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What Causes Erectile Dysfunction?

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Posted on Thu, 7 Sep 2017
Question: Hello doctor I am 27 year old XXXXXXX male, i have always had weak erections from the start. I attributed it to a short frenulum due to which i was not able to retract my foreskin completely. One year back i had frenulum lenghthening surgery after which my erections improved. I feel my frenulum is still short and i need another surgery. Because I am not able to retract it completely in erect state.
Also i am not able to get erections without physical stimulation. I get little stronger erection while watching porn and stimulating continuous and tend to loose the erection a soon as i stop shaking the fore skin. I dont remember getting any morning erection recently. Although i had a spontaneous erection recently without any physical stimulation.
I have never had intercourse so I cant comment on what will happen while i am with a girl.
My masturbation habits for longest time of my life have been different. I used to masturbate and ejaculate in flaccid state by holding the tip of my foreskin and rubbing it continuously. I also used to lie on my stomach and rubbed my penis on the matress or floor in my teens. For few years I have stopped them completely and masturbated normally in erected state. Now I am worried about my ED because I am about to get married. I have been always avoiding the possibilty of having a sexual intercourse with someone due to my tight frenulum and unabilty to achieve hard erections. Kindly advise on what should i do?? Does my habit of masturbating has caused damage to my penile veins or since i have been ejaculating in flaccide state for years and not tried to achieve erections for years of my teenage. Also my penis has a slight down and left curvature.
doctor
Answered by Dr. Dr. Ashok Kumar Choudhary (44 minutes later)
Brief Answer:
Please provide more details

Detailed Answer:
Hello,
Thanks for using Healthcaremagic.

I read your query and understand your concerns.

Although you have provided lot of details but I think more information will help us to make a perfect diagnosis and so I am posting some of the questions related to your sexual health. You are requested to provide answers as detailed as possible.

1. How long you are facing this problem (ED) ?

2. How the problem started whether it was sudden in onset or build up slowly over the months or years?

3. Frequency of the problem in a week/month ? Are you able to have some successful sexual intercourse/masturbation?

4. In a typical month out of what number of sexual interactions/masturbation do not achieve success?

5. What are the factors that increase the problem ?

6. Factors that relieve the problem- thoughts, situations, partner, place etc.

7. Do you get early morning erection?

8. If yes how frequent and how intense?

9. What is the frequency of spontaneous erections?

10. Effect on your health so far due to problem

11. Details of medical illness, like duration, any complications, treatment received till date.

12. Medications you are receiving currently, if any including ayurvedic homeopathic or any other.

13. Medication you received in past and their effect?

14. Do you have any psychiatric illness (like anxiety, depression, fear)?

15. Investigations done till date and reports of most latest investigations- serum testosterone, TSH, T3, T4 and any other?


I must assure you that once we identify cause it will be easy to correct it.
I look forward to see more details.

Thanks and regards
Above answer was peer-reviewed by : Dr. Prasad
doctor
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Follow up: Dr. Dr. Ashok Kumar Choudhary (1 hour later)
1. How long you are facing this problem (ED) ?
Never had full erections from the start of puberty. Best erections that i have had was after frenuloplasty last year. I used bad masturbation techniques as explained in the question which might have damaged the penis. My erections are weaker at base and my penis bends downwards and falls down fast. Only able to get erection while masturbating which dont last for long. Spontaneous erections are very very rare. I still have short frenulum and looking for another frenuloplasty.

2. How the problem started whether it was sudden in onset or build up slowly over the months or years?

It has been the case throughout but i never worried about it much until recently.

3. Frequency of the problem in a week/month ? Are you able to have some successful sexual intercourse/masturbation?

Never had intercourse but can masturbate successfully, able to achieve 60-70 % erection while masturbating. But while masturbating to porn erections get stronger. In both cases erection dont last for long.

4. In a typical month out of what number of sexual interactions/masturbation do not achieve success?
I am able to masturabate and ejaculate even without strong erections.


5. What are the factors that increase the problem ?
Recent stress and lack of proper sleep has affected more i guess.

6. Factors that relieve the problem- thoughts, situations, partner, place etc.

Watching porn while masturbating increases the quality of erection

7. Do you get early morning erection?

I cant remember waking upto an erection for a long time.

8. If yes how frequent and how intense?

None recently. Even from when i remember long time ago, were not very intense.

9. What is the frequency of spontaneous erections?
Very rare although i got a spontaneous erection last week half asleep in a train.

10. Effect on your health so far due to problem

It has given me more stress

11. Details of medical illness, like duration, any complications, treatment received till date.

Had frenuloplasty once last tear, frenulum is still tight, looking for another surgery
Suffering from androgenic hairloss

12. Medications you are receiving currently, if any including ayurvedic homeopathic or any other

Multivitamin for hairloss

13. Medication you received in past and their effect?

None regularly

14. Do you have any psychiatric illness (like anxiety, depression, fear)?

I have been feeling stress and some kind of depression for last 2-3 months due to relationship issues, family loss and hairloss. Not able to have a sound satisfying sleep. I work in rotating shifts so do not have a same sleep schedule throughout the week.

