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Hi Doctor, For The Past Almost 9 Months Ive Had

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Posted on Wed, 25 Dec 2019
Question: hi doctor,

for the past almost 9 months ive had inconsistent quality of erections while masturbating and also sometimes when i am with someone.
i also noticed imfrequent morning erections

im 27 years old and otherwise healthy. i dont have any vascular or neurological disease that would be an obvious link to this. i dont know how to explain it but it all started when i first noticed that my penis (in a flaccccid) state wasnt moving when i tried moving it internally. i hope that makes sense.

is this likely an emotional or physchological issue? or is this a cause of organic issues with penile artery or veins?

basically, i am wondering what kinda signs i should look for to confirm if this is psychological or physical.
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Follow up: Dr. Dr. Erion Spaho (0 minute later)
hi doctor,

for the past almost 9 months ive had inconsistent quality of erections while masturbating and also sometimes when i am with someone.
i also noticed imfrequent morning erections

im 27 years old and otherwise healthy. i dont have any vascular or neurological disease that would be an obvious link to this. i dont know how to explain it but it all started when i first noticed that my penis (in a flaccccid) state wasnt moving when i tried moving it internally. i hope that makes sense.

is this likely an emotional or physchological issue? or is this a cause of organic issues with penile artery or veins?

basically, i am wondering what kinda signs i should look for to confirm if this is psychological or physical.
doctor
Answered by Dr. Dr. Erion Spaho (4 hours later)
Brief Answer:
Tests are necessary to exclude physical problems.

Detailed Answer:
Hello and welcome to "Ask a Doctor " service.

I have read your query.

Erectile dysfunction in young healthy men is mainly related to underlying psychological issues.

However, before to exclude completely the physical problems, tests should be carried out.

Hormonal levels ( testosterone, prolactin, thyroid hormones, etc.) should be measured.

Ultrasound of the penis and testes, direct injection of prostaglandins into the corpora cavernosa, also may be necessary to evaluate any physical problem.

If the physical causes will be excluded after such tests, you should work with a Psychologist for your issues.

Hope you found the answer helpful.

Let me know if I can assist you further.
Above answer was peer-reviewed by : Dr. Raju A.T
doctor
doctor
Answered by Dr. Dr. Erion Spaho (0 minute later)
Brief Answer:
Tests are necessary to exclude physical problems.

Detailed Answer:
Hello and welcome to "Ask a Doctor " service.

I have read your query.

Erectile dysfunction in young healthy men is mainly related to underlying psychological issues.

However, before to exclude completely the physical problems, tests should be carried out.

Hormonal levels ( testosterone, prolactin, thyroid hormones, etc.) should be measured.

Ultrasound of the penis and testes, direct injection of prostaglandins into the corpora cavernosa, also may be necessary to evaluate any physical problem.

If the physical causes will be excluded after such tests, you should work with a Psychologist for your issues.

Hope you found the answer helpful.

Let me know if I can assist you further.
Above answer was peer-reviewed by : Dr. Raju A.T
doctor
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Follow up: Dr. Dr. Erion Spaho (3 hours later)
What kind of underlying psychological issues causes it? Would psychological issues cause lack of morning erections too?

I understand that getting all those tests done would rule it out completely but my doctor isn’t ordering those tests. The only test I did was a full blood test and all my hormones came back normal.

Would organic arterial and venous damage be possible at my age?
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Follow up: Dr. Dr. Erion Spaho (0 minute later)
What kind of underlying psychological issues causes it? Would psychological issues cause lack of morning erections too?

I understand that getting all those tests done would rule it out completely but my doctor isn’t ordering those tests. The only test I did was a full blood test and all my hormones came back normal.

Would organic arterial and venous damage be possible at my age?
doctor
Answered by Dr. Dr. Erion Spaho (3 hours later)
Brief Answer:
Answered below.

Detailed Answer:
Hello again.

Vascular problems linked to erectile dysfunction are seen mostly in men older than 50 years.

Psychological causes may be performance anxiety, depression, widower syndrome, posttraumatic stress disorder.

Morning erections are mostly linked to testosterone levels.

Hope I helped you.

Feel free to ask if you have further questions.


Above answer was peer-reviewed by : Dr. Arnab Banerjee
doctor
doctor
Answered by Dr. Dr. Erion Spaho (0 minute later)
Brief Answer:
Answered below.

