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Male 31yo, otherwise healthy, no medication, no significant…

Customer Question
Hello, male 31yo, otherwise...

Hello, male 31yo, otherwise healthy, no medication, no significant medical history, would like to hear expert opinion on the cause of erectile dysfunction.

Doctor's Assistant: Any pain or burning sensation while urinating? What color is your urine?

No dysuria, normal color

Doctor's Assistant: Anything else in your medical history you think the doctor should know?

Inguinal hernia operation in 2011, but problems seem unrelated to time of operation.

Submitted: 8 months ago.Category: Urology
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Answered in 5 minutes by:
11/19/2017
Urologist: Dr. Arun Phophalia, Urologist replied 8 months ago
Dr. Arun Phophalia
Category: Urology
Satisfied Customers: 38,748
Experience: MBBS MS (Surgery) Vast experience and routinely perform all urology procedures including endoscopy.
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Welcome to Just Answer.
Answers here are for education and information.
I will respond shortly with an answer, or further information request.

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Urologist: Dr. Arun Phophalia, Urologist replied 8 months ago

For an healthy individual like you, the most important thing is that it a single 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.

Still if you feel that problem can be organic; you may consider to consult a urologist who would advise you the following investigations;

1) All hormones; thyroid, prolactin, testosterone, adrenal functions.

2) Autonomic nervous system testing;

Penile thermal sensory testing

3) Somatic nervous system testing;

Penile glans biothesiometry

Bulbocavernosus reflex latency test

4) Penile magnetic resonance imaging (MRI)

5) Penile angiography

6) Duplex ultrasonography

7) Combined intracavernous injection and stimulation

Please feel free for your follow up questions.

I would be happy to assist you further, if you need any more information.

Thanks for using Just Answer.

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Customer reply replied 8 months ago
Thank you for your reply.I don't have a partner.I understand there's 2 pathways to erection: psychogenic and reflex. I barely, if ever, have reflex erections (by touch alone). I can't remember the last time I had a spontaneous erection during waking hours. During masturbation, the only thing that seems to get me to an 8/10 quality erection is imagination - the psychogenic pathway.I have been to urologists, who have been generally not very helpful. During a long, long episode of almost total ED, I tried a regimen of Levitra, and that ended the episode completely - I was now able to perform without medical help for years.I feel pretty confident, I don't feel depressed, I don't worry excessively. But for the last 10 years, ED has been the norm, outside of periods of high sexual activity.I wonder about the lack of spontaneous erections and the inability to get erections by touch alone.
Customer reply replied 8 months ago
I was also under the impression I would be able to speak to a urologist - and a quick google search indicates you are a general surgeon. If that's the case, could I speak with a specialist?
Urologist: Dr. David, MD replied 8 months ago
Dr. David
Category: Urology
Satisfied Customers: 49,910
Experience: Experienced physican in Urology
Verified

This is Dr. David

I'm afraid a urologist is not available at his point.

I have helped 30,000+ clients here on JA

I am glad you have been able to have periods of high sexual activity

having periods of no erections between sex doesn't mean you have ED.

lack of spontaneous erections doesn't mean you have ED

ED is when you are wanting to have sex and with a partner and you are unable to have an erection able for penetration at that point

it doesn't sound like you have ED

let me know if you have questions.

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