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Suffering from erectile dysfunction and testicle pain after masturbation. Sign of impotency?

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Dr. Jonas Sundarakumar

Psychiatrist

Practicing since :2003

Answered : 2190 Questions

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Posted on Wed, 6 Feb 2013 in Men Sexual Problems
Question: I consulted a doctor (general physician on this website) and following is the consultation given:

MY QUESTION:
I am 25 years old male, not married. My problem is that i am not able to sustain erection for long and i tend to ejaculate in 10 to 15 seconds only during masturbation. This problem is from the beginning. And after masturbation i feel little pain near testicles area like thighs, hips and all. Also i am feeling that erection is not so hard. Is this impotency? Can it be cured? I am worried about my "to be married life". Please advice.
I got my total and free testosterone levels checked which were 296 ng/dl and 28.30 pg/ml respectively. My vitamin 25 Hydroxy (OH) Vit D level is 6.90 ng/dl.
     
DOCTOR'S REPLY:
Hello,

Thanks for query.
You maybe suffering from Erectile dysfunction with Premature Ejaculation. Both can cause sexual dissatisfaction in married life,specially to your partner.
In erectile dysfunction,a man is unable to get or maintain erection for certain time, which is needed firm enough to complete sexual intercourse. In Premature Ejaculation,male ejaculate within 1 min or prior to intimate/sexual intercourse with partner. If both condition last for long time,they can cause impotency/loss of libido / infertility after married life.
Your all lab test values are below normal range. Normal values for Total & Free Testosterone are 300-1000 ng/dl & 35-155 pg/ml and normal Vitamin D level is 20-56 ng/dl. You have low testosterone with much more deficiency of Vitamin D.There are several reasons to be ruled out like Hypogonadism,Psychological, Smoking/alcohol, Some drugs,Prostate Hypertrophy/Prostatitis, Varicocele/hydrocele, Arthritis or Autoimmune disorder,High BP,Diabetes,Thyroid problem,Neurological causes etc.
A complete clinical examination is needed by urologist/sexologist to confirm diagnosis.Please do consult with any one of them to take suggestive measures.
Do the following things for life style modification & Prevention of above condition:
1) Quit smoking and alcohol.You may need psychotherapy /counseling.
2) Decrease frequency of masturbation if you do.
3) Take healthy diet, do physical exercise regularly and maintain personal hygiene.
4) Avoid stress/psychological upset/depression by regular XXXXXXX breathing/ yoga.
5) In Premature Ejaculation:
a) Master & XXXXXXX / Stop & Start Technique are very good and much helpful. You can google about them.
b) Use anaesthetic gel to desensitize penis or condom for temporary delaying
c) Certain drug like Dapoxetine, a class of SSRI,short acting and well approved.
d) Intracavernous Therapy with injecting vasodilator substance to control premature ejaculation & maintain erection.
e) Kegel exercise or strengthening of PC muscle by contraction and relaxation as on holding & releasing urine.
6) Drug like Sildenafil may be helpful in treating erectile dysfunction. Discuss with urologist/sexologist.
7) Need Vitamin-D supplements with Testosterone Depot Inj /Androgenic drug to increase testosterone level.
8) Need proper sleep,Avoid hot working place and tight underwear.
Hope I have answered your query. If you have any further questions I will be happy to help.
Wish you good health.

MY FOLLOW-UP QUESTION:
Thanks doc for the answer.
Shall i start the drugs suggested by you now or after marriage? As in are there any side effects of the drugs? And can this be treated successfully?
Also please tell whether i should stop androanagen tablets?

