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Hi Doctor, I Am A Young 27 Year Old Seemingly

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Posted on Sat, 17 Aug 2019
Question: Hi doctor,

I am a young 27 year old seemingly health male. I have been having erection issues for 4 months now. Basically, my erections are inconsistent. Sometimes I am able to get really hard and rigid erections and other times it is very difficult to do so. Before these 4 months, I was having normal erections just like any other male in their 20;s. I was able to get an erection without even thinking about it and didn't even think twice about losing them since they were such a normal every day part of life. These days, I am not even getting nocturnal erections daily. I only get them maybe 3-5 times a week. Some mornings I wake up with an erection, other days I wake up with no initial erection but as soon as I wake up I feel my penis getting erect and other days I wake up with no erection at all. I do not have any medical conditions that I am aware of. The only autoimmune disease i have is psoriasis and I am pretty sure psoriasis is not linked to erectile dysfunction at all. I spoke yo several doctors and all of them said that this is a psychological issue but I am not 100% convinced that this is a psychological issue because if it were then I would still get morning erections daily just like how I used to and I would also be able to get a rigid erection when I masturbate. From my understanding, performance anxiety would be the only type of anxiety that would cause ED and that would only occur in the moments when I am intimate with somebody. It wouldn't be an ongoing daily issue. From your studies and your knowledge in urology, what are some things you would assume would physically be wrong with me? Is there something wrong with blood circulation? injury to my penile arteries?

The only test my doctors have taken was a testosterone test and other blood tests such as glucose levels and everything from my blood and urine analysis came back normal, including normal testosterone. I asked my doctors to do further testing such as an ultrasound of my penis as well as some tests for my heart but they refused to do so and are seeming to only blame my anxiety as the issue which I find strange since if I really do have severe anxiety wouldn't I have more physical symptoms other than just erection problems? Why would my anxiety only focus on my penis area?
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Follow up: Dr. Aaron Branch (0 minute later)
Hi doctor,

I am a young 27 year old seemingly health male. I have been having erection issues for 4 months now. Basically, my erections are inconsistent. Sometimes I am able to get really hard and rigid erections and other times it is very difficult to do so. Before these 4 months, I was having normal erections just like any other male in their 20;s. I was able to get an erection without even thinking about it and didn't even think twice about losing them since they were such a normal every day part of life. These days, I am not even getting nocturnal erections daily. I only get them maybe 3-5 times a week. Some mornings I wake up with an erection, other days I wake up with no initial erection but as soon as I wake up I feel my penis getting erect and other days I wake up with no erection at all. I do not have any medical conditions that I am aware of. The only autoimmune disease i have is psoriasis and I am pretty sure psoriasis is not linked to erectile dysfunction at all. I spoke yo several doctors and all of them said that this is a psychological issue but I am not 100% convinced that this is a psychological issue because if it were then I would still get morning erections daily just like how I used to and I would also be able to get a rigid erection when I masturbate. From my understanding, performance anxiety would be the only type of anxiety that would cause ED and that would only occur in the moments when I am intimate with somebody. It wouldn't be an ongoing daily issue. From your studies and your knowledge in urology, what are some things you would assume would physically be wrong with me? Is there something wrong with blood circulation? injury to my penile arteries?

The only test my doctors have taken was a testosterone test and other blood tests such as glucose levels and everything from my blood and urine analysis came back normal, including normal testosterone. I asked my doctors to do further testing such as an ultrasound of my penis as well as some tests for my heart but they refused to do so and are seeming to only blame my anxiety as the issue which I find strange since if I really do have severe anxiety wouldn't I have more physical symptoms other than just erection problems? Why would my anxiety only focus on my penis area?
doctor
Answered by Dr. Aaron Branch (1 hour later)
Brief Answer:
There are many possible causes

Detailed Answer:
Hello, I'm Dr. Branch, thanks for using Ask a Doctor. There are many conditions that can interfere with erectile function, including smoking, obesity, diabetes, high blood pressure, high cholesterol, and certain medications, including antidepressants and medications for gastric reflux. Strokes, spinal cord injuries, and mulitiple sclerosis are possible neurological causes. Frequent bicycling has been implicated as a possible factor but this isn't clear yet. Endocrine disorders, especially low testosterone, are another cause.

However, since you seem to otherwise be healthy, I would consider these causes to be unlikely. Also, the fact that you do still have erections sometimes argues for that there is nothing physically wrong, especially with your arteries or nerves. Even if you have spontaneous erections less than normal, the fact that you have any at all is important here. A penile ultrasound would normally be the next step in evaluation, but I agree that it will not likely show anything.

As much as you don't want to hear it, anxiety and other underlying psychological and relationship factors are the most likely cause of these changes. The good news is that this will usually improve over time, and in the meantime you can use certain medications to help you have an erection, which over time may help you to be able to have them more reliably.

