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Question
I am suffering from erectile dysfunction and pre-ejaculation for the last one month. I am married for three years now and never faced anything like this before. I have a very healthy relationship with my wife.I consulted an urologist who advised me to do the following tests
TSH
FSH
TESTOSTERONE
RANDOM GLUCOSE
SEMEN ANALYSIS
The report suggests every thing is within the normal range. However the problem persists. The doctor has prescribed me to take Tazzle 20mg(tadalafil). But still the situation has not improved. Request your expert advice.

Answer
Swagatam:

The above blood tests are reasonable.  I would have included blood pressure and cholesterol.  It also isn't clear to me what benefit a semen analysis would be to diagnosing erection function.

Tadalafil is considered a good first line agent for ED.  Usually, we will try at least one more before going on in treatment.

Additional testing can be done such as nocturnal penile tumescence monitoring, biothesiometry and penile duplex ultrasound.  These can help determine blood flow abnormalities, nerve sensation issues and the potential degree of psychogenicity.  Unfortunately, while treatment is available, rarely are we able to achieve a cure in the traditional sense.  Additional treatment options include external vacuum devices, penile injection therapy, MUSE urethral suppositories and penile prothetic implants as a last resort.  In most cases, we do not focus too much on the cause since curing it is rarely possible, and instead focus on finding a treatment that is acceptable.

Premature ejaculation is probably at least partially due to the ED but is thought to be an anxiety-control related issue rather than physical.  In many cases, when the ED is resolved, the premature ejaculation will be too.  If not, separate treatment of premature ejaculation can be done with either SSRI type medications or behavioral modification therapy by a certified therapist.

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Stephen W. Leslie, MD

Expertise

Questions concerning erectile dysfunction, kidney stones and prostate disorders including prostate cancer. I have a special interest in kidney stone disease prevention.

Experience

Full time practicing urologist with 30 years experience. Associate Professor of Surgery and Chief of Urology at Creighton University Medical Center. Editor in Chief of eMedicine Urology internet textbook. Author of only NIH approved book written for patients by a urologist on the subject of kidney stones "The Kidney Stones Handbook". Inventor of the "Parachute" and "Escape" kidney stone baskets and the "Calculus" stone prevention analysis computer program.

Organizations
American Urological Association, Ohio State Medical Association, Sexual Medicine Society

Publications
Men's Health, Journal of Urology, Urology, Healthwatch Magazine, Emergency Medicine Monthly, eMedicine, "The Kidney Stones Handbook", and numerous articles in various newspapers. He is also the editor of the Urology Board Review by McGraw-Hill used by urologists to study for their Board Certification Examinations.

Education/Credentials
Graduate of New York Medical College with residencies completed at Metropolitan Hospital New York, Albany Medical Center and University of Wisconsin-Madison.

Awards and Honors
Thirlby Award of the American Urological Association. Rated as one the country's Best Urologists by the Independent Consumer's Research Institute

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