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Urodoc, Doctor
Category: Urology
Satisfied Customers: 8013
Experience:  M.D with over 30 years of experience in practice.
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How are you? Good thanks I have a question about which

Customer Question

Hi How are you?
JA: I'm good. And you?
Customer: Good thanks I have a question about which specialist do I have to meet regarding a sexual issue
JA: Glad to hear it. What is your issue regarding?
Customer: It's not gitting hard unless if I took ciales or Viagra
JA: Have you seen a doctor about this yet? What medications are you taking?
Customer: Nothing One family doctor gave me viagra
JA: Anything else in your medical history you think the doctor should know?
Customer: No
Submitted: 1 month ago.
Category: Urology
Expert:  Urodoc replied 1 month ago.

Hello and thanks for trusting me to help you. I am a board certified consultant with over 30 years of experience.
Please provide more information regarding your question so I can help you in detail.

What is your age?

Any medical history like Diabetes,hypertension,etc?

Are you taking any medications?

Since how long have you been suffering from?

Any investigations so far?

Do you have stress and anxiety?

Alcohol and smoking history?

Do you notice nocturnal/morning erections?


Waiting for your response.

Customer: replied 1 month ago.
I am 27.
No medical history.
No I'm not taking any medications.
Started 5 years ago until this moment.
I have stress a little bet.
No I don't drink and I never smoked.
no I didn't notice anything.
I need your help so much because I'm a married man and this keep embarrassing me since I got married 3 years ago.
Expert:  Urodoc replied 1 month ago.

Thanks for all these additional information.
I understand your concern.

Well as you describe,inability to maintain an erection can be a sign of erectile dysfunction(ED).

Psychological factors such as stress, anxiety, guilt, depression, low self-esteem, and fear of sexual failure,poor performance anxiety cause 10 to 20 percent of ED cases.
In most of the cases,it will improve if they simply stop having sexual intercourse for a while and instead focus on enjoying the physical sensations of pleasure rather than sexual arousal.
Fore play can be very important and help improve erection.
Also regular exercise helps to have a good sexual life.

Monitoring erections that occur during sleep can help rule out certain psychological causes of ED.

Healthy men have involuntary erections during sleep.

If nocturnal erections do not occur, then ED is likely to have a physical rather than psychological cause.

As you are suffering from last few years so you should get your detailed physical examination including blood sugar levels,CBC, urinalysis, lipid profile, serum creatinine and LFT, free testosterone to rule out any systemic physical cause of ED as well.

Further utrasonography of testes, penile nerve test,snap and strain guage test,penile biothesiometry can be done.

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.

Now line of treatment may include

1)Sildenafil (Viagra), vardenafil (Levitra) and tadalafil (Cialis).You didn't get any improvement.

2) Use of intraurethral suppositories,the vacuum device, and intracavernous injection.

3)Placement of a penile prosthesis. This is a surgical option.

4) Combination therapies like

Sildenafil Plus Intraurethral Prostaglandin E1

Oral PDE-5 Inhibitors Plus Intracavernous Injection of Prostaglandin E1

Sildenafil Combined with an Oral Alpha-Antagonist

Intracavernous Prostaglandin E1 Combined with Oral Alpha-Antagonist

Vacuum device and intracavernous injection therapy

Testosterone Plus Sildenafil

For treatment you need to see a Urologist for further evaluation and management.

I hope this helps.

Let me know if you have any further query so we can discuss it thoroughly in every aspect.
Please use the REPLY/SEND BUTTON to reply back to me. It's request to avoid poor/bad rating.
It’s my pleasure to continue this conversation until you satisfy.
Waiting for your response.

Expert:  Urodoc replied 1 month ago.

It's my privilege to help you if you have any further query regarding your this health issue.
May I help you further?
Waiting for your response.

Customer: replied 1 month ago.
I used cialis but it didn't work at all. Viagra I took until 100 and that works. But the insurance don't cover the viagra because I have different insurance than before. Do you recommend Levitra? If yes how can I get it from a pharmacy?
Expert:  Urodoc replied 1 month ago.

This is a prescription only medication and you should visit your primary care doctor.