I have had a few prolonged erections after taking viagra im 26 years old I had an increadibly intense hard erection after a viagrs and since then my erections are soft shrunken and numb I need manual stimulation to get any erection I het no sexual pleasure from my penis my orgasms arent as intense it has been over a year. I have had a ultrasound scan that came back no fibrosis yet im sure the outer tissue is scarred as it clearly looks scarred. The best erection I got was wen doing a test with caverjet my penis became erect even though not completly ridgid but hard enough to penetrate. I am trying to get ed 1000 shockwave treatment done a top surgeon said it could help I have read it can regenerate erectile tissue andvsmooth muscle what do u think are my chances of this shockwave treatment getting me my normal erections back

James, I have no personal experience or expertise in shock wave therapy for ED.  To follow is an article from the USA on all the various new forms of treatment available for ED (including shock wave therapy) that should be of interest to you.


In reviewing your information, I question why a 26 year old man would need to use Viagra.  Most men in their 20s have trouble keeping their penis from getting erect too often and sometimes, at inappropriate times.  You state that you had "prolonged erections" from Viagra but you did not note the length of time your penis was erect.  Priapism is defined as a full erection lasting more than 4 hours.  Shorter episodes of prolonged erections rarely, if ever, produce damage (fibrosis) to the penis.  If indeed you were having difficulty with ED and this led you to taking the Viagra initially, this would suggest some other underlying cause for your ED.  Certainly if you had penile fibrosis, it would have showed up on the ultrasound.

Therefore, I suggest that you have an evaluation for ED before considering the shock wave treatment.  In there is an underlying problem, you probably could use Viagra (or one of the other drugs in its class of medications) but in a lower dose.  To follow is some information that I have written on ED that should be of interest to you.

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.


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Arthur Goldstein, M.D.


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.


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.

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

College degree - BS Medical degree - MD Master of Science - MS

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