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What causes erectile dysfuntion?

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Posted on Mon, 20 Oct 2014
Question: Hello Doctor,

Hope you remember, couple of week back we were have conversaion about my ED problem also you looked at my Penile doppler test report that I sent.
I got few question doctor.
My erection details In this month september :
Ist week : I was able to have intercourse with my wife starting from (Friday to Sunday) with proper ejaculations.
2nd Week: I was able to have intercourse with my wife on (Friday and Saturday )
3rd Week : I was able to have intercourse on friday couple of times ( after coming back from office and at night) I was ended up up with no ejaculations, but on saturday and sunday I got week erections and sometimes I got erections but not able to maintain it.
4th Week: Yesterday night, got erection I believe not a effective had intercourse but not no ejaculations.
I addition to this, for last 3 days in my spleep I'm getting week erections and it's not maintaining for longtime like before in this 5 months.
Why I'm seeing this varations in my erections?.
Does my erections getting worst?
Please suggest me.
doctor
Answered by Dr. Ashok Kumar (3 hours later)
Brief Answer:
variability is rule in biology

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

Before I answer I need to know few questions from you.

1. Do you have same energy or concentration every day ?
2. What happens to your work performance if you are stressed due to some thing?
3. What happens to you if you are convinced that you are going to lose before you start?
4. What you feel if something goes wrong at your work? After each failure do you think you are loser?

Exactly I want to say the answer to your question lies in the answers of the above questions.
By the day we know from each specialist that physically there is nothing wrong with your erections. Nornal variations do occur in everypart of our life and erection is not different.

No disease affects in such a way that you notice difference in performance as described by you without any abnormality. If this pattern of ed occur that can be detected by doppler etc.
Please be assured that these are just normal variations and that occur due to various factors including psychological.

I hope this answers your question. If you have any questions I am always at your service.
Feel free to write to me.
Thanks and regards.
Above answer was peer-reviewed by : Dr. Vinay Bhardwaj
doctor
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Follow up: Dr. Ashok Kumar (22 hours later)
Hello Doctor,

I completely agree with you doctor and my answers to your questions as follows :
1. Do you have same energy or concentration every day ? NO
2. What happens to your work performance if you are stressed due to some thing? I can't perform well.
3. What happens to you if you are convinced that you are going to lose before you start? I can't win either will try hard to win
4. What you feel if something goes wrong at your work? After each failure do you think you are loser? No will try to improve and will try to do better next time.

I never saw such kind of variations before I got married or After I got married untill ED issue started.
Before I got married, I was lot more under stress and anxiety with various reasons but then I use to get erection with in no time while I see pronography or when ever I like to mastrubute to get relief my self from stress.

In 2013 XXXXXXX I got married, I still see the same erection behavior and was able to have sexual intercourse with my wife with out any issues, I believe my ED problem is started in April only after I applied Navarthana oil (Mint Oil) unfortunately, since then I was started thinking only about my ED problem.but from penile doppler ultrasound report shows every thing normal.I still believe there is something missing in the report which was not identified by urologist or there might be any microscopic injuries happened to penile due to mint oil i applied.
my question is, In my penile doppler report says every thing is normal then why I'm not getting my erection like before my marriage or like before problem started its been almost 5 month's. Is my ED problem caused because of Navartna oil (Mint Oil) for this same quesstion you gave me as NO navartna oil can't cause any damage. I would like to know why navartna oil can't cause damage if penile skin is senstive and that got lot of nerves on it does oil will not penetrate in to erectile tissue?

Please help me to understand.
do I need to go through with any further physical test's to know the cause of my ED problem

Thanks
doctor
Answered by Dr. Ashok Kumar (14 hours later)
Brief Answer:
you do not need any further investigation

Detailed Answer:
Hello,
Thanks again for posting a query directly to me.

I think theoretically the answer is yes, it may cause damage to nerve ending but practically not.
But the erection is a complex mechanism which involves both sympathetic and para sympathetic nervous system. The nerve endings from the surface of penis are responsible for sending signal to spinal cord regarding sensation and that sensation is integrated with higher nervous center (which involves thinking, smell, sight and pleasure mechanism). I like to emphasize here that the erection is generated from higher centers and spinal cord. The superficial nerves have minimal contribution for erection, they are responsible for pleasure that generates following sexual stimulation.

In case there is damage to nerve endings at penis it is possible that you will not feel anything while sex. It is also possible that you may not sense the touch of your hands or your partner's manipulation. As per my knowledge the sensation is perfectly normal for you and you never complained of same in last one month.

