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Erectile Dysfunction (ED)

Erectile Dysfunction question

02/20/2006

Question:

Hello, I am a 21 year old male and I have been experience some erectile dysfunction. For some history, about 8-9 years ago I had abdominal surgery. They removed 80-90% of my colon. My abdominal situation is fine now (completely healthy). My erections were fine after this for about 5-6 years, so I don`t think the two problems are connected. Starting about 3 years ago, my erections became less firm. This phenomenon occured during a 1-yearish episode of depression, which I immediately linked to this symptom. It is now 3 years later, however, and I am not depressed at all anymore and I have not been for about 2.5 years. The problem has continued and even gotten worse. I do not often experience morning erections. They do occur occasionally, but quite infrequently. Whereas I used to get spontaneous erections and be able to achieve erection just by visual stimuli, this is no longer the case. I almost always need direct stimulation for a chance to achieve erection. When I masturbate, I almost always achieve erection and maintain it with continued stimulation. However, the glans often does not become hard although the shaft is. If I discontinue stimulation, the erection disappears quite quickly. Often, if I stand up, even with continued stimulation, the erection disappears. During intercourse, there are rare times when I can maintain an erection for a longer period of time (15-30 minutes). But as said, these times are rare. Sometimes (about 1 time out of every 5 sessions) I lose my erection during intercourse. Sometimes I am able to get it back. I am not experiencing performance anxiety and I have spoken with my partner about the problem. I do not think that any (conscious) psychological difficulty is affecting this. The soft glans during erection as well as the quick drainage after the cessation of stimulation (and standing up) leads me to suspect the problem might be related to venous leakage. However, does this theory clash with the occasional secure erection? What do you think the likely cause of this is? I have done all the reading on drugs, etc. What treatment options are available, if any, that are more permanent? Thank you very much.

Answer:

This is a complicated case. you will need a very thorough evaluation, both from a physical and psychological standpoint.  You may need to see a urologist and a psychologist to get the process started.

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Response by:

Allen D Seftel, MD Allen D Seftel, MD
Formerly, Professor of Urology
School of Medicine
Case Western Reserve University