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Dr. Mark
Dr. Mark, Psychotherapist
Category: Mental Health
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Experience:  Dr. Mark is a PhD in psychology in private practice
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! am 74 and I have not had sexual relations with a women for

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! am 74 and I have not had sexual relations with a women for 14 years. I can not get hard and when i ejaculate I do not feel it. I saw a urologist and he checked my testosterone. I give my self testosterone injections. It was 168. Is there any help for me to get back to normal sex

Hi! I believe I can be of help with this issue.

I can imagine how frustrating this situation must be for you. There are two distinct problems you are discussing and they will need to be addressed separately: the erection is one problem; the ejaculation is another. You will need to discuss both with your doctor but let me give you information, guidelines, and ideas to bring up and work from in that discussion with your doctor. You've seen a urologist, but I don't get the sense from you that you're confident he/she is experienced or highly interested in sexual function in older adults. Therefore, you might talk with your regular doctor and ask to be referred to a urologist in your area who specializes, or at least is known for taking an interest in, these issues of older adults. So either with your current urologist or someone else you can discuss these possibilities. Remember, after this long a period of disuse, it's not clear what can be restored. But please do not give up on this. Make the effort because it's worth it.

Ejaculation is a matter of sperm production as well as muscle function. The muscles have to push the sperm out for the ejaculation. So you need to discuss with your doctor whether there is any sperm production at this time and if the muscles are able to function properly. So that is one discussion. But separately, you need to work on the erection problem. And it may be that working on this problem will help with the ejaculation. Let's start with the introduction that an ejaculation is dependent on the blood flow through the tiny blood vessels in the penis that are what an erection is.

There are a number of ways to address the lack of blood flow. Part of the problem is also that once you see your erection is not that hard, there's a psychological element that gets involved wherein you lose heart and that makes the erection go away even more.



You don't state if you've tried any of the PDE-5 inhibitors. Viagra is the most well know. The first discussion with your doctor is whether to try it and what's the best dosage for you. Then, make sure to not eat before taking the Viagra; take it on an empty stomach. It works better that way. Play with how long before taking it to not eat. And you may need to adjust dosage. The next discussion after Viagra would be whether Cialis might work better for you. Yes, they both are PDE-5 inhibitors. But they have some differences and some men do better with one versus the other.

Next, a penile pump and ring may be helpful as well. There's a lot of history with a vacuum pump and penile ring. Here's some information:

http://www.medicinenet.com/penis_prosthesis/article.htm


After these options there are two other medical options. The way most patients choose between them is they decide which application method they're most comfortable with.


Intracavernosal penile injections (IPE) have been shown in research to be the most effective medical ED treatment option. But intraurethral alpostradil (called MUSE commercially for Medicated Urethral System for Erection) is a close second.


They both involve applying something to the penis under the skin. But the word injection gets some people nervous, whereas the MUSE uses an applicator that's inserted into the tip of the penis. Even though many people are queasy about injecting their penis, once they are used to it, there is very little complaint. The first application of either medication requires it to be done in a supervised fashion. That's important. So make sure your doctor doesn't just describe the procedure. No embarrassment allowed here.


The other determining factor is side effect. The most common for IPE is pain. For MUSE it's a burning sensation. Now when I say common, I mean reported, not that everyone gets these side effects. But the success with either of these methods has been well documented without any problems for most men who try them.

Okay, I wish you the very best!

My goal is for you to feel like you've gotten Great Service from me and the site. If we need to continue the discussion for that to happen, then please feel free to reply and we'll continue working on this. If the answer has given you the help you need, please remember to give a rating of 5 (Great Service) or 4 (Informative and helpful), or even 3 (Got the job done) button. This will make sure that I am credited for the answer and you are not charged anything more than the deposit you already made by pressing any of these buttons. Bonuses are always appreciated! If I can be of further help with any issue now or in the future, just put "For Dr. Mark" in the front of your new question, and I'll be the one to answer it. All the best, XXXXX XXXXX

Customer: replied 3 years ago.

thank you for your reply.


Yes I have tried Viagra. It helped with the erection but not with the ejaculation or the feeling that comes with it.


 


I live in a rural area between St Louis and Kansas City. Other close cities are Jefferson City and Columbia, MO. Where would I best find Urologists who can treat my problem.


 


Finally are IPE and MUSE treatments for the erection or the feeling of ejaculation?

Unfortunately, both are going to address the erection issue much more than the ejaculation feeling. That is going to be a tough one because the neurological pathways may have deactivated. But again, you need to see an expert in this.


I would think that the University of Missouri might have doctors who are experienced. However, I couldn't find anything on their website that would indicate any interest at all. I just spent quite a bit of time navigating through their site and not anything about men's issues came up and only urological surgery or oncology. That is disappointing. St. Louis is a big city (as is KC) with university hospitals.


I still think that asking your primary care physician to look for help in identifying someone in St. Louis, KC or Columbia is the best way to proceed. Putting the word out through the professional network is often very effective.


I wish you the very best!

My goal is for you to feel like you've gotten Great Service from me and the site. If we need to continue the discussion for that to happen, then please feel free to reply and we'll continue working on this. If the answer has given you the help you need, please remember to give a rating of 5 (Great Service) or 4 (Informative and helpful), or even 3 (Got the job done) button. This will make sure that I am credited for the answer and you are not charged anything more than the deposit you already made by pressing any of these buttons. Bonuses are always appreciated! If I can be of further help with any issue now or in the future, just put "For Dr. Mark" in the front of your new question, and I'll be the one to answer it. All the best, XXXXX XXXXX

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