What can be wrong and what to do next?

[worried601]

I don't know where to begin.my husband is 65, does not smoke, drinks light beer occasionally, is slightly overweight and now is experiencing a rapid decline in sexual function.  His cholesterol is low, his sugar is just a few points over the normal upper limit, and his testosterone level is 12 points above the upper recommended number for suggested testosterone supplement treatment.  He found a lump in his right testicle at the end of June.  Prior to that there was no problem in getting and maintaining an erection, however in the last year he has had a hard time getting to climax and ejaculation and often the quantity of the semen was low.  Since the discovery of the lump, he started having trouble getting an erection.  It would take a lot of stimulation just to get even a soft erection which would quickly fail within a minute or two.  We attributed that to worry from the lump, but going to the doctor and finding it to be a harmless cyst did not improve things. The doctor ordered an ultrasound to confirm his exam of the lump and said it could not cause the dysfunction problems he had. The doctor was content to do nothing and only referred him to a urologist on his request to see about the ED.   That visit was not much help either.  The urologist said the cyst was from the vasectomy he had 30 years ago and was unrelated to the sexual problems and would not need to be removed unless it became too uncomfortable.  Based on the fact that he seldom has nocturnal and/or morning erections, the ED was diagnosed as organic.  By the time he did see the urologist, he had declined to the point of being unable to get any kind of erection, even a soft one.  I would have thought the doctor would have then dug deeper to find the physical cause to then treat that but instead just gave him a sample of Levitra  to use if he wanted to have sex.  The Levitra did help, but not all that much...the erection was soft and still failed shortly after attaining and there was of course no climax or ejaculation for him.  He also had quite a headache the next day and at $14 a dose doesn't seem to be a good solution.  So we are left wondering "what now"?  I am trying to get him to go for a 2nd opinion but he is resistant figuring it will be of no more help then the doctors he has seen already.  He is able to more then satisfy me when we attempt anything which I do tell him so as to not make him feel that he is letting me down because he isn't!  I just would want him to once again be able to experience the pleasure and satisfaction he gives to me which now seems to be a hopeless pipe dream.  Is there any help for us and this man that I love so dearly?  Please, offer any suggestions that might give us answers or solution.  Thank you.

[TxMama09]

Circumcision also causes erectile dysfunction, since it desensitizes the glans by causing it to become keratinized. If your husband is circumcised, have him look into foreskin restoration.

[worried601]

So much of what you suggest has been recently checked.  His BO is low, his cholesterol is 159, blood sugar just a very few points above the normal limit. His testosterone was classified as normal but was just 12 points above the lowest end of the normal range.  He saw a urologist concerning the cyst but he was content in just giving him Levitra instead of checking to see what the cause of the ED and absence of ejaculation was. I am puzzled as to why neither the general doctor or the urologist did a physical check of his prostate to check for enlargement.  Shouldn't that be standard procedure for men of his age in an exam?  He also takes no medications for any health condition.  After all that , any other ideas?

[Bhupinder Kaur, MD]

Hello,
I can understand your concern. At this age it is better to get your usband’s cardiac status checked. It is said that erectile dysfunction and heart disease go hand in hand because about 7 in 10 cases of erectile dysfunction are due to narrowing of the small arteries in the penis.

Levitra may not be effective if you have uncontrolled diabetes, very low blood pressure (hypotension) or uncontrolled high blood pressure (hypertension), heart disease or heart failure, stroke or you are taking any nitrate drugs for angina, blood-thinning (anticoagulant) medications, antihypertensives or alpha blockers for enlarged prostate.
It is very difficult to precisely confirm a diagnosis without examination and investigations and the answer is based on the medical information provided. For exact diagnosis, you are requested to consult your doctor. I sincerely hope that helps. Take care and please do keep me posted on how you are doing.