Detailed Answer:
Hello again.

Vascular problems linked to erectile dysfunction are seen mostly in men older than 50 years.

Psychological causes may be performance anxiety, depression, widower syndrome, posttraumatic stress disorder.

Morning erections are mostly linked to testosterone levels.

Hope I helped you.

Feel free to ask if you have further questions.


Above answer was peer-reviewed by : Dr. Arnab Banerjee
doctor
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Follow up: Dr. Dr. Erion Spaho (3 hours later)
I understand that it is mostly seen In men in their 50’s but what are the chances of a young man to have vascular ED and what would cause it? Is it like 1/10 men in their 20’s with physical ED issue?

I’m asking because I’ve seen 3 doctors so far and they all told me it is due to anxiety without doing any proper testing. The only testing they did was a blood test and my testosterone level came back normal at 425. This was back in March though.

But since you’re saying vascular reasons are found mostly in men in their 50’s wouldn’t that be the same for low testosterone levels?

I’m just worried that this is going to be a physical issue and I’m only 27...I still have my whole life to live and I don’t want to spend my young life worrying about erections.

Plus, I don’t have performance anxiety or widower syndrome or depression...so I don’t understand how this can be a psychological problem.

If I do find out this is a physical problem like a venous leak or insufficient blood to the penis is there a way I can cure it and go back to having normal natural erecrions again?
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Follow up: Dr. Dr. Erion Spaho (0 minute later)
I understand that it is mostly seen In men in their 50’s but what are the chances of a young man to have vascular ED and what would cause it? Is it like 1/10 men in their 20’s with physical ED issue?

I’m asking because I’ve seen 3 doctors so far and they all told me it is due to anxiety without doing any proper testing. The only testing they did was a blood test and my testosterone level came back normal at 425. This was back in March though.

But since you’re saying vascular reasons are found mostly in men in their 50’s wouldn’t that be the same for low testosterone levels?

I’m just worried that this is going to be a physical issue and I’m only 27...I still have my whole life to live and I don’t want to spend my young life worrying about erections.

Plus, I don’t have performance anxiety or widower syndrome or depression...so I don’t understand how this can be a psychological problem.

If I do find out this is a physical problem like a venous leak or insufficient blood to the penis is there a way I can cure it and go back to having normal natural erecrions again?
doctor
Answered by Dr. Dr. Erion Spaho (17 hours later)
Brief Answer:
Answered below.

Detailed Answer:
Welcome back.

The physical causes of erectile dysfunction such as vasculogenic cannot be excluded entirely in younger people although it may be very rare.

Even in older people with erectile dysfunction and vasculogenic cause, there are comorbid conditions such as hyperlipidemia, hypercholesterolemia, tobacco use, diabetes, or coronary artery disease.

It is my opinion that, before leaving the culprit to psychological causes, physical possible causes of erectile dysfunction should be excluded.

Simple tests such as duplex ultrasound of the penis, direct injection of prostaglandins into corpora cavernosa, can evaluate the vascular status properly.

So, please discuss this with your doctor in order to get these tests done.

Hope this helps.

Regards


Above answer was peer-reviewed by : Dr. Arnab Banerjee
doctor
doctor
Answered by Dr. Dr. Erion Spaho (0 minute later)
Brief Answer:
Answered below.

Detailed Answer:
Welcome back.

The physical causes of erectile dysfunction such as vasculogenic cannot be excluded entirely in younger people although it may be very rare.

Even in older people with erectile dysfunction and vasculogenic cause, there are comorbid conditions such as hyperlipidemia, hypercholesterolemia, tobacco use, diabetes, or coronary artery disease.

It is my opinion that, before leaving the culprit to psychological causes, physical possible causes of erectile dysfunction should be excluded.

Simple tests such as duplex ultrasound of the penis, direct injection of prostaglandins into corpora cavernosa, can evaluate the vascular status properly.

So, please discuss this with your doctor in order to get these tests done.

Hope this helps.

