Urology/Erection

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Question
Hello doctor i'm a 35 y old male from Rome Italy since 1 year i'm not able to get erection by mind command when i think a girl as in past i get it only if i sleep or mastrubation induce it but i get them like a teen ager when i sleep my psa is of a 18 20 y old as my looks so even if i don't have tyroid and left testicle as i had cancer non seminoma psa is perfect therapist told me is psychological that i'm overcoming some issues in my life in january 2011 they told me i got prostate sligly iflamed to a side lef i think but they say my case is just psychological as i get super erections when i sleep or masturbate but when i try think of getting hard on command on girl i like i can barely do it anymore as before like last year for example but i have sexual insecurity's since kid for abuse i had and bully dad that i feel less to other males i'm solving in counseling i all ways was not able to get hard with girls in sex in real life and barely on cam  even at 15 so they say is all psychological that i'm overcoming ct scan shows prostate in the limits even if i suffer of over masturbation since kid btw vegan diet and krill oil helping me much to deflame it i reduced to once in a while now to mastrubate do you also think is all psychological my issue as my psychiatrist and counselour say  as also all sperm and urine uretra test are clean no infection ?

Answer
Luca:

From your description, it sounds like your problem is probably psychological in nature.  If there were a significant physical problem, then you would not be seeing any erections either asleep or awake and you've indicated a fair number of potential psychological issues which could certainly cause problems.

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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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