not firm// less satisfaction

I am 45 Y/O AA-M,(black)   overweight 280lb , 5-9 ,  I had a visectomy, (sp)

10 yrs ago and it seemed my ejectulations were weaker. I was told, it was in my head. In the last two yrs, I almost never awaken hard. and right before a orgacism my erection soften. I thought it is to get firmer? but it does not!!

I use to enjoy my climax on a scale of 1 to 10---it was a 10,  now it is barely 7. even before the climax--the feeling is not as good as it use to be.  I have serveral possible difficulties: medications for hypertension, colestoral, and depression----
wellbutrin 150 mg,  lisnopril 20 mg, hydrchlorothiazide 25 mg, doxazosin mesylate 1 mg, and sometimes  lovastatin 20 mg.
I don't always take the last because it causes iritation in my penis.

I seem to always need oral sex to be aroused. two yrs ago, I could just look at a women and get an erection. what may be the cause ? I already know I need to see a urologist but I have no ins. currently. Lastly, can the size or shape of a women's vigina (vagina)
"ever" lead to less satisfaction for the male?

thanks for your answer.

[Kevin Pho, MD]

There are several possible reasons.  The first would be side effects from medication.  The Wellbutrin may have erectile dysfunction as a side effect.  

The other consideration would be a low testosterone level - this can be easily measured at your physician's office.  There are various forms of testosterone replacement if this is the case.

Finally, anatomical abnormalities (i.e. problems with blood flow and circulation) can also be considered.  A physical exam to examine the pulses leading to the penis or an ultrasound looking for structural abnormalities can be considered.

If everything is normal, you may want to discuss with your urologist or personal physician to see if a medication such as Viagra is right for you.  

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.