Regards


Above answer was peer-reviewed by : Dr. Arnab Banerjee
doctor
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Follow up: Dr. Dr. Erion Spaho (14 hours later)
i did discuss with all 3 of them and they said it is not necessary.

what are my chances that this is a physical problem? i don't have any other vascular issue that would cause ED. I don't have diabetes or had trauma to the penis or anything like that.

plus, how can i tell if my erections are rigid enough to rule out having a physical cause? it's honestly so annoying even thinking about it. there are men int ehri 70's who stilll get normal erections so why am i suffering with this in my 20's? it's just not fair and it's even less fair that the only treatment options are medications and an implant...

and how does the doppler test even work? is it accurate? it seems to be the last resort option of testing when all other tests work and it seems very invasive with the injection. can they do the ultrasound witout the injection? if i tell them i want them to analize my erection that i achieve naturally won't that be the same thing?i think honestly if i find out i have a physical causing problem i would be severly severly depressed and maybe even suicidal.

also, if it were due to anxiety wouldn't i have other problems too throughtout my body? it wouldnt just effect erections right?
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Follow up: Dr. Dr. Erion Spaho (0 minute later)
i did discuss with all 3 of them and they said it is not necessary.

what are my chances that this is a physical problem? i don't have any other vascular issue that would cause ED. I don't have diabetes or had trauma to the penis or anything like that.

plus, how can i tell if my erections are rigid enough to rule out having a physical cause? it's honestly so annoying even thinking about it. there are men int ehri 70's who stilll get normal erections so why am i suffering with this in my 20's? it's just not fair and it's even less fair that the only treatment options are medications and an implant...

and how does the doppler test even work? is it accurate? it seems to be the last resort option of testing when all other tests work and it seems very invasive with the injection. can they do the ultrasound witout the injection? if i tell them i want them to analize my erection that i achieve naturally won't that be the same thing?i think honestly if i find out i have a physical causing problem i would be severly severly depressed and maybe even suicidal.

also, if it were due to anxiety wouldn't i have other problems too throughtout my body? it wouldnt just effect erections right?
doctor
Answered by Dr. Dr. Erion Spaho (12 hours later)
Brief Answer:
Try not to worry in orde to solve your problem.

Detailed Answer:
Welcome back.

Doppler ultrasound is done without any injections and is a simple imaging study modality that evaluates with high accuracy the blood supply ( and any abnormalities ) of the genitalia.

Injection is another test and is not so difficult.

At your age chances that you have a vascular problem are very low since you have no comorbidities.

Above mentioned tests in my opinion are necessary to evaluate any structural ( congenital ) vascular problem that still chances in favour of it are very low.

Anxiety affecting only sexuality is possible.

You should not be worried and you should not feel suicidal because your problem has solution.

Discuss with your Doctor for the ultrasound and get help from a Psychologist.

Hope this helps.

Regards.

Above answer was peer-reviewed by : Dr. Raju A.T
doctor
doctor
Answered by Dr. Dr. Erion Spaho (0 minute later)
Brief Answer:
Try not to worry in orde to solve your problem.

Detailed Answer:
Welcome back.

Doppler ultrasound is done without any injections and is a simple imaging study modality that evaluates with high accuracy the blood supply ( and any abnormalities ) of the genitalia.

Injection is another test and is not so difficult.

At your age chances that you have a vascular problem are very low since you have no comorbidities.

Above mentioned tests in my opinion are necessary to evaluate any structural ( congenital ) vascular problem that still chances in favour of it are very low.

Anxiety affecting only sexuality is possible.

You should not be worried and you should not feel suicidal because your problem has solution.

Discuss with your Doctor for the ultrasound and get help from a Psychologist.

Hope this helps.

Regards.

Above answer was peer-reviewed by : Dr. Raju A.T
doctor
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Follow up: Dr. Dr. Erion Spaho (2 hours later)
What does structural or congenial mean? and what would be the symptoms of structural causes of erectile dysfunction?

Is there an exact percentage that you can provide regarding having organic ED in your 20’s?

Also, I haven’t read anywhere that this problem has a solution. If you are referring to getting a penile implant then I wouldn’t really call that a solution. If there is something else I am missing can you please let me know? Thanks!
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Follow up: Dr. Dr. Erion Spaho (0 minute later)
What does structural or congenial mean? and what would be the symptoms of structural causes of erectile dysfunction?

Is there an exact percentage that you can provide regarding having organic ED in your 20’s?

