I suffer from ED and at my last checkup with the urologist complained about not being able to maintain an erection during sex. He suggested the penile doppler sonograph which we did today. After injecting my penis with the medication, he returned 10 minutes later to do the sonograph, but I still didn't have an erection. He took his readings, and was very discouraged, and suggested I may have to go the route of a penile implant. I'm devastated by the prospect. But one question I have is once injected, do you automatically get an erection, or do you have to be stimulated? I know with Cialis, without stimulation, there is no erection. Is it the same with the injection? I mean, I still get erections when I sleep, and when I have sex, maintaining them is the issue. I don't want to replace the tissues in my penis with inflatable bladders. Is my problem psychological? I'm not sure where to go next. He has an appointment set up with the surgeon who specializes in implants, but I'm very reluctant. I'm only 53, and don't know where to turn. Should I have done something different at the test other than just lie there? Any guidance is appreciated.
There are several issues you need to consider before making any decision:
1) You need more details from your urologist. The test you underwent is to determine blood flow to your penis. During sexual excitement, blood fills the chambers, and that is what creates erection. During the test, a substance is injected which fills the chambers, causing an erection. Any blockage will affect erection. Did your urologist inform you how much blockage he discovered? If not, you need to ask.
2) You state that you still get erections when sleeping. All healthy penises undergo cycles of erection during sleep. Let me ask you this: if your arms were paralyzed during waking hours, but you had full use of them during sleep, what would you think?
3) There are several possibilities, the most common being that there is some blockage of blood flow to the penis and it’s not severe enough to totally block blood flow, thus erections occur sometimes—especially during sleep, when no anxiety is present. Often, the first time a man experiences an erection problem, he gets worried and anxious. This then becomes a vicious cycle: anxiety about not getting an erection which then inhibits erection and so on. In other words, if you have even a small blockage, it can be made worse by any worries, anxieties, fears, or other factors.
4) Lastly, you have the right to total information about your penis! Sometimes you need to ask questions several times in order to understand the answer. You (or your insurance) are paying for medical services, and you should speak up and be sure you’re getting the whole story. Most physicians are happy to have patients involved in their own healing process. So don’t be shy. You need a lot more information before you make the decision whether to proceed with medical intervention, counseling or a combination of both. Good luck to you. Dr. J
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