Urology/ED..

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Question
Sir,
 I am 28 now. But I am facing a serious problem. I have a bad habit of masturbating from the age of 14.But from the last 2 years I have observed my sex power is reducing day by day and now at this stage I feel totally loss of sex power. First I thought it will be cured if I kept off masturbating.But the improvement was not seen.
I think I have ED cause my penis is not get hard enough if I think or see any exciting thing.If I do masturbate then very few amount of semen comes out and also it looks like water and and the speed of coming out is very low.
My nightfall has not been occurring for the last 1 year. But after 2 months ago It was happened just for one night but I felt pain when I got up.
My penis is also bent to the left and its size is reduced than before.When I get up from the sleep I understand that it is hard but then within few seconds the penis goes soften.
In this stage of age this types of serious problem hampering me to gain up my carrier. From the few months really I am in depression I know this will affect also the sex but as I came to know from doctor that there are no medicine yet invented to cure the this problem permanently and no treatment to cure the damage nerve its make me so hopeless.Just heard that these medicine is equivalent to cure as by taking medicine everyday then that day is cured from ED and if off for one day then ED start from then.
As I am an Asian here in India lot of herbal treatment available where they said within three months of course ED is totally curable and the also said penis can be also enlarged by1 to 2 inch but I don't believe as where modern medical have no medicine to cure it permanently then how a herb can do that.
Can you please give me a suggestion please. I am not married and and if ED is serious then Should it be married with girl by me as I don't want to waste another life to enjoy her life?

Regards

Answer
Hamed, I agree with you in that herbal medicines will not help you problem to any significant degree.  I also suggest that you avoid any of the techniques recommended to enlarge the penis because most of them have some complications that could make your ED worse.  Your main problem seems to be the ED and not penile size per se.  I don't know why you mention nerve damage as there is nothing in the history you provided to suggest this.  You need to see a urologist who has expertise in the evaluation and treatment of ED and not just a family doctor.  I no nothing about the medical facilities in Bangladesh but if no such doctor is available to you, most medical universities have such specialists.  I don't know if you have ever read the information I have written on ED so will attach my "macro" for you to read.  As you will see, there are many possible reasons for this and thus the need for medical evaluation.

As mentioned, there are many causes for erectile dysfunction (ED).  The most common diseases associated with this disorder are vascular conditions (ie atherosclerosis – “hardening of the arteries” and abnormal varicose veins inside the penis - so called "venous leak") and diabetes.  Some others include hormone imbalances, neurologic pathology, local penile diseases (ie Peyronie’s disease), smoking, obesity, alcoholism, prostatitis, prostate surgery, certain medications, "recreational drugs", trauma to pelvic nerves or vasculature and chronic perineal pressure from overly aggressive bike or horse back riding.  A variety of emotional disturbances (most commonly depression or performance anxiety) can also cause or be a significant factor in those suffering from ED.  Very commonly, the etiology is multifactoral.  As a result, consultation with a urologist skilled in the evaluation and treatment of ED is recommended.   

In addition to a history and physical examination, specialized tests may be indicated to find a cause.  Some of the commonly ordered studies include routine blood tests, hormone levels, and penile duplex color ultrasound.  

If a correctable cause is found, specific treatment is instituted.  If the condition is irreversible, most men today can still be restored to normal functionality with the numerous treatments available including oral medications in the class of PDE5 inhibitors  (ie Viagra, Levitra, Cialis & Stendra), vacuum erection devices (VEDs), confidence rings (for those with a pure venous leakage), penile injections (ie Edex, Caverject), urethral suppositories (Muse) and penile prosthetic surgery.   PDE5 inhibitors (in proper dosage which varies with the individual) have shown success in about 80% of patients.  Side effects may include headaches, flushing, heart- burn, nasal congestion, visual disturbances, dizziness, etc.  These drugs are contraindicated in patients with coronary artery disease who take nitrates (ie nitroglycerine) as some deaths have occurred in this group.   There is also the potential for a severe drop in blood pressure if PDE5 inhibitors are used in patients who take alpha- blockers (ie Hytrin, Cardura, etc.) or are hypertensive.  It is now a recommendation that not more than 25 mgm of Viagra be used within 4 hours of taking an alpha blocker  Several other types of medication may alter the blood level of PDE5 inhibitors possibly leading to significant side effects.  Other contraindications include certain types of liver and visual disorders (ie retinitis pigmentosa).  PDE5 inhibitors have been noted to cause abnormal liver function tests in some otherwise normal men.  Because of this, although PDE5 inhibitors are well tolerated by most, they should only be taken with caution and under the supervision of a physician.   All 3 of the PDE5 inhibitors available in the USA have about the same success rate.  If one fails to respond to the initial dose, it should be increased until either tolerance or the desired effect is obtained.  

The way one takes the PDE5 inhibitors may significantly affect their action.  The following should guide you in their administration. One should initially start with the lower dose.  

Cialis is available in 2 forms: daily use and long acting.  The former comes in 2.5 and 5 mgm. doses while the latter is available in doses of 5,10 & 20 mgm.  They  can be taken without regard to meals. The onset of action is 30-60 minutes for the daily dose and 30 minutes to 4 hours for the long acting form. Cialis for daily use lasts 4 hours while the beneficial effect of  the long acting form lasts 18-36 hours.    

Viagra is available in doses of 25, 50 & 100 mgm.  Levitra comes in 2.5, 5, 10 & 20 mgms doses.  Both medications have an  onset of action in 30-60 minutes and last about 4 hours.  They are typically taken 1 hour before planned sexual intercourse.  The absorption of these 2 medications can be adversely affected by diet, especially a diet high in fat.   Therefore, it is best to take these an hour or 2 after meals.

Stendra was approved by the FDA in April of 2012.  It comes in doses of 50, 100 and 200 mgms.  It has a rapid onset in the 15-30 minute range and lasts 3-6 hours.  It is not effected by dietary intake.  Although the potential exists to lower the blood pressure too much in men taking nitrates, the risker is lower than with the other drugs in this class.

About 60% of patients who fail to respond to maximum doses of one of the PDE5 inhibitors, respond favorably to another and, in the absence of side effects, this is worth trying.  Good luck.

Urology

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Arthur Goldstein, M.D.

Expertise

Problems or questions related to the field of urology; ie urinary stone disease, urinary cancers (kidney, bladder, prostate, testis, etc.), urinary infections, etc. I no longer answer questions related to erection problems or male sexual dysfunction.

Experience

I am retired from the active practice of urology. My 34 years was totally in the clinical field and involved the entire gamut of genitourinary problems, with special interest in endourology.

Organizations
American Medical Association, American Urological Association, American College of Surgeons

Education/Credentials
College degree - BS Medical degree - MD Master of Science - MS

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