Also, I haven’t read anywhere that this problem has a solution. If you are referring to getting a penile implant then I wouldn’t really call that a solution. If there is something else I am missing can you please let me know? Thanks!
doctor
Answered by Dr. Dr. Erion Spaho (12 hours later)
Brief Answer:
Answered below.

Detailed Answer:
Welcome back.

Structural means that there may be a problem with the anatomy of the genitalia vasculature. By the way, this is very rare and there is difficulty in providing exact percentages.

I think that your problem has a solution since the cause seems to be psychological.

The organic causes should be excluded in order to give you peace of mind.

Hope this helps.

Take care.
Above answer was peer-reviewed by : Dr. Yogesh D
doctor
doctor
Answered by Dr. Dr. Erion Spaho (0 minute later)
Brief Answer:
Answered below.

Detailed Answer:
Welcome back.

Structural means that there may be a problem with the anatomy of the genitalia vasculature. By the way, this is very rare and there is difficulty in providing exact percentages.

I think that your problem has a solution since the cause seems to be psychological.

The organic causes should be excluded in order to give you peace of mind.

Hope this helps.

Take care.
Above answer was peer-reviewed by : Dr. Yogesh D
doctor
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Follow up: Dr. Dr. Erion Spaho (1 hour later)
I really hope it is purely psychological.

I mean...I had normal erections before March of this year so would the structure of my penis changed that drastically for erections to be weak?

I would think structural is having peyroines disease or something right?

Also, even if I am 100% convinced my problem is psychological I would still feel bad and uneasy knowing there are young men with physical ED who have to resort to injecting their penis every time they want an erection or getting an implant. Is there current research going on for a complete cure of ED where you won’t need to go through this much trouble to get an erection? Maybe some type of permanent shock wave therapy that will permanently make erectikns normal again especially for men under 50?
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Follow up: Dr. Dr. Erion Spaho (0 minute later)
I really hope it is purely psychological.

I mean...I had normal erections before March of this year so would the structure of my penis changed that drastically for erections to be weak?

I would think structural is having peyroines disease or something right?

Also, even if I am 100% convinced my problem is psychological I would still feel bad and uneasy knowing there are young men with physical ED who have to resort to injecting their penis every time they want an erection or getting an implant. Is there current research going on for a complete cure of ED where you won’t need to go through this much trouble to get an erection? Maybe some type of permanent shock wave therapy that will permanently make erectikns normal again especially for men under 50?
doctor
Answered by Dr. Dr. Erion Spaho (20 hours later)
Brief Answer:
Answered below.

Detailed Answer:
Hello again.

Peyronie's disease is also evaluated by ultrasound and injections, besides physical examination.

low-intensity shock wave therapy is a possible treatment way for the people that are unresponsive to drug treatment.

If your case will be confirmed to be purely psychological, sexual counseling in combination with drugs that promote sufficient erections should improve significantly your problem.

Hope this helps.

Greetings.
Above answer was peer-reviewed by : Dr. Kampana
doctor
doctor
Answered by Dr. Dr. Erion Spaho (0 minute later)
Brief Answer:
Answered below.

Detailed Answer:
Hello again.

Peyronie's disease is also evaluated by ultrasound and injections, besides physical examination.

low-intensity shock wave therapy is a possible treatment way for the people that are unresponsive to drug treatment.

If your case will be confirmed to be purely psychological, sexual counseling in combination with drugs that promote sufficient erections should improve significantly your problem.

Hope this helps.

Greetings.
Above answer was peer-reviewed by : Dr. Kampana
doctor
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Follow up: Dr. Dr. Erion Spaho (4 hours later)
I don’t understand how ED drug intake will help my situation. That will only maybe help for 5-10 minutes when I want a rigid erecrion but in my mind I would think that I’m only getting a hard erecrikn because I’m taking a drug. I would believe that naturally I wouldn’t be able to get an erecrion this hard.

Plus, I read stories of Doppler test giving false results so I’m not sure how reliable that test is. I’m honestly just so annoyed. Ever since I found out I had phimosis I’ve been finding other things wrong with my penis. I think maybe my worry about phimosis caused me to think I have ED too and later on i also found out about my varicocele and stressed about having fertility problems until I got tested for that too and everything came back normal.

