Persistent Erection Issues: Causes and Solutions

Q: Persistent Erection Issues: Causes and Solutions

Men： You can undergo further relevant examinations. 1. Penile erection test： This can be conducted using medication or other specialized instruments. 2. Penile ultrasound. 3. Penile angiography： To determine if there is venous leakage. If there are any

Unable to endure?

The family has a history of cardiovascular disease.
Recently, I started exercising and my control has been good.
Aside from having visceral fat at 13 and body fat at 21 (last year's data, which should be lower now), all other test results are normal.
At the beginning of last year, I was diagnosed with low testosterone, with a level of only 3.
The doctor prescribed a topical medication that I had to pay for myself, but subsequent tests showed a level of 2.
I suspected the doctor was incompetent, so I went to another clinic, where my testosterone level was 7.2.
A few months later, I paid for a follow-up test, and it was 6.7, which are both within normal ranges.
Currently, in addition to jogging, I have started doing squats, and my thigh muscles are quite firm.
Recently, I also began doing Kegel exercises, occasionally standing up at work to do a few, and I do some before going to sleep.
However, I still experience issues with endurance.
Usually, when I am feeling good, I have a strong reaction in the morning.
Sometimes, when I lie in bed at night watching suggestive content on TV, I might react briefly, but it doesn't last long during intercourse.
If the foreplay is good, I perform well when I do react, but I always struggle with endurance.
It feels like a deflating balloon; once it’s inflated, it slowly loses air (unless intercourse continues).

Previously, I consulted a urologist who said there was no significant issue and prescribed me Cialis 5mg.
I take it daily, and after a week, the downside is that I get an erection from simple sexual teasing, which is more pronounced than usual.
However, during intercourse, I still face the same problem.
Even with the medication, it only increases hardness but does not improve endurance.
This means I end up having to rush through intercourse; once I’m hard, I can only finish quickly.
If it takes too long without continuous intercourse, I will lose my erection.

Whether I take the medication or not, the situation remains the same.
There have been several occasions where I felt very pleasurable, changing positions multiple times (with continuous intercourse), but if it drags on for too long (about 20-30 minutes), I end up losing my erection again, and it’s difficult to regain it.
This happens regardless of whether I take the medication.

Could you please tell me what symptoms this indicates? Is it mild erectile dysfunction? The medication only seems to increase hardness.
Could there be another underlying cause? What tests should I undergo? Every time I see a doctor, they say it’s psychological, but I clearly do not have any psychological factors.

MEN, 30~39 year old female. Ask Date: 2015/12/04

Dr. Xu Weikai reply Urology

Men: You can undergo further relevant examinations.
1.
Penile erection test: This can be conducted using medication or other specialized instruments.
2.
Penile ultrasound.
3.
Penile angiography: To determine if there is venous leakage.
If there are any unclear points, feel free to ask again for further discussion and research.
Online responses should only be used as a reference; it is essential to seek medical care at a healthcare facility if necessary.
This message is from Dr.
Hsu Wei-Kai, Director of the Urology Department, Taitung Hospital, Ministry of Health and Welfare.

Reply Date: 2015/12/04

More Info

Understanding persistent erection issues can be complex, as they may stem from a variety of causes, including physiological, psychological, and lifestyle factors. Based on your description, it seems you are experiencing difficulties with maintaining an erection during sexual activity, despite having normal erectile function at times, such as in the morning or during sexual arousal from visual stimuli. This situation can be frustrating and may lead to concerns about underlying health issues.

Possible Causes
1. Hormonal Imbalances: You mentioned a history of low testosterone levels, which can significantly impact sexual function. Although your recent tests show improvement, fluctuations in testosterone can still affect libido and erectile function. It's essential to monitor these levels regularly and discuss any concerns with your healthcare provider.

2. Cardiovascular Health: Given your family history of cardiovascular disease, it’s crucial to consider how your vascular health may influence erectile function. Good blood flow is essential for achieving and maintaining an erection. Factors such as high blood pressure, high cholesterol, or other cardiovascular issues can impede blood flow to the penis, leading to difficulties in maintaining an erection.

3. Psychological Factors: While you mentioned that you do not believe psychological factors are at play, it’s worth noting that anxiety, stress, and performance pressure can contribute to erectile difficulties. Even if you feel confident, subconscious concerns about performance can manifest physically.

4. Physical Fitness and Muscle Tension: You noted that you have been engaging in exercises like squats and Kegel exercises. While these can strengthen pelvic floor muscles and improve erectile function, excessive tension in the pelvic area can sometimes lead to difficulties. It’s essential to balance strengthening with relaxation techniques.

5. Medication Effects: You are currently taking a medication (likely a PDE5 inhibitor like Viagra or Cialis) that can enhance erection hardness but may not address the underlying issue of duration. If the medication helps with hardness but not with lasting power, it may indicate that the issue is not solely related to blood flow.

Recommendations
1. Comprehensive Evaluation: It may be beneficial to undergo a thorough evaluation by a urologist specializing in sexual health. This evaluation could include blood tests to check hormone levels, cardiovascular assessments, and possibly a nocturnal penile tumescence test to evaluate erectile function during sleep.

2. Consider Psychological Counseling: Even if you feel there are no psychological factors, consulting with a therapist specializing in sexual health can provide insights into any underlying anxieties or stressors that may be affecting your performance.

3. Lifestyle Modifications: Continue with your fitness regimen, but also incorporate relaxation techniques such as yoga or meditation to alleviate any muscle tension and stress. Maintaining a healthy diet and avoiding smoking or excessive alcohol consumption can also support erectile health.

4. Review Medications: Discuss with your doctor the possibility of adjusting your current medication or exploring other options that may help with both hardness and duration. There are various treatments available, including different classes of medications or even vacuum erection devices.

5. Open Communication: If you have a partner, maintaining open communication about your experiences and feelings can alleviate performance pressure and enhance intimacy, which may improve your sexual experiences.

Conclusion
Persistent erection issues can be multifaceted, and addressing them often requires a comprehensive approach that considers both physical and psychological aspects. Regular follow-ups with healthcare providers, along with lifestyle adjustments, can lead to improvements in your sexual health. If you continue to experience difficulties, do not hesitate to seek further evaluations and explore all available treatment options.

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