15. Investigations done till date and reports of most latest investigations- serum testosterone, TSH, T3, T4 and any other?

Checked thyroid 3 years back was normal
Never had testosterone checked
doctor
Answered by Dr. Dr. Ashok Kumar Choudhary (12 hours later)
Brief Answer:
Please get following tests done

Detailed Answer:
Hello,
Thanks for reverting back to me with potentially useful details.

From the available description there is possibility of organic problem.

I request you to get following tests done from nearby laboratory

1. Complete blood count
2. Liver profile
3. Renal Profile
4. Blood sugar
5. Lipid profile
6. T3, T4 and TSH
7. Serum testosterone
8. Serum prolactin
9. LH and FSH
10. Penile doppler study

Once the tests are done report back to me with reports.
Thanks and regards.
Above answer was peer-reviewed by : Dr. Kampana
doctor
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Follow up: Dr. Dr. Ashok Kumar Choudhary (5 hours later)
Thanks doctor,
I have some more queries.
Can these tests be done without a written consultation from a doctor?Specially the doppler test. What would be the approx cost for the tests?
Should i consult a urologist first physically?
Should i go through second frenuloplasty before doppler ultrasound to get better accurate results? Also this thread is going to close soon. How can i contact you later when i get reports or if i need consultation in future.
doctor
Answered by Dr. Dr. Ashok Kumar Choudhary (1 hour later)
Brief Answer:
Follow up

Detailed Answer:
Hello,
Thanks for reverting back to me.

Since there was some improvement after first frenuloplasty it is possible that with better correction you can better results.

It is always better to consult a doctor in person as online consultation can not supplement the need for in person consultation. Only is better if there are no local facilities are available sort there is need for second opinion. I mean to say that it is better to consult a urologist in person if available.

The tests are possible without consultation provided you are in XXXXXXX In case no, you will need to see a doctor before going for test.

The approximate cost for all tests is around 4-6 thousand in XXXXXXX

For consultation you can approach me at www.icliniq.com/ashok

I hope this answers you.
Thanks again.
Above answer was peer-reviewed by : Dr. Vaishalee Punj
doctor
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Follow up: Dr. Dr. Ashok Kumar Choudhary (11 hours later)
Thanks doctor last thing I want to ask if these tests are to be done fasting and are all of them readily available in small towns in XXXXXXX I will have blood tests and then visit a urologist. Thanks
doctor
Answered by Dr. Dr. Ashok Kumar Choudhary (3 hours later)
Brief Answer:
Most tests are available

Detailed Answer:
Hello,
Thanks for follow up.

Yes most of the tests are available in smaller cities except penile doppler study. Some of the tests such as thyroid profile, lipid profile, serum prolactin are done at fasting so it is better to get all of them tested at same time.

Since this is the last follow up you are allowed for the current question I request you to open a new thread if there are more questions.

While posting another query please use my url which is as follows. This will ensure direct delivery of your question to me and continuity of care.

http://doctor.healthcaremagic.com/doctors/dr-ashok-kumar/67386

Thanks and regards.
Note: For further guidance on mental health, Click here.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
Answered by
Dr.
Dr. Dr. Ashok Kumar Choudhary

Psychiatrist

Practicing since :2000

Answered : 3355 Questions

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What Causes Erectile Dysfunction?

Brief Answer: Please provide more details Detailed Answer: Hello, Thanks for using Healthcaremagic. I read your query and understand your concerns. Although you have provided lot of details but I think more information will help us to make a perfect diagnosis and so I am posting some of the questions related to your sexual health. You are requested to provide answers as detailed as possible. 1. How long you are facing this problem (ED) ? 2. How the problem started whether it was sudden in onset or build up slowly over the months or years? 3. Frequency of the problem in a week/month ? Are you able to have some successful sexual intercourse/masturbation? 4. In a typical month out of what number of sexual interactions/masturbation do not achieve success? 5. What are the factors that increase the problem ? 6. Factors that relieve the problem- thoughts, situations, partner, place etc. 7. Do you get early morning erection? 8. If yes how frequent and how intense? 9. What is the frequency of spontaneous erections? 10. Effect on your health so far due to problem 11. Details of medical illness, like duration, any complications, treatment received till date. 12. Medications you are receiving currently, if any including ayurvedic homeopathic or any other. 13. Medication you received in past and their effect? 14. Do you have any psychiatric illness (like anxiety, depression, fear)? 15. Investigations done till date and reports of most latest investigations- serum testosterone, TSH, T3, T4 and any other? I must assure you that once we identify cause it will be easy to correct it. I look forward to see more details. Thanks and regards