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Greetings Ray.I am sorry that your question was unanswered for very long.I am a general surgeon and had done 4 years senior residency in urology. I regularly do all urology endoscopic procedures. I also deal in male erectile function disorders and male infertility (do procedures like vas epididymis anastomosis etc). The most common cause of erections to diminish rapidly is psychological issues. The erection is a complicated phenomenon which entails involvement of following body systems;1) autonomic nervous system2) vascular system3) endocrine system.There is a very complex interplay between these system. Just a small stress or anxiety or minor physical ailment can affect;a) libidob) firmness of penis during erectionc) erectile dysfunctiond) loss of erection rapidly.But all these do recover usually fast and spontaneously. The causes are mostly complex and sometimes difficult to ascertain exactly. Performance stress, anxiety, penis sensitivity, lack of sleep, body aches; all can affect it. For an healthy individual like you, this should be not worrying. The most important thing is that it even a mild erection problem plays in the mind. This can give in the back of mind a performance anxiety and you start watching yourself more closely. This close scrutiny of yourself can loose the concentration from the sex and you get a bit softer. Please remember sex in not in organ but in mind. Once you start enjoying it you will regain the same strength. Nothing happens suddenly in sex, it is like sports, sometimes you excel and sometimes you are mediocre. If your wife / partners is part of all this understanding you would be back to your best. Don't put yourself under the scrutiny and just start enjoying it. Things should come back to normal. You may need psycho sexual therapy which helps to reduce performance anxiety, develop the new sexual skills and knowledge, modify negative sexual attitudes, and improve communication between both of you. Involving the partners in the counseling process and psycho sexual therapy helps dispel misperceptions about the problem, decreases stress, enhances intimacy and ability to talk about sex, and increases the chances of successful outcome. Fibromyalgia is a chronic condition, which may have following of the manifestations;
1) widespread muscle pain, "myalgia,"
2) excessive tenderness in many areas of the body
4) sleep disturbances,
6) mood disturbances, such as depression and anxiety.
The goal of fibromyalgia treatment (or related conditions) is to improve the physical and mental health and quality of life. This goal implies helping manage distressing symptoms, but with decreased dependence on the medical care system. The common recommendations of education, exercise, and pharmacotherapy are often appropriate. Comorbid conditions, such as arthritis and obesity, should be treated because they can contribute to increasing physical and mental symptoms. In fibromyalgia; you are best person to guide your physician, as there are no set rules or standard of protocol which can be effective. The treatment which have been best and efficacious for you in past can be repeated. Because medical therapy is unsatisfactory, patients find their way to alternative therapies. Some of these therapies may be helpful to individual patients, such as massage, water therapy, spa treatment, and acupuncture. So, your decision to choose them supersede the physician's recommendations. The research, in addition to the clinical experience, indicates that the addition of education and a behavioral or cognitive-behavioral component to fibromyalgia treatment protocols is warranted. A combination of the Patient Education, Cognitive-Behavioral Therapy, Relaxation Techniques, and Complementary and Alternative Medicine is suppose to bring the best outcome in quality of life. Please feel free for your follow up questions.
I would be happy to assist you further, if you need any more information.
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Hello Dr. Phophalia,
Thank you for your excellent and thorough response. There's no need to apologize for how long my question went unanswered. It wasn't that long, first of all, and I'm a bartender, my hours opposite most people, so I wasn't expecting a reply until today.
One point I'd like to clarify:
Psychological stress and chronic worrying can affect erectile firmness even during sleep?
Thank you again.
You are very welcome, Ray.Thanks for your kind words.Psychological stress and chronic worrying do affect the firmness even during sleep. These (stress and worry) affect our autonomic nervous system which decreases the firmness (in time and strength) during sleep as well as awake.I would not worry as there is noting serious or significant going on. Just relaxation should be helpful in resolution.It is privilege assisting you.
Thank you very much, Doctor. If I may ask a quick follow-up:
The fact that this has been going on -- with some fluctuation -- for six or seven months now does not concern you?