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Urology/Unexplainable erectile dysfunction

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Question
I am experiencing erectile dysfunction and I absolutely cannot figure out the answer as to why. I am 29 years old, am somewhat overweight at 250 lbs on a 6'2" frame, but otherwise am in good health. The only abnormal thing about me sexually is that I have a hydrocele on my right testicle but have had it examined and all results show its fine and it causes me no pain. I take 40 mg Prozac daily for mild depression but no drugs otherwise. I drink 1-2 beers daily, no tobacco, or illegal drugs. I have been married for one year and this problem is taking a toll on my short marriage. This has been going on for 10 years since I became sexually active. I always explained it away and blamed it on too much alcohol, not enough sleep, etc. Over the years, my weight has been as low as 200 to as high as 255, I have been on the Prozac and been off, I have quit drinking and drank more. What I am driving at is that throughout the years things have changed but this has not. While my wife and I were dating, I never had an occurance of it, but literally one week into our marriage was when it reared its ugly head. When she and I were dating, I would have morning erections, now I never do. My penis is now small and retracted, similar to when it is cold, as if there wasn't ample blood flow. I would say that probably 70% of the time that we try to have sex, I either can not achieve an erection, or it goes down during intercourse. I went to a urologist that did a blood test and penile ultrasound. The ultrasound showed normal blood flow but the blood test showed slightly low testosterone levels and he put me on testosterone injections, which had no effect and I quit doing them after about three months. He then prescribed Cialis. The Cialis worked great. I cut the pill into quarters and would take one daily but Cialis costs $40/pill and I really do not want to be enslaved to something that just masks the symptoms. I have gone down the lists ruling out the usual physical causes. When I come to the psychological causes, I can rule out most of them as well. As stated earlier, I do deal with some slight depression but it is managed with Prozac and my erectile dysfunction was present pre and post Prozac. Also, it seems to me that if my problem were psychological, the Cialis would not have been as effective as it was but even long before I had an erection from it, my penis was larger and no longer "retracted", I am assuming from increased blood flow. I cannot keep going on this way, I have been married for a year and this problem is ruining an otherwise perfect marriage. Please help me.

Answer
Ben

Virtually all physical causes of erectile dysfunction are incurable so maybe you should concentrate on therapy rather than diagnosis. A small dose of cialis works fines which is a good start. Your low testosterone is probably not the problem or the shots would have helped. The fact that you have depression and even a small dose of cialis works suggests a psychogenic component, the lack of morning erections suggests a physical cause gll
A nocturnal penile tumescence test could help determine this.

You can spend a lot of time, money and effort.trying to find an elusive cause or evaluate the other potential treatment. Your wish to avoid the need for ongoing medication for.ED is understandable but perhaps not realistic. Talk to your urologist about your concerns and options.

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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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