrees, 90 degrees, or greater?
3.
Measuring rigidity requires specialized instruments, which you can get at larger hospitals.
Additionally, a simpler method is to inquire if there are any rigidity testing stickers available; place one around your penis before sleeping and check for any breakage of the paper upon waking.
This can give you a rough idea of the rigidity of your erections.

4.
In your case, psychological factors play a significant role.
As for how long to take the medication, if it were me, I would continue until I have recovered and then stop, as the influence is primarily psychological, and the body is functioning normally.
The medication is just a means to help the body through this period.
Sincerely,
Director of Urology, Taitung Hospital, Department of Health, Executive Yuan
Dr.
Hsu Wei-Kai

Reply Date: 2004/12/15

More Info

Erectile dysfunction (ED) in young men, particularly those in their late teens to early twenties, can be a distressing experience. Understanding the underlying causes and treatment options is crucial for addressing this issue effectively.
Firstly, it's important to recognize that erectile dysfunction in younger individuals is often multifactorial. The most common causes include psychological factors, lifestyle choices, and, less frequently, physiological issues. Psychological factors can include anxiety, depression, and stress, particularly related to performance pressure or relationship dynamics. Lifestyle factors such as poor diet, lack of exercise, smoking, and excessive alcohol consumption can also contribute to ED.
In your case, you mentioned experiencing difficulties with morning erections and reduced hardness. The fact that you were able to achieve morning erections suggests that your body is capable of physiological erections, which is a positive sign. However, the loss of erection after urination could indicate a psychological component, especially if you feel anxious about your performance.
Regarding the medications prescribed by your doctor, trazodone is often used to treat depression and can help with anxiety, which may indirectly improve erectile function. Dibenyline is used to improve peripheral circulation, which can also be beneficial. Vitamin E is an antioxidant that may support overall vascular health. The introduction of Viagra (sildenafil) is a common approach for treating ED, as it enhances blood flow to the penis, helping to achieve and maintain an erection.

1. Should you take Viagra? It's essential to follow your doctor's advice regarding medication. Viagra can be effective for many men, but it should be used under medical supervision, especially considering your age and the potential for psychological factors at play. If your doctor believes it is appropriate, it may be worth trying, but be sure to discuss any concerns you have about its use.

2. Is there evidence of venous leakage? Diagnosing venous leakage typically requires a more thorough evaluation, often including a physical examination and possibly imaging studies. If your doctor suspects this condition based on your symptoms and response to treatment, they may recommend further testing. However, it's important to note that many young men worry about venous leakage without it being the actual cause of their ED.

3. How long does it take for psychological ED to improve? The timeline for improvement can vary widely among individuals. Some may see significant improvement within weeks, especially with the right combination of therapy, lifestyle changes, and medication. Others may take longer, particularly if anxiety or other psychological issues are deeply rooted. Engaging in counseling or therapy can be beneficial in addressing these underlying psychological factors.

In addition to medication, consider lifestyle modifications that can enhance your overall health and potentially improve erectile function. Regular exercise, a balanced diet, adequate sleep, and stress management techniques such as mindfulness or yoga can all contribute positively.
Lastly, open communication with your partner about your concerns can alleviate some of the pressure you may feel during intimate moments. Remember, you are not alone in this experience, and many young men face similar challenges. Seeking support from healthcare professionals and possibly a therapist can provide you with the tools to navigate this situation effectively.
In summary, while erectile dysfunction can be concerning, especially at a young age, understanding its potential causes and treatment options can empower you to take proactive steps toward improvement. Always consult with your healthcare provider for personalized advice and treatment plans tailored to your specific situation.

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