Erectile Dysfunction: Causes, Symptoms, and Solutions

Erectile dysfunction

Hello, Dr.
Hsu: Before May of this year, I could achieve an erection naturally with minimal sensory stimulation, and my penis would remain erect for a long time while standing.
I also experienced morning erections strong enough to urinate, and even during urination, my penis remained firm, making it difficult to urinate.
The erection would gradually subside only after a slow and intermittent urination.
However, on June 28, while having intercourse with my girlfriend, I noticed that my penis began to soften before penetration, and I needed manual stimulation to maintain rigidity.
Even with forced penetration, it would quickly soften if I didn't thrust.
For several consecutive days, my condition was not good, and the sensitivity of my penis was not like it used to be.

I started to worry about my sexual function.
Over the past three weeks, I have been observing myself.
Sometimes I wake up in the morning with a strong erection while lying down, but it gradually fades after I stand up.
For more than two weeks, I have focused on maintaining a healthy lifestyle, paying attention to my diet, and exercising daily.
My overall energy and mood are good, but my sexual function has not returned to the previous level of natural erections and libido.
During this period of self-care, I occasionally wanted to test my condition but only dared to lightly touch my penis without prolonged manual stimulation or ejaculation.
I found that the speed of achieving an erection through manual stimulation was very slow and not very pleasurable, and it quickly subsided once I stopped.

Could this indicate a problem with my prostate, or could it be due to abnormalities in the arterial or venous blood vessels of the penis? On July 11, I had blood tests done, and my testosterone level was 402 ng/dl, which is considered low but still within the normal range.
The outpatient doctor mentioned that having morning erections indicates that my function is still normal and did not recommend further examination.
However, I feel that my body is indeed different from before.
What should I do? I am about to get married and want to have children, and I am very concerned that there may be an issue with my sexual function.

Cai Xiansheng, 30~39 year old female. Ask Date: 2015/07/21

Dr. Xu Wencang reply Urology

There are many factors that can affect erectile dysfunction.
Excluding physical issues, it is rare to have organ problems at your age.
I suggest you relax and not put too much pressure on yourself; consider taking a long break.
If the issue persists, you may seek medical advice for appropriate treatment.

Reply Date: 2015/07/21

More Info

Erectile dysfunction (ED) is a common condition that can significantly impact a man's quality of life, particularly when it comes to intimate relationships and family planning. Understanding the causes, symptoms, and potential solutions is crucial for addressing this issue effectively.

Causes of Erectile Dysfunction
ED can arise from a variety of physical and psychological factors. Physically, it may be linked to:
1. Cardiovascular Issues: Conditions that affect blood flow, such as atherosclerosis (hardening of the arteries), can impede the blood flow necessary for an erection.

2. Hormonal Imbalances: Low testosterone levels can lead to reduced libido and erectile difficulties. Your recent testosterone level of 402 ng/dl is within the normal range, but it is on the lower end, which could contribute to your concerns.

3. Nerve Damage: Conditions like diabetes or prostate surgery can damage nerves that are essential for achieving an erection.

4. Psychological Factors: Stress, anxiety, and depression can all contribute to ED. Performance anxiety, especially in the context of an upcoming marriage and desire for children, can exacerbate the situation.

5. Lifestyle Factors: Smoking, excessive alcohol consumption, obesity, and lack of physical activity can all negatively impact erectile function.

Symptoms of Erectile Dysfunction
The primary symptom of ED is the inability to achieve or maintain an erection sufficient for satisfactory sexual performance. Other symptoms may include:
- Reduced sexual desire or libido
- Difficulty achieving an erection during sexual activity
- Erection that is not firm enough for penetration
- Erection that lasts for a shorter duration than desired
In your case, the gradual loss of erection during intimate moments and the variability of morning erections suggest that there may be an underlying issue that needs to be addressed.

Solutions and Recommendations
1. Consult a Specialist: Since your primary care physician did not recommend further testing, consider seeking a referral to a urologist or an endocrinologist who specializes in male sexual health. They can conduct a more thorough evaluation, including tests for blood flow, nerve function, and hormone levels.

2. Lifestyle Modifications: Continue focusing on a healthy lifestyle. Regular exercise, a balanced diet, and maintaining a healthy weight can improve overall health and potentially enhance erectile function. Reducing stress through mindfulness, yoga, or therapy can also be beneficial.

3. Psychological Support: If anxiety or stress is a contributing factor, consider speaking with a mental health professional. Cognitive-behavioral therapy (CBT) can help address performance anxiety and improve sexual confidence.

4. Medications: If lifestyle changes and psychological support do not yield improvements, medications such as phosphodiesterase type 5 inhibitors (e.g., Viagra, Cialis) may be prescribed. These medications enhance blood flow to the penis and can help achieve and maintain an erection.

5. Monitoring and Follow-Up: Keep track of your symptoms and any changes you notice. Regular follow-ups with your healthcare provider can help monitor your condition and adjust treatment as necessary.

6. Consider Underlying Conditions: Since you mentioned concerns about prostate health or vascular issues, it may be worthwhile to discuss these specifically with your doctor. Tests such as a Doppler ultrasound can assess blood flow to the penis, and prostate health can be evaluated through a digital rectal exam or prostate-specific antigen (PSA) testing.

Conclusion
Erectile dysfunction can be a complex issue with multiple contributing factors. Given your concerns and the significant life changes ahead, it is essential to take proactive steps. Seeking specialized care, making lifestyle changes, and addressing psychological factors can all contribute to improving your erectile function. Remember, you are not alone in this, and many men experience similar challenges. Open communication with your partner and healthcare providers will be key as you navigate this situation.

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