DOCTOR'S REPLY:
Hello,
Thanks for follow up query.
You might need a complete clinical examination with some investigations as done by Urologist / sexologist to pin point a diagnosis. A complete treatment can be done based on the evaluation. Therefore consider consulting them before starting treatment.
Vitamin and Testosterone supplements may be started after complete examination and obviously before marriage to get rid of those problems.
Drugs like sildenafil have short lived effects and are helpful only when taken a few hours before sexual activity. Should you need this drug, it can only be taken a few hours before sexual intercourse.
The drugs have some side effects but are tolerable. You may consult with your physician if any drug reaction occurs.
In the interim need not change Androanagen tabs as it is very much helpful in treating hair fall and without sexual side effect.
If you do not have any clarifications, you can close the discussion and rate the answer.
Wish you good health...

PLEASE ADVICE ON THE ABOVE. I really want to get rid of this problem before marriage. Please give your views. Kindly prescribe the drugs required or tests to be done.
doctor
Answered by Dr. Jonas Sundarakumar 1 hour later
Hello,

I can understand that you are quite anxious and worried about your sexual problem. Firtly, I would like to calrify that as long as you are able to get an erection, masturbate and ejaculate, you don't have impotency. Impotency is a condition where there is failure to get an erection. From the description of your symptoms, your predominant problem seems to be premature ejaculation along with poor quality of erection.

Actually, premature ejaculation is a very common problem in young males and many men start having doubts and fears before marriage regarding this issue and their future sexual performance in married life.

Now, like the previous doctor has mentioned, the first and most important step in the management of sexual problems is a comprehensive evaluation. This will include a detailed medical, sexual, personal and social history, a thorough physical examination (including a nervous system examination and checking blood pressure) and certain investigations, as per the necessity. In your case, I'm not sure what all investigations have been done, but I would suggest the following basic investigations: hemoglobin, blood sugars, urea, creatinine, lipid profile, thyroid profile.

Regarding the testosterone and vitamin D levels which you have already done, the testosterone level is just below the normal limits, but the vitamin D levels are quite low. I would suggest that you have a repeat of the testosterone levels - better to have morning (8am to 10 am) levels tested, because testosterone levels can be variable from day-to-day, and levels also change throughout the day, particularly in younger men. Testosterone levels are also affected by protein levels in the blood. Sometimes low levels of protein will cause measurements of total testosterone to be low. You may also need other hormone tests like FSH / LH, GnRH and Prolactin levels. So, I would not rush into testosterone replacement treatment before getting a clear picture. But regarding the vitamin D levels, you will definitely need further treatment with vitamin D injections.

Now, the good news is that in more than 90% of persons with the problem of premature ejaculation, there is no medical abnormality causing this. Most of the times, the underlying causes are the following:
1) Subconscious anxiety / fears / doubts about inadequate sexual performance (called as "performance anxiety")
and / or
2) A sensitization or hypersensitive response of the penis

Treatment of premature ejaculation problem is behavioural techniques as well as medication, in some cases. Usually medication is kept only as the last resort as most of the problems will resolve with proper behavioural techniques.

I would suggest the following tips to overcome this problem:

1) Firstly get rid of thoughts that you may be sexually inadequate or your doubts that you may not be able to perform properly. Like I mentioned before, performance anxiety, feelings of sexual indequacy, self-doubts, guilt, past negative sexual experiences, poor communication / understanding with the partner, etc. can all affect sexual functioning and performance. So, removing the person's doubts and fears, and improving his self-confidence levels will definitely help in improving sexual performance. Remember that sex is not just a physical act but also a psychological process involving an expression of emotions, intimacy and love. So, just involve yourself in those feelings and stop focussing on your "performance" alone. Once you do that, then I assure you that your sexual performance will automatically improve.

Most importantly, performance anxiety soon becomes a "viscious cycle" That is, anxiety leads to poor performance and poor performance then leads to further anxiety and this keeps on increasing. So, the key is to break this cycle at some point of time and take control of yourself.

2) The second cause for pre-mature ejaculation is hypersensitivity of the penis to touch sensations. Now, there are certain specific sexual techniques which can reduce this hypersensitivity. The "stop-start technique" or "squeeze technique" have been proven to be successful in reducing this hypersensitivity and increasing the ejaculatory time.

