Erectile Dysfunction: Is It Psychological or Physical?

Following up on the previous inquiry regarding erectile issues?

Hello Dr.
Hsu,
Last time I asked about my erectile issues, the doctor advised me to get checked for blood flow problems.
I have seen a urologist twice, with my most recent visit this past Thursday.
I told the doctor that since a certain day in December 2014, after I masturbated, I lost my sex drive and started having erectile problems.
The doctor asked about my morning erections, and I mentioned that over the past week, I only had about 1 to 3 instances, which is significantly less than before.
I also noted that previously, I would feel a strong urge to masturbate during morning erections, but now I don’t feel that at all.

The doctor then asked about my reactions to watching adult films, and I said I don’t feel much response; my erections are slow to come, and sometimes I don’t feel anything at all.
However, I can still manage to achieve an erection when I stimulate myself slowly.
The doctor conducted a testosterone test, and when I returned this Thursday, the report showed a level of 602.
The doctor said that’s quite high and sufficient, attributing my issues to psychological factors.
He advised me to take a break and not think about it too much.
If I still lack confidence later, he suggested I could return for a prescription for Viagra.

No other tests were performed.
During my first visit, the doctor also mentioned psychological factors.
I later tried traditional Chinese medicine for over a week but didn’t feel any improvement, so I stopped.
My second visit was the recent one.
I’m unsure what to do now; I’ve been trying not to think about it, but I still feel no desire.
I previously experienced a failed sexual encounter that led to psychological erectile dysfunction, but at that time, I had normal reactions to adult films.

Currently, I do have nocturnal erections (I can confirm that sometimes I wake up at night with a firm erection), but my morning erections are sometimes absent or soft, unlike before when they were firm and accompanied by a strong urge to masturbate.
Now, I have no sexual desire at all; there’s no sexual impulse leading to an erection.
Recently, I started dating someone and attempted to have sex, but I couldn’t achieve an erection, and even when she touched me, I struggled to get hard.
I realized I was a bit tense at that moment, but I don’t know why.

Dr.
Hsu, based on my current situation, do you think this is a psychological issue?

Youyou, 20~29 year old female. Ask Date: 2015/04/18

Dr. Xu Weikai reply Urology

Hello, based on your description, it seems that while watching adult films is normal for you, you are experiencing erectile dysfunction during actual intercourse, which may be caused by psychological factors.
It's important to adjust your mindset, and you might consider using medications like Viagra as an aid.
The absence of morning erections could be due to your bladder not being full.
Drinking more water before bed to fill your bladder may help you achieve morning erections.
I hope this information is helpful.
If you have further questions or need more details, feel free to ask for further discussion.
Please remember that online responses are only for reference, and it is essential to seek medical attention at a healthcare facility if necessary.
The Ministry of Health and Welfare Taitung Hospital cares about you.

Reply Date: 2015/04/18

More Info

Erectile dysfunction (ED) is a complex condition that can stem from both psychological and physical factors. Based on your description, it appears that you are experiencing a significant change in your sexual function, which has understandably caused you distress. Let's break down the potential causes and considerations regarding your situation.

Psychological Factors
1. Anxiety and Stress: It seems that your experience with ED began after a specific event in 2014, which may have created a psychological barrier. Performance anxiety, fear of failure, or stress related to sexual encounters can lead to a cycle of anxiety that exacerbates the problem. The fact that you mentioned feeling "tight" during attempts with your new girlfriend suggests that anxiety may be playing a significant role.

2. Depression: A lack of sexual desire and diminished arousal can also be linked to depressive symptoms. If you are feeling low or unmotivated, this can affect your libido and overall sexual function.

3. Conditioning: Your body may have developed a conditioned response to sexual stimuli. If you have experienced difficulties in the past, your body may now associate sexual situations with anxiety, leading to a lack of arousal.

Physical Factors
1. Hormonal Levels: You mentioned that your testosterone levels were measured at 602, which your doctor indicated is within a normal range. However, it’s important to note that testosterone levels can fluctuate, and symptoms of low testosterone can still occur even within the normal range.
2. Blood Flow Issues: While your doctor did not perform extensive tests, erectile function is heavily reliant on adequate blood flow. If there are any vascular issues, they could contribute to difficulties in achieving or maintaining an erection.

3. Neurological Factors: Conditions affecting the nervous system can also lead to ED. If there are any underlying neurological issues, they may need to be evaluated.

Recommendations
1. Further Evaluation: If you feel that your current healthcare provider is not addressing your concerns adequately, consider seeking a second opinion. A urologist specializing in sexual health may offer more comprehensive evaluations, including tests for blood flow and nerve function.

2. Psychological Support: Engaging with a therapist who specializes in sexual health or cognitive-behavioral therapy may help address the psychological aspects of your ED. Therapy can provide coping strategies and help reduce anxiety related to sexual performance.

3. Lifestyle Modifications: Regular exercise, a healthy diet, and adequate sleep can improve overall well-being and may positively impact sexual function. Reducing alcohol consumption and quitting smoking can also be beneficial.

4. Medication: If psychological factors are significant and lifestyle changes do not yield improvements, medications like Viagra (sildenafil) may be prescribed. These can help improve blood flow and facilitate erections, but they do not address the underlying psychological issues.

5. Open Communication: Discussing your feelings and experiences with your partner can help alleviate some of the pressure you may feel during intimate moments. A supportive partner can make a significant difference in your comfort level.

Conclusion
In summary, your situation appears to be influenced by both psychological and possibly physical factors. While your testosterone levels are normal, the psychological impact of past experiences and current anxiety may be significant contributors to your ED. Seeking further evaluation and support, both medically and psychologically, can help you navigate this challenging situation. Remember, you are not alone in this, and many men experience similar issues at different points in their lives.

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