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Question
Hello Dr. Leslie,

I'm 30 years old, suffering from a 5 year long ED and low libido problem. My symptoms:

No morning or daytime erections

Lack of sexual desire

Loss of sensitivity in the penis

Erections are weak and flaccid, it doesn't angle up the way it used to

Soft or hard, my penis seems smaller and feels constricted

A sensation of being dry, my penis hardly lubricates itself

Little pleasure at time of ejaculation

Quantity of semen greatly diminished and very weak, feels as though it struggles to travel down
the shaft and I have to squeeze the remainder of it out

Sensations of blood being pumped into the penis non existant along with that flush sensation in the body during arousal missing

Flaccid penis seems rubbery, like a dangling elastic band, and I can't seem to be able to flex it anymore

I can achieve erections on my own, but obtain almost no satisfaction from the entire experience. I have taken Cialis on many occasions and while it does help somewhat, it does not correct many of the problems listed above. I have seen a couple of urologists and have had several blood tests done without any leads to work on. I've had an echograph and injection with the results being, to quote the doctor, "not as much blood flow as I'd like." Can this account for these symptoms? He did not elaborate or recommend any follow ups to this.

I seem to be doing worse since this started. I'm hardly out of shape, but was healthy and fit before this started, doing weights and cardio fairly regularily and was a smoker. I have since kicked cigarettes. I'm frequently tired and foggy in the brain with low motivation and a lack of energy. I plan on seeing a sleep specialist soon. I did have, what I believed to be, a urinary tract infection which I was never treated for because symptoms went away the next day and never came back. I also used to bike ride 15 minutes to work and back for about 2 years. The only other noteworthy thing I can mention is that I pushed the base of my penis into the edge of my desk a few times while masturbating by accident, but found that it felt pretty good.

I'm interested in hearing what you think. Should I see another urologist? If so, what can I say to him? Can any of the activities above be responsible for my condition? Does it sound like it might be the fatigue or perhaps a mild depression? Are there other tests that I can submit to? I fear that I may never enjoy sex or masturbation ever again.

I appreciate any advice and thank you for your precious time.

Answer
Chris:

The cause for your ED is unclear.  There could be some depression or low testosterone levels.  There also appears to be some decreased blood flow to the penis. This is sometimes seen in bicycle riders but it is uncertain if this is the cause in your case or not.  It's not just fatigue.

A more comprehensive approach might be useful.  You can seek another opinion from a Urologist at a tertiary care center or a member of the Sexual Medicine Society who deals with more complex ED problems.  Meanwhile, a "checkup" with a psychiatrist or other mental health professional to determine if there is any depression would be helpful.  IF there is, treat it and if not, then we know.  

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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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