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Ask Dr. Arun Phophalia Your Own Question
Dr. Arun Phophalia
Dr. Arun Phophalia, Doctor (MD)
Category: Health
Satisfied Customers: 31316
Experience:  MBBS, MS (General Surgery), Fellowship in Sports Medicine
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This question is for a urologist. Im a 42-year-old male,

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This question is for a urologist.

I'm a 42-year-old male, in excellent shape, who over the course of the past seven months has undergone a tremendous amount of anxiety related to an enigmatic medical condition which doctors -- including a neurologist -- have loosely diagnosed as "a fibromyalgia-like condition." I cannot overstate the degree of that anxiety.

In addition to the physical symptoms, my hypochondria has spun out of control. I'm talking about hypochondriasis in the clinical sense. I obsess now more or less continually over my health.

My reason for writing a urologist specifically is this:

My erections in the morning now diminish more rapidly than ever before. Also, I've begun to notice a slight but definite loss of firmness in my erections. As well as that, after sex with my wife, my erection goes down much more quickly than ever before.

I am still able to get an erection, and I do still get nighttime erections.

The firmness and duration of those erection has diminished slightly.

I do not believe this particular issue is age-related. I'm not in denial about growing older. But the change occurred so suddenly and completely concurrent with my other illness -- the main illness -- which my neurologist believes is, at least in part, hormone related.

My testosterone tests normally (820).

My question is this:

What, in general, causes erections to diminish more rapidly?

I've also noticed a definite loss of libido.

There is a certain come-and-go nature to this. For example, three weeks ago my libido significantly returned -- and then I got a VERY bad cold, and everything went away.

Thank you very much for your time.

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 system
2) vascular system
3) endocrine system.

There is a very complex interplay between these system. Just a small stress or anxiety or minor physical ailment can affect;

a) libido
b) firmness of penis during erection
c) erectile dysfunction
d) 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

3) fatigue,

4) sleep disturbances,

5) headaches,

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.


We have recently implemented a new rating and feedback system. Please be aware that you are rating my courtesy and service as a professional. If you have any questions whatsoever, or there is anything I can clarify for you, please temporarily bypass the rating system by clicking “Continue the Conversation” or "Reply."

Clicking either of the lowest two options reflects poorly on me so please reply to me if there is anything else I can do to help before choosing those options. I appreciate your patience while we work out the kinks. It's important to me that you are 100% satisfied with the service I have provided you. Thank you.

Customer: replied 3 years ago.

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.

Dr. Arun Phophalia and 4 other Health Specialists are ready to help you
Customer: replied 3 years ago.

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?

You are welcome, Ray.

A fluctuation point that organic cause is less likely and it is more related to the psychological issue. A long duration is also due to the lingering anxiety / depression. A proper management should be able to overcome it.

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