I hope that helps, please let me know if you have any questions about any of that, and I would be glad to discuss it with you further.
Above answer was peer-reviewed by : Dr. Nagamani Ng
doctor
doctor
Answered by Dr. Aaron Branch (0 minute later)
Brief Answer:
There are many possible causes

Detailed Answer:
Hello, I'm Dr. Branch, thanks for using Ask a Doctor. There are many conditions that can interfere with erectile function, including smoking, obesity, diabetes, high blood pressure, high cholesterol, and certain medications, including antidepressants and medications for gastric reflux. Strokes, spinal cord injuries, and mulitiple sclerosis are possible neurological causes. Frequent bicycling has been implicated as a possible factor but this isn't clear yet. Endocrine disorders, especially low testosterone, are another cause.

However, since you seem to otherwise be healthy, I would consider these causes to be unlikely. Also, the fact that you do still have erections sometimes argues for that there is nothing physically wrong, especially with your arteries or nerves. Even if you have spontaneous erections less than normal, the fact that you have any at all is important here. A penile ultrasound would normally be the next step in evaluation, but I agree that it will not likely show anything.

As much as you don't want to hear it, anxiety and other underlying psychological and relationship factors are the most likely cause of these changes. The good news is that this will usually improve over time, and in the meantime you can use certain medications to help you have an erection, which over time may help you to be able to have them more reliably.

I hope that helps, please let me know if you have any questions about any of that, and I would be glad to discuss it with you further.
Above answer was peer-reviewed by : Dr. Nagamani Ng
doctor
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Follow up: Dr. Aaron Branch (1 hour later)
You're right about my medical conditions. I do not have any of the named medical conditions you listed. Also, I do not smoke nor do I ride a bike.

What do you think the psychological issue would be here? I've been stressed several times in my life so I don't see why the stress regarding my erections would be any different to the point that it would cause erection issues. The reason why I think this is physical is because I have trouble when I am masturbating as well. I am not in any relationship so we can rule out any relationship issues. Is the fact that I am specifically anxious about my erections now causing my erections to become weaker?

also, sometimes I am able to get a really hard and rigid erection but other times (like right now) when I try to masturbate I am having trouble getting one. How would this be a performance anxiety issue when I am not even performing while I am masturbating by myself? I do not want to take any erection drugs at 27. That would make my self esteem even lower and I would be less confident knowing every other man my age is able to get erections whenever they want and i am the only one having to take a viagra.

I recently found out abut my phimosis earlier this year. Which did cause me a bit of anxiety since I felt "different" for having a tight foreskin. I also felt very self conscious that it took me to 26 years to figure out that the foreskin needs to be retracted and after doing research I found out that less than 1$ of men over the age of 18 have phimosis so that made me even more self conscious knowing most other men were able to retract their foreskins naturally as kids while I am in an extremly rare case of men who aren't able to do so. Before the phimosis realization, I was never self consicous about my penis or sex in general. After I found out about phimosis I would constantly think about my penis and even measured it for the first time in my life and was just thinking about my genital area a lot. i don't know if this type of anxiety was what initially led to my erection problems but I did notice that one day during this 1 week period I woke up for the very first time in my life with no morning erection. I resolved it now due to stretching excersizes but my erection problem literally occurred 1 week after I retracted my foreskin for the first time. Would resolving my phimosis have any link to my erection issues now? I am thinking maybe there is a link to the anatomical change in my penis to how blood is flowing in it now. Also, is there such an erection issue where a man gets more erect sometimes moreso then another time? Before I had this issue I would get the same quality erection with the same size and girth regardless if when I got an erection. Now, I noticed sometimes my erect penis is longer or smaller from time to time and also it is more rigid sometimes and really soft other times. Is there anything urgent I can do to get my erections back naturally? All I've been doing for these 4 months is praying that i'll wake up again one day and have my erections back to normal. like I said, I refuse to take any drugs for this since that won't help cure this condition. As a matter of fact, it will make it even more humiliating. And if the problem really is psychological then I don't think viagra would work for psychological problems.
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Follow up: Dr. Aaron Branch (0 minute later)
You're right about my medical conditions. I do not have any of the named medical conditions you listed. Also, I do not smoke nor do I ride a bike.

What do you think the psychological issue would be here? I've been stressed several times in my life so I don't see why the stress regarding my erections would be any different to the point that it would cause erection issues. The reason why I think this is physical is because I have trouble when I am masturbating as well. I am not in any relationship so we can rule out any relationship issues. Is the fact that I am specifically anxious about my erections now causing my erections to become weaker?

also, sometimes I am able to get a really hard and rigid erection but other times (like right now) when I try to masturbate I am having trouble getting one. How would this be a performance anxiety issue when I am not even performing while I am masturbating by myself? I do not want to take any erection drugs at 27. That would make my self esteem even lower and I would be less confident knowing every other man my age is able to get erections whenever they want and i am the only one having to take a viagra.