I also agree with microscopic damage but to my knowledge if that happens why you should have the normal erection in first and second weeks of September.

Your statement "since then I was started thinking only about my ED problem" underlines the pathological mechanism. Since as a men we attach lot of ego to penis (it is prevalent in all cultures), a single failure perpetuates vicious cycle of erectile dysfunction. Due to this ego we tend to believe that something is wrong or doctor is missing something. This vicious cycle of thoughts aggravates the problem. If somebody gets the second occasional failure or third one they have the idea at delusional level.

We at this stage need to break this vicious cycle. Since we do not have direct conversation and answering a query has its own limit if things are over whelming for you, seeing a local therapist is better idea.

I am not in favor of any further investigation. We as a human being has tendency to attach some cause for anything. If we gt succeed we say that was my good luck, that was due to praying. Most of the time we do not try to realize our potential hard work. In contrary to that if we fail at some where, we attach all responsibility to internal factors like past sin, family or so on(exceptions are every where).

At this stage there is need to stop blaming the Navratna oil. There is nothing with the mint oil. It was only co incidence that made you to thought in some particular line.
I hope this clears some doubt at your end.
"If you do not have any clarifications, you can close the discussion and rate the answer.
Wish you good health".
Above answer was peer-reviewed by : Dr. Prasad
doctor
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Follow up: Dr. Ashok Kumar (6 hours later)
Hello Docotor,

Regarding Senses, I'm having senses when either my self and my wife touches penile, I've tested by moving my hand all around my penile and I can feel sense moreover, while I penetrate while intercourse or while ejaculations I can feel senses also while I'm in sleep, when I rub my penile with hand I'm getting erections.

Regarding Simulations, before my ED problem started I use to get erections with in notime while I watch pronography videos or when I like to mastrubute to get relief from stress, but now I see the difference though I watch pronography videos for 30 mins also I'm not getting nay erections and I tried to mastrubute some time i get week erections or sometime my penile becomes big but no erections sometime i get strong erections.

before my ED problem, I use to get erections with in notime when ever I want to or in our foreplay but now things been completely different after a long foreplay I may get strong erections, may be no erection ,sometime week erections lastely I may not sustain erections.

Very rearly I'm getting erections, If start getting erections I will get erections continiously for 10 days sometime for 4 days or weekly once during this time I was able to ejaculate, later I'm getting back to ED problem state.

Please suggest me does any of my symptoms matches to your above answer related to nerve senses? hypothatically If I have problem with nerve senses can that be cured?

In USA getting hold of neurologist is very difficult when compared with other specialist

Please let me know.

Thanks
doctor
Answered by Dr. Ashok Kumar (1 hour later)
Brief Answer:
No this does not match with nerve loss

Detailed Answer:
Hello,
Welcome back.

No your symptoms does not match for criteria of nerve loss.
It was my attempt to explain that the Navratna oil is not responsible for your condition.
There is no place for hypothetical condition and treatment as it is not reported in literature. Since it is not a condition or disease so no treatment described anywhere.
But yes theoretically treatment is possible as few of the molecules help in generation of new neurons.

The variations you see in your erections are indicative of psychogenic ED and no disease present in such form.

I agree that appointment with neurologist is difficult but you do not need to visit neurologist. You can visit a psychiatrist, psychologist or sex therapist. These experts are well versed in treatment of psychogenic erectile dysfunction.

I hope this clears the way for future treatment.
"If you do not have any clarifications, you can close the discussion and rate the answer.
Wish you good health".
Above answer was peer-reviewed by : Dr. Ashwin Bhandari
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Dr. Ashok Kumar

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What causes erectile dysfuntion?

Brief Answer: variability is rule in biology Detailed Answer: Hello, Thanks for reverting back to me. Before I answer I need to know few questions from you. 1. Do you have same energy or concentration every day ? 2. What happens to your work performance if you are stressed due to some thing? 3. What happens to you if you are convinced that you are going to lose before you start? 4. What you feel if something goes wrong at your work? After each failure do you think you are loser? Exactly I want to say the answer to your question lies in the answers of the above questions. By the day we know from each specialist that physically there is nothing wrong with your erections. Nornal variations do occur in everypart of our life and erection is not different. No disease affects in such a way that you notice difference in performance as described by you without any abnormality. If this pattern of ed occur that can be detected by doppler etc. Please be assured that these are just normal variations and that occur due to various factors including psychological. I hope this answers your question. If you have any questions I am always at your service. Feel free to write to me. Thanks and regards.