27 year old male with severe ED

I am a 27 years old male with a case of ED that first started 3 years ago. I am convinced that for the first two years the problem was caused by extreme stress and depression - I continued to get normal erections while masturbating and every morning. However, about a year ago the problem started to get progressively worse and physical changes became more apparent. As of right now, my morning erections became much weaker and less frequent. Spontaneous erections have disappeared completely. I am no longer able to achieve normal erections while masturbating (they go down as soon as I take my hand off or do not appear at all). Also, the base of the penis has become much harder and rubbery if I try to bend it. There is frequent pain on the left side of the head and discomfort all along the trunk of the penis - not severe but quite noticeable. Pre-ejaculate fluid always seems to be visible at the tip of the penis which never happened before. I have also been recently diagnosed with HPV which broke out after I had what looked like a yeast infection. The head of the penis always looks red and irritated.

I have been smoking about a pack a day for the last three years and masturbating at least 2-3 times a day for the last three years. Now, I occasionally (but VERY rarely) get a more or less normal erection w/o Viagra when I am with a partner but always after a prolonged period of manual stimulation by her.

Also, I have seen a noticeable deterioration of my general health during the same three year period - cataracts in both eyes were found, severe acne outbreaks, occasional very painful lumps in my throat.

I am on Viagra (which works well enough) and tried Caverject injections. It seems that the hardness and the rubbery feel appeared after I tried the Caverject.

I was tested for syphilis, hepatitis, HIV (all negative). Testostorone levels are normall too. Finally going to see a urologist for ultrasound on Thursday

My questions are:

1)what are the symptoms of smoking-induced ED - no erection at all or weaker ones? Could it appear after three years of smoking a pack a day?
2)is it reversible?
3)does the fact that I occasionally get a normal erection rule out smoking-induced impotence?
4) is it possible that stress and depression alone begin to affect morning/spontaneous erections?
5) I heard that all cases of impotence are reversible more or less completely  except: if you have a broken spine, severe kidney/liver damage or advanced cancer. Is it true?
6) do you have any other ideas as to what might be happening with me or what I should be doing?

[Kevin Pho, MD]

To answer your questions:
1) To my knowledge, there are no specific characteristics of ED directly attributable to smoking (i.e. the symptoms of ED should be the same whether you are smoking or not).  The presentation of ED may vary between patients.  

2) Depending on the cause, ED can be treated.  There are now other medications, such as Levitra and Cialis that may have a different effect.  If there is an anatomical abnormality (which can be seen during ultrasound), this needs to be appropriately addressed.

3) Not necessarily - the fact you can get a normal erection makes it less likely that an anatomical abnormality is present.

4) Yes, stress and depression can affect quality and quantity of erections.

5) The only absolute in medicine is that there are never absolutes.  Keeping this in mind, most cases of erectile dysfunction can be treated successfully.  There are cases of causes by neurological diseases that make it harder to treat.  

6) I would agree with the urology followup.  The ultrasound is a reasonable test to perform.  You may want to consider nocturnal penile tumescence testing which can provide accurate, reproducible information quantifying the number, tumescence and rigidity of erectile episodes a man experiences as he sleeps in the comfort of his own bed.  It can identify impotence caused by physiological or psychological causes.  This can be discussed with your personal urologist.

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Thanks,
Kevin, M.D.