Erectile Dysfunction: Causes, Concerns, and Solutions

Sexual dysfunction

Hello Doctor: Recently, I've been very troubled by my erections.
Last year, after a day of masturbation, I noticed that I had lost my sex drive and my ability to achieve an erection.
I used to be able to masturbate while watching adult films, and I still experienced morning erections, but recently I haven't had any morning erections and I feel no arousal even when watching adult films.
I’m not sure if I'm too focused on my performance or what, but I can only achieve an erection with manual assistance, and it goes soft immediately after ejaculation.
I visited a major hospital near Zhongli and explained my situation to the doctor.
He said there was no issue with my urinary system and that erectile dysfunction was not directly related.
He then tested my testosterone levels (male hormone 602) and upon seeing the results, he suggested it was a psychological issue and advised me to relax.
He mentioned that if things didn’t improve, I could return for a prescription for Viagra.
I think the urologist at that hospital must be quite frustrated with me.
I’m unsure how to further explain my problems to the doctor.

1.
Sometimes at work, I experience random erections that become very hard but then go soft again.
What could be the cause of this?
2.
I feel that my worries about sexual matters have been very distressing for me.
I’ve had previous relationships that ended unsuccessfully, but back then, I could achieve an erection quickly while watching adult films, which helped me succeed during intercourse.
However, with my current girlfriend, I’ve also failed completely to achieve an erection.
The doctor keeps saying it’s a psychological factor, but I feel a sense of helplessness regarding my performance.
I came here to ask for your opinion as well.

Niming, 20~29 year old female. Ask Date: 2015/06/27

Dr. Fu Shizhang reply Urology

I share the same view as that doctor; the influence of psychological factors is significant.
After all, testosterone levels have been tested and found to be normal.
If there are still concerns, a cavernosography can be arranged, but theoretically, everything should still be normal, especially since erections still occur during work.
Psychological factors encompass a wide range of issues, including persistent focus on the problem.
The more you concentrate on erectile function issues, the harder it becomes to achieve an erection; and the more difficult it is to achieve an erection, the more you worry, creating a vicious cycle.

Reply Date: 2015/06/27

More Info

Erectile dysfunction (ED) is a common issue that can significantly impact a man's quality of life, self-esteem, and relationships. Understanding the causes, concerns, and potential solutions is crucial for addressing this condition effectively.

Causes of Erectile Dysfunction
ED can stem from a variety of factors, which can be broadly categorized into physical and psychological causes:
1. Physical Causes:
- Hormonal Imbalances: Low testosterone levels can lead to decreased libido and erectile issues. Your testosterone level of 602 ng/dL is within the normal range, but hormonal issues can still be complex.

- Vascular Problems: Conditions like hypertension, high cholesterol, and diabetes can impair blood flow to the penis, making it difficult to achieve or maintain an erection.

- Neurological Disorders: Issues affecting the nervous system, such as multiple sclerosis or spinal cord injuries, can interfere with the signals necessary for an erection.

- Medications: Some medications can have side effects that include ED. It's important to review any medications you are taking with your doctor.

2. Psychological Causes:
- Anxiety and Stress: Performance anxiety, particularly after previous experiences of ED, can create a cycle of anxiety that exacerbates the problem. Your concern about not being able to perform can lead to increased anxiety, which further impacts your ability to achieve an erection.

- Depression: Mental health issues can significantly affect libido and sexual performance.

- Relationship Issues: Problems with a partner can also contribute to ED.

Concerns Related to Erectile Dysfunction
ED can lead to several concerns, including:
- Impact on Relationships: Difficulty in achieving an erection can strain romantic relationships and lead to feelings of inadequacy or embarrassment.

- Self-Esteem Issues: Many men experience a decline in self-esteem and confidence due to ED.

- Underlying Health Conditions: ED can sometimes be an early warning sign of more serious health issues, such as cardiovascular disease.

Solutions for Erectile Dysfunction
1. Medical Treatment:
- Phosphodiesterase Type 5 Inhibitors: Medications like Viagra (sildenafil) can help increase blood flow to the penis and facilitate an erection. It's important to follow your doctor's guidance on using these medications.

- Hormone Therapy: If hormonal imbalances are identified, testosterone replacement therapy may be an option.

2. Psychological Counseling:
- Therapy: Speaking with a psychologist or counselor can help address anxiety, depression, or relationship issues contributing to ED. Cognitive-behavioral therapy (CBT) is particularly effective for performance anxiety.

- Sex Therapy: This can help couples work through sexual difficulties and improve communication.

3. Lifestyle Changes:
- Exercise: Regular physical activity can improve blood flow and reduce anxiety.

- Diet: A healthy diet can improve overall health and potentially reduce ED symptoms.

- Avoiding Alcohol and Smoking: Both can negatively impact erectile function.

4. Communication with Your Partner: Open discussions about sexual health and concerns can alleviate anxiety and improve intimacy.

Addressing Your Specific Concerns
1. Inconsistent Erections: The fact that you sometimes experience spontaneous erections at work but struggle during intimate moments suggests that anxiety may play a significant role. This is not uncommon and can be addressed through relaxation techniques and counseling.

2. Performance Anxiety: Your previous experiences with partners and the pressure you feel can create a cycle of anxiety that affects your performance. It may be beneficial to focus on intimacy and connection rather than performance.

3. Follow-Up with Your Doctor: If you feel that your concerns are not being adequately addressed, consider seeking a second opinion or discussing your feelings more openly with your healthcare provider. It’s important to communicate that you believe psychological factors are significantly impacting your sexual health.

In conclusion, ED is a multifaceted issue that often requires a comprehensive approach to treatment. By addressing both physical and psychological factors, you can work towards regaining confidence and improving your sexual health. Don't hesitate to reach out for help and support, whether through medical professionals or counseling services.

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