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Question
Hi Dr. ,

So, in the past year to year and a half, my naturally occurring erections have been almost non existent. I can get hard and masturbate only by laying on my back, usually while watching porn.   I thought this might be porn-induced erectile dysfunction, and I have tried to limit porn and masturbation recently... but if I'm not getting natural erections, even upon waking, I feel like my penis will just atrophy.

Before this, I had been masturbating - 'edging' almost every morning,  but only ejaculating maybe once or twice a week.  At this time my penis felt fully engorged, but I could only maintain through direct stimulation.

It's also like something in my body has changed.  The padding of fat around my pubic area seems to have increased, and my corpus spongiosum doesn't seem to want to 'inflate'.  I have to flex my pc muscles to get the underside  of my penis to respond.  The top and sides of the penis - corpus cavernosa seem to be doing okay...they seem to get fairly rigid. I thought my problem might have been from being overweight and the excess fat.  But I am currently losing weight (down about 20 lbs so far) and exercising more.


One symptom I have just noticed is that when masturbating I can feel a swelling in my perinium and it feels lumpy, and when I trace my fingers from there to where the corpus spongiosum begins, I can feel a dent in between..almost as if there is a dead spot or blockage.  I don't know enough about anatomy to know if this supposed to be there, or if I have damaged something.


thanks

Answer
Alan:

There should not be a dent in the corpora spongiosum, but it's hard to be sure without an actual examination.  It is also difficult to sort out your ED problem.  In general, either the erection works or it doesn't.  Psychological and anxiety related issues typically give intermittent problems while organic or physical issues are relatively permanent and consistent.  Your story seems a little of both.

I suggest you consult a local urologist to sort this out for you.  A trial of Viagra may be all you need.  

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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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