ED since early age

[bct4058]

I am a 25 year old male with ED and PE ever since I have been sexually active.

I have considered three possible physical sources. First, I am slight and have abnormally small amounts of hair on my chest, arms, and face (but quite a bit in the pubic area), and am concerned about my hormonal levels. I got some basic tests – Prolactin at 13.6 (2.2-18.5 ng/mL) and Testosterone at 571 (200-1200 ng/DL). The blood was taken at mid-morning.

Second, when I began masturbating at 12 I experienced a extremely severe dull pain in my groin and lower penis after ejaculation, particularly the first time ejaculating. The pain diminished as I masturbated with more frequency but still occurred after orgasm for several years, but I no longer experience this and never discovered the source.

Finally, I received some testicular trauma at the age of thirteen – my scrotum was punctured by the small end of a chicken wire fence. The doctors said there was no internal damage (there was hardly any bleeding) but no follow up tests were ever performed. I received two stitches.

My specific symptoms are as follows. When with a sexual partner I have considerable difficulty getting, but more specifically maintaining an erection. Sometimes I get erect very quickly during foreplay (more when I was younger) but I lose erections extremely quickly without constant, focused physical stimulation. As far as I can recall this has always been the case, but I did not really realize that something was wrong until I tried to have intercourse late in college.

I have never been able to successfully perform intercourse medication. Usually to get erect I need intense oral or manual (with lubrication – I do not precum) stimulation, and often I am not able to sustain a full erection. When I reach the point of sufficient hardness for penetration I am too close to orgasm, and *** when I enter my partner, often on the first thrust. Frequently this occurs when I am not even fully erect and penetration is difficult.

For the last year I have been using Viagra, which has helped but I have to take *a lot*. With 50 mg things are a little better and it is somewhat easier to get erections, but intercourse usually doesn’t last more than a few minutes and sometimes much less. With 100mg the difference is dramatic and intercourse is sustained and intense.

I have discussed the problem with doctors and therapists in the past, and most assume that the source is mental and caused by anxiety. This seems to me increasingly unlikely since I am currently with a supportive partner and the problems are severe and do not seem to be improving. Moreover I believe the symptoms, while less noticeable in the past, have existed at least since I was 16 and first became sexually active.

The problem is deeply affecting my self esteem and my ability to pursue and sustain healthy relationships, and I don’t know what medical course to pursue. I really need help. Thanks.

[Kevin Pho, MD]

It is difficult to say without evaluation.

Low testosterone would be an unlikely cause given the normal levels.

You can consider anatomical or vascular causes - and this can be imaged with an ultrasound or MRI of the penis.  

If the tests continue to be negative - psychogenic causes indeed comprise a large proportion of ED cases.

Blood tests checking for diabetes or thyroid dysfunction should also be considered.

These options can be discussed with your personal physician, or in conjunction with a 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.

Kevin, M.D.
kevinmd_

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