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Question
Dr.

Ok. How do you distinguish between physical or mental problems that can cause erection trouble?   Again, i'm 27, no diabetes, not overweight. I've had had night time hard erections and no trouble at all in maintaining erection during masterbation.

Answer
Ron:

In your case, there are no clear signs of a problem so there is not enough information to determine the cause.

With the lack of any clear etiology, the most common sign is the timing and nature of the erection trouble.  If there is no trouble with masturbation but nothing works when with a partner, the cause is clearly situational and probably psychological.

Testing can be done to clarify this if necessary.  We can do a nocturnal penile tumescence test which measures the nighttime erection rigidity.  In physical problems, the nighttime rigidity is lost or minimized while it is normal with psychogenic 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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