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Suggest treatment for erection problems, anxiety and OCD

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Posted on Sat, 30 May 2015
Question: I've had erection problems for a long time. I failed to have erections since i was around 16 or 17 many times. At that age i went to a urologist and he told me that everything was fine i.e. testosterone levels, other hormones, and physical organs. I went to another urologist when i was 24 and he told me the same thing. I did MRI but it showed no problem either. I was told that i was nervous, but after several tries i know that's not the case. Even when i'm by myself, manual ejaculation is necessary to have an erection. I tried quiting smoking and alcohol, I exercised regularly, did kegel exercises, and i tried not masturbating for a couple of weeks. Nothing worked. I dont have any thyroid problems, my zink and vitamin levels , including vitamin D, are fine, i'm not depressed, i don't have diabetes or high blood pressure. Basically im in good health.

I got so frustrated that I considered the idea that i might be XXXXXXX but watching XXXXXXX porn did not do anything for me, and i was never attracted to masculinity . On the other hand, I enjoy female porn, and i have strong desire to engage in sexual intercourses with women. However, i still cant have an erection without manual or oral stimulation. In occasions my erection weakened during vaginal intercourses. Also i never have morning erections.

What else can i consider and what else can i do to fix or mitigate my erection problem without using drugs such as viagra or substances like genko belboa, gensing, or amino acids?
doctor
Answered by Dr. Saatiish Jhuntrraa (5 hours later)
Brief Answer:
Please evaluate on the scales suggested

Detailed Answer:
Hello
Thanks for the query.
I looked at your previous questions . you were having depression and took effexor for some time. From your description, it seems you expect a spontaneous erection and you have tried to quit smoking and alcohol. So are you still taking these drugs of abuse? You need to evaluate yourself by Hamilton's Anxiety Rating scale and YBOCS for obsessive symptoms. these two are responsible for erection problem in a large number of persons with ED with all physical tests normal. I need to understand your psychological status from beginining to help you.

The Hamilton's rating scale for Anxiety and XXXXXXX Brown Obsessive Compulsive scale are readily available free on the web. You can download it and send me the results. We can start our discussion based on the results.

Dr Saatiish Jhuntrraa
Above answer was peer-reviewed by : Dr. Prasad
doctor
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Follow up: Dr. Saatiish Jhuntrraa (25 hours later)
Hi doc,

Thank you for the prompt response.

I took the Hamilton's Anxiety Rating scale and the YBOCS and scored 18 and 15 respectively. Regarding smoking and drinking, i meant that i have successfuly stoped them to test if stoping them would improve my ercetile problems, but I didn't notice any effect. About depression and taking effexor, i have suffered from depression through much of my adulthood, but the depression is cyclical, and my erections don't improve much when I'm not depressed.

You are right. I want to have spontaneous erections. I want to add one thing that might help your diagnosis. It's oddly easier for me to get erect when I drink alcohol, and I experience harder erections when i smoke marijuana.

I hope this helps.

Thank you
doctor
Answered by Dr. Saatiish Jhuntrraa (2 hours later)
Brief Answer:
Please inform whether taking any medicine now

Detailed Answer:
Hello
You have significant anxiety and mild to moderate OCD as per your scoring. This can explain the persistent ED Stopping drugs of abuse help by ensuring no further damage but it will not result in immediate recovery. You need to control there anxiety symptoms first to have a good erection. in your previous query, you had mentioned to have taken very very high doses of effexor , please do not repeat this with any psychiatric medicines as this can be fatal. marijuana and alcohol will result in erection but can be extremely harmful and lose their "potency after some time. Please explain whether you are taking any medicine now.
Dr Saatiish Jhuntrraa
Above answer was peer-reviewed by : Dr. Pradeep Vitta
doctor
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Follow up: Dr. Saatiish Jhuntrraa (1 hour later)
I'm currently on effexor 150 mg as per my psychiatrist instructions. It used to work on my GAD, but it has lost its effects. Im also on Wellbutrin (Bupropion), a dopamine norepinphrine reuptake inhibitor as a combination with effexor to treat depression. It increases my libido, but i still need manual stimulation.,
doctor
Answered by Dr. Saatiish Jhuntrraa (1 hour later)
Brief Answer:
Add udenafil 50-100 mg

Detailed Answer:
Hello
Combination of Effexor with wellbutrin is very good as it enhances all the monoamines but both enhance norepinephrine . You are scoring high on YBOCS so Effexor would be less effective . Instead Escitalopram 20-30 mg is aa much better choice . I think, it is unfair to expect your penis respond by itself all your age. It was the pattern in twenties but things are going to change with addition of years to age. if you can get erection after foreplay , it improves the quality of sex. Not having spontaneous erection is not a disadvantage . Still, you can add tab Udenafil 100 mg at night after 1 hour before sex . Be careful about possible headache ,in which case, need to reduce to 50 mg
Dr Saatiish Jhuntrraa
Above answer was peer-reviewed by : Dr. Vaishalee Punj
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Dr. Saatiish Jhuntrraa

Sexologist

Practicing since :1983

Answered : 1525 Questions

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Suggest treatment for erection problems, anxiety and OCD

Brief Answer: Please evaluate on the scales suggested Detailed Answer: Hello Thanks for the query. I looked at your previous questions . you were having depression and took effexor for some time. From your description, it seems you expect a spontaneous erection and you have tried to quit smoking and alcohol. So are you still taking these drugs of abuse? You need to evaluate yourself by Hamilton's Anxiety Rating scale and YBOCS for obsessive symptoms. these two are responsible for erection problem in a large number of persons with ED with all physical tests normal. I need to understand your psychological status from beginining to help you. The Hamilton's rating scale for Anxiety and XXXXXXX Brown Obsessive Compulsive scale are readily available free on the web. You can download it and send me the results. We can start our discussion based on the results. Dr Saatiish Jhuntrraa