Urological Concerns: When to Seek Medical Advice

Doctor, do I have any issues?

Hello Dr.
Hsu, I had my testosterone levels tested, and you previously reassured me that there were no issues, which put my mind at ease.
A few days after your last response, I was able to achieve normal erections, and I noticed that I would naturally become erect when exposed to more stimulating visuals, so I was less concerned.
However, after two or three days, it seems like I am having difficulties again.
Now, I suddenly find myself unable to achieve an erection.
I have been paying attention to the fact that I do experience nocturnal erections while I sleep.
Does this indicate that I have a problem or not? This has left me quite confused.

Yesterday, I visited an orthopedic doctor and discovered that I have some issues with my cervical vertebrae (C5, C6, and C7) that seem to be misaligned by about 0.3 cm.
Could this be related to my current situation? I have another appointment with the doctor on Thursday.
Additionally, I have noticed that my lower back tends to feel quite sore, especially when lying down on the bed.
Should I consider seeing a urologist? If so, how should I approach the conversation with the doctor? Thank you.

Tian, 20~29 year old female. Ask Date: 2005/06/14

Dr. Xu Weikai reply Urology

Hello, I'm glad to hear that your issue has shown some initial improvement.
However, I want to emphasize that for young individuals, psychological factors often play a significant role, as they may be causing unnecessary anxiety.
That said, if there is a displacement in the lumbar spine, it could potentially compress nerves related to sexual function.
Therefore, I recommend consulting with an orthopedic or neurology specialist to confirm the situation.
If necessary, physical therapy may help alleviate the symptoms.

Sincerely,
Dr.
Hsu Wei-Kai,
Director of Urology,
Taitung Hospital, Department of Health, Executive Yuan.

Reply Date: 2005/06/14

More Info

Hello, thank you for reaching out with your concerns regarding your urological health. It’s great to hear that you’ve had some positive experiences with your testosterone levels and that you’ve been able to achieve normal erections in certain situations. However, I understand that you are experiencing fluctuations in your erectile function, which can be concerning.

First, it’s important to recognize that erectile dysfunction (ED) can be influenced by a variety of factors, including psychological stress, physical health issues, and even lifestyle choices. The fact that you are able to achieve erections during sleep (known as nocturnal penile tumescence) is a positive sign, as it indicates that the physiological mechanisms for erections are functioning properly. This suggests that your erectile dysfunction may have a psychological component, especially since you mentioned feeling anxious about the situation.

Regarding your neck issues, it’s possible that cervical spine problems could contribute to your symptoms, but it’s not a direct cause of erectile dysfunction. However, pain and discomfort in the neck and back can lead to increased stress and anxiety, which may indirectly affect your sexual performance. It’s wise to follow up with your orthopedic doctor about your cervical spine condition, as they can provide guidance on treatment options that may alleviate your discomfort.

As for your lower back pain, it’s not uncommon for individuals to experience discomfort in the lumbar region, especially if they have underlying issues such as muscle strain or spinal alignment problems. If this pain is persistent or worsening, it may be beneficial to consult with a healthcare provider who specializes in musculoskeletal issues.

Now, regarding whether you should see a urologist, it may be a good idea if your erectile difficulties continue or worsen. When you visit the urologist, it’s essential to communicate your symptoms clearly. Here are some tips on how to effectively describe your situation:
1. Be Honest and Direct: Start by explaining your concerns about erectile dysfunction. Mention that you have had periods of normal erectile function but are currently experiencing difficulties.

2. Describe Your Symptoms: Provide details about when the issues occur. For example, do you have trouble achieving an erection, maintaining it, or both? Are there specific situations where you notice the problem more?
3. Mention Other Health Issues: Inform the urologist about your neck and back problems, as well as any other health concerns you may have. This information can help them understand your overall health picture.

4. Discuss Psychological Factors: If you feel that anxiety or stress may be contributing to your symptoms, mention this to the doctor. They may ask about your mental health and suggest counseling or therapy if needed.

5. Ask Questions: Don’t hesitate to ask the doctor about potential causes of your symptoms, treatment options, and any lifestyle changes that could help improve your situation.

In summary, while your nocturnal erections are a good sign, the fluctuations in your erectile function warrant further investigation, especially if they persist. Consulting with a urologist can provide you with the necessary insights and treatment options. Additionally, addressing any physical discomfort you are experiencing with your neck and back may also contribute to your overall well-being. Remember, open communication with your healthcare providers is key to finding the right solutions for your health concerns.

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