In the stop-start technique, the penis is stimulated (by sexual intercourse or by masturbation) till a point when you feel close to orgasm. At that point, the stimulation is stopped for some time and after a small gap, it is continued. This process is repeated repeated a few times.

In the squeeze technique, the penis can be stimulated by hand (by masturbation or by your partner) till a point when you feel close to orgasm. At that point, the lower part of the head of the penis is squeezed tightly with the index finger and thumb around for a few seconds till the erection decreases. Then the stimulation is restarted and the process is repeated a few times.

Both these techniques, if practised regularly can definitely increase your time taken for orgasm.

3) One more problem responsible for early ejaculation is inadequate sexual arousal. When the person is not properly aroused, the blood flow to the penis is not maximal, and so, after a few strokes, the erection weakens and ejaculation occurs. The way to tackle this is not to rush into masturbation quickly, but wait till you get fully aroused.

4) There are also certain medication like Dapoxetine (Prilyxet), which can help you with this specific problem of premature ejaculation. But like I mentioned before, medication should be kept only as a last resort after trying the behavioural methods and sexual techniques.

It is also important to avoid alcohol and smoking and eat a healthy & balanced diet, exercise regularly and try to stay positive and stress-free.

So, in conclusion...
- Don't get too alarmed by the low testosterone test results. Repeat the test (in the morning time) and take the other tests which I have suggested.
- Have a thorough physical examination - including genital and nervous system examination.
- Get treatment for the low vitamin D deficiency.
- Practice the sexual techniques which I have suggested
- Get rid of your anxiety, doubts and fears regarding your sexual performance. You can try yoga or meditation to relax your mind and relieve the anxiety.
- Further medication for your sexual problem can be decided after the evaluation results.

Wish you all the best.

- Dr. Jonas Sundarakumar
Consultant Psychiatrist & Sexologist

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Jonas Sundarakumar 15 hours later
Thanks for your response doctor...

I have attached my detailed report which was conducted around a month back. Please review and give your valuable comments.
Also i want to tell you that the blood sample for these tests was taken at around 10:30 am. I am taking Calcirol (one per week) for vitamin D.
doctor
Answered by Dr. Jonas Sundarakumar 9 hours later
Hello again,

I have reviewed your reports in detail. Except for the low vitamin D level, there is nothing seriously concerning. Like I had mentioned before, the total testosterone levels is just in the lower range of the normal limits, and the free testosterone (which is a much more reliable indicator of testosterone levels) is within the normal range. So, my personal opinion is that you don't have to worry much about the hormone levels.

I would advise you to continue to take the calcitriol supplements and try the psychological and sexual techniques which I have suggested. You can also try Dapoxetine, as it is an approved and safe drug for the treatment of premature ejaculation. With these remedial measures, your problem should most likely get resolved. In case it still persists, then you have to consult a sexologist in person for a more detailed evaluation and further management.

Wish you all the best.

Regards,
Dr. Jonas Sundarakumar
Consultant Psychiatrist & Sexologist
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Jonas Sundarakumar 47 hours later
Thanks doctor for a positive response which makes me feel better..

Can you suggest me the dosage and course of dapoxetine??
doctor
Answered by Dr. Jonas Sundarakumar 10 hours later
Hello again,

Dapoxetine tablets (available in India as Prilyxet) can be taken at a dose of 30mg. It is advisable to take it as "on-demand" or whenever needed only - 1 to 2 hours before intended sexual activity. The dosage should not exceed more than one tablet per 24 hours. It usually takes 2 weeks for the medication to become fully effective, so you have to be patient till then.

Don't forget to try the sexual techniques also and to keep your mind relaxed and free of anxiety.

Best wishes,
Dr. Jonas Sundarakumar
Consultant Psychiatrist & Sexologist

(Kindly close this query and leave a review if you are happy with the answer.)
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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