I recently found out abut my phimosis earlier this year. Which did cause me a bit of anxiety since I felt "different" for having a tight foreskin. I also felt very self conscious that it took me to 26 years to figure out that the foreskin needs to be retracted and after doing research I found out that less than 1$ of men over the age of 18 have phimosis so that made me even more self conscious knowing most other men were able to retract their foreskins naturally as kids while I am in an extremly rare case of men who aren't able to do so. Before the phimosis realization, I was never self consicous about my penis or sex in general. After I found out about phimosis I would constantly think about my penis and even measured it for the first time in my life and was just thinking about my genital area a lot. i don't know if this type of anxiety was what initially led to my erection problems but I did notice that one day during this 1 week period I woke up for the very first time in my life with no morning erection. I resolved it now due to stretching excersizes but my erection problem literally occurred 1 week after I retracted my foreskin for the first time. Would resolving my phimosis have any link to my erection issues now? I am thinking maybe there is a link to the anatomical change in my penis to how blood is flowing in it now. Also, is there such an erection issue where a man gets more erect sometimes moreso then another time? Before I had this issue I would get the same quality erection with the same size and girth regardless if when I got an erection. Now, I noticed sometimes my erect penis is longer or smaller from time to time and also it is more rigid sometimes and really soft other times. Is there anything urgent I can do to get my erections back naturally? All I've been doing for these 4 months is praying that i'll wake up again one day and have my erections back to normal. like I said, I refuse to take any drugs for this since that won't help cure this condition. As a matter of fact, it will make it even more humiliating. And if the problem really is psychological then I don't think viagra would work for psychological problems.
doctor
Answered by Dr. Aaron Branch (4 hours later)
Brief Answer:
Medications may help with your confidence.

Detailed Answer:
After hearing more of your story, it is almost certain that this is related to your anxiety and performance issues, especially with you focusing on your penis so much. I can tell you that if you are still able to get erections at all, that means there is nothing wrong with the actual penis, which includes the blood flow and nerves to the penis. This almost always is caused by a psychological cause. The reason I say that is because if there was something physically wrong, then you would never be able to get an erection, because the physical problems that cause erectile dysfunction are not the kind of problems that come and go like that. Your phimosis would also not be related to any erectile problems as well. It is also not surprising you have trouble with masturbating, since you are probably thinking about these problems and making yourself anxious the whole time.

The best thing for you to do is to stop focusing on it so much, and try to relax about it. I think using medication for awhile may help you to get your confidence back. There's nothing embarrassing about using medications at your age, and many men use them. After a while you'll probably find that you don't need them as much, and then eventually can stop them completely.

Please let me know if you have any other questions, I'd be glad to help any way I can.
Above answer was peer-reviewed by : Dr. Yogesh D
doctor
doctor
Answered by Dr. Aaron Branch (0 minute later)
Brief Answer:
Medications may help with your confidence.

Detailed Answer:
After hearing more of your story, it is almost certain that this is related to your anxiety and performance issues, especially with you focusing on your penis so much. I can tell you that if you are still able to get erections at all, that means there is nothing wrong with the actual penis, which includes the blood flow and nerves to the penis. This almost always is caused by a psychological cause. The reason I say that is because if there was something physically wrong, then you would never be able to get an erection, because the physical problems that cause erectile dysfunction are not the kind of problems that come and go like that. Your phimosis would also not be related to any erectile problems as well. It is also not surprising you have trouble with masturbating, since you are probably thinking about these problems and making yourself anxious the whole time.

The best thing for you to do is to stop focusing on it so much, and try to relax about it. I think using medication for awhile may help you to get your confidence back. There's nothing embarrassing about using medications at your age, and many men use them. After a while you'll probably find that you don't need them as much, and then eventually can stop them completely.

Please let me know if you have any other questions, I'd be glad to help any way I can.
Above answer was peer-reviewed by : Dr. Yogesh D
doctor
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Follow up: Dr. Aaron Branch (7 hours later)
by medication do you mean viagra or anxiety medication?

If you are referring to viagra I don't see how that will help with my confidence since I'll probably just think the only time I am able to get and maintain a hard erection is when I am taking medicine and not being able to do it naturally all the time.

Can you please let me know some other ways I can increase my confidence to the level it was before without relaying on medication?

There are instances where I feel really confident because I see that my erections are finally going back to how they were again but even in those moments I always worry in the back of my mind that it might worsen again and it usually does.