I keep reading stories online of men who do go in for a Doppler and find out they have insuffienct blood flow or venous leak and the cause is unknow but when I talk to doctors they tell me the only way to have ED at a young age is if you have spinal chord damage or vascular issues.

Scientifically speaking, physical ED would have a cause right? It wouldn’t just happen to me with no explanation right?
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Follow up: Dr. Dr. Erion Spaho (0 minute later)
I don’t understand how ED drug intake will help my situation. That will only maybe help for 5-10 minutes when I want a rigid erecrion but in my mind I would think that I’m only getting a hard erecrikn because I’m taking a drug. I would believe that naturally I wouldn’t be able to get an erecrion this hard.

Plus, I read stories of Doppler test giving false results so I’m not sure how reliable that test is. I’m honestly just so annoyed. Ever since I found out I had phimosis I’ve been finding other things wrong with my penis. I think maybe my worry about phimosis caused me to think I have ED too and later on i also found out about my varicocele and stressed about having fertility problems until I got tested for that too and everything came back normal.

I keep reading stories online of men who do go in for a Doppler and find out they have insuffienct blood flow or venous leak and the cause is unknow but when I talk to doctors they tell me the only way to have ED at a young age is if you have spinal chord damage or vascular issues.

Scientifically speaking, physical ED would have a cause right? It wouldn’t just happen to me with no explanation right?
doctor
Answered by Dr. Dr. Erion Spaho (16 hours later)
Brief Answer:
Physical ED has an underlying cause.

Detailed Answer:
Hello again.

Yes, physical erectile dysfunction has an underlying cause.

This is assessed by tests that we mentioned before.

Hope this helps.

Regards.
Above answer was peer-reviewed by : Dr. Kampana
doctor
doctor
Answered by Dr. Dr. Erion Spaho (0 minute later)
Brief Answer:
Physical ED has an underlying cause.

Detailed Answer:
Hello again.

Yes, physical erectile dysfunction has an underlying cause.

This is assessed by tests that we mentioned before.

Hope this helps.

Regards.
Above answer was peer-reviewed by : Dr. Kampana
doctor
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Follow up: Dr. Dr. Erion Spaho (10 hours later)
what would be my cause? for a 27 year old with no other medical problem related?

It just doesn't make sense if te doctors find insufficient blood flow to the penis or a venous leak or something what would they say the cause was?
default
Follow up: Dr. Dr. Erion Spaho (0 minute later)
what would be my cause? for a 27 year old with no other medical problem related?

It just doesn't make sense if te doctors find insufficient blood flow to the penis or a venous leak or something what would they say the cause was?
doctor
Answered by Dr. Dr. Erion Spaho (14 hours later)
Brief Answer:
A sort of erection anxiety.

Detailed Answer:
Hello.

It is my opinion that you somehow developed a type of anxiety about your erections.

A venous leak etc. may manifest with other visible signs such as swelling of the genitalia, discoloration, etc.

Again, get the necessary tests to exclude organic problems and start working with an experienced Psychologist.

Take care.
Above answer was peer-reviewed by : Dr. Nagamani Ng
doctor
doctor
Answered by Dr. Dr. Erion Spaho (0 minute later)
Brief Answer:
A sort of erection anxiety.

Detailed Answer:
Hello.

It is my opinion that you somehow developed a type of anxiety about your erections.

A venous leak etc. may manifest with other visible signs such as swelling of the genitalia, discoloration, etc.

Again, get the necessary tests to exclude organic problems and start working with an experienced Psychologist.

Take care.
Above answer was peer-reviewed by : Dr. Nagamani Ng
doctor
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Dr. Dr. Erion Spaho

Neurologist, Surgical

Practicing since :2004

Answered : 4494 Questions

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Hi Doctor, For The Past Almost 9 Months Ive Had

hi doctor, for the past almost 9 months ive had inconsistent quality of erections while masturbating and also sometimes when i am with someone. i also noticed imfrequent morning erections im 27 years old and otherwise healthy. i dont have any vascular or neurological disease that would be an obvious link to this. i dont know how to explain it but it all started when i first noticed that my penis (in a flaccccid) state wasnt moving when i tried moving it internally. i hope that makes sense. is this likely an emotional or physchological issue? or is this a cause of organic issues with penile artery or veins? basically, i am wondering what kinda signs i should look for to confirm if this is psychological or physical.