The reason why this whole thing started was because i was driving to work one day and I felt my penis was numb. In the car, I couldn't feel any sensation down there and this led me to panic the whole time at work and driving back home I even had a panic attack in the car (fast heart beat, yelling, pulling my hair, stomping my feet, etc.) I tried to come home to masturbate and I couldn't get an erection all. This made me think I had a physical problem. Days later I calmed down but I still thought I had a problem because I didn't think that anxiety would have had this much effect on my penis. Also, I read online that if you masturbate to too much porn at a young age it causes ED so this made me more upset thinking that this was the reason I was having ED.

As days went by I noticed I was getting erections again but not as much as I'd like. As you can tell, this is literally been on my mind 24/7 for the past 4 months. My days have been consumed of just this issue. In retrospect, the numbness in the penis was probably caused by something else (my company just moved into a new office a month prior to this happening and we had new chairs that I did feel were putting pressure on my testicles) so i am guessing my numb penis was a result of this but since I was still depressed and self conscious about my phimosis I think my brain might have taken my numb penis feeling and automatically made me believe that there was yet something else wrong with my genital area.

One last question though, how come all my doctors basically don't want to take any physical tests because they don't want to entertain the fact that this may be a physical erection issue? They all seem to say the same thing about it not being possible for a young man to have physical erection issues? Is it really that impossible for a young guy to have circulation problems in the penis? Young people around the world have cancer, kidney problems, diabetes, lupus, etc. So what would make having an erection problem so impossible? I am just asking out of curiosity. It seems as do doctors were trained to just turn anybody with an erection issue away or prescribe them viagra. I am 95% sure that this is an anxiety issue but what if it is a physical problem? I read online that the first sign of heart problems is erection issues.
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Follow up: Dr. Aaron Branch (0 minute later)
by medication do you mean viagra or anxiety medication?

If you are referring to viagra I don't see how that will help with my confidence since I'll probably just think the only time I am able to get and maintain a hard erection is when I am taking medicine and not being able to do it naturally all the time.

Can you please let me know some other ways I can increase my confidence to the level it was before without relaying on medication?

There are instances where I feel really confident because I see that my erections are finally going back to how they were again but even in those moments I always worry in the back of my mind that it might worsen again and it usually does.

The reason why this whole thing started was because i was driving to work one day and I felt my penis was numb. In the car, I couldn't feel any sensation down there and this led me to panic the whole time at work and driving back home I even had a panic attack in the car (fast heart beat, yelling, pulling my hair, stomping my feet, etc.) I tried to come home to masturbate and I couldn't get an erection all. This made me think I had a physical problem. Days later I calmed down but I still thought I had a problem because I didn't think that anxiety would have had this much effect on my penis. Also, I read online that if you masturbate to too much porn at a young age it causes ED so this made me more upset thinking that this was the reason I was having ED.

As days went by I noticed I was getting erections again but not as much as I'd like. As you can tell, this is literally been on my mind 24/7 for the past 4 months. My days have been consumed of just this issue. In retrospect, the numbness in the penis was probably caused by something else (my company just moved into a new office a month prior to this happening and we had new chairs that I did feel were putting pressure on my testicles) so i am guessing my numb penis was a result of this but since I was still depressed and self conscious about my phimosis I think my brain might have taken my numb penis feeling and automatically made me believe that there was yet something else wrong with my genital area.

One last question though, how come all my doctors basically don't want to take any physical tests because they don't want to entertain the fact that this may be a physical erection issue? They all seem to say the same thing about it not being possible for a young man to have physical erection issues? Is it really that impossible for a young guy to have circulation problems in the penis? Young people around the world have cancer, kidney problems, diabetes, lupus, etc. So what would make having an erection problem so impossible? I am just asking out of curiosity. It seems as do doctors were trained to just turn anybody with an erection issue away or prescribe them viagra. I am 95% sure that this is an anxiety issue but what if it is a physical problem? I read online that the first sign of heart problems is erection issues.
doctor
Answered by Dr. Aaron Branch (7 hours later)
Brief Answer:
You may need to treat your anxiety

Detailed Answer:
I was talking about medications like viagra, but if you feel that way about them, then I agree you probably shouldn't take them. You may, however, need treatment for your anxiety. The challenge is that many of the medications used to treat anxiety also can cause erectile dysfunction, so it may be best to deal with this with psychotherapy if you are able. Unfortunately, I am not a psychotherapist so I don't think I would be able to help you with this. My only advice would be to try not to think about this, but I realize that is easier said than done.

The reason your doctors don't want to do any more testing is basically because your report of still occasionally having spontaneous erections means that you already passed the test. There would be no point in doing the test, because whatever the test says, you have already shown that your penis is physically capable of having an erection. And doctors don't like doing unnecessary tests because it takes up resources that are needed for patients who really need the testing. This may seem unreasonable to you, but you have to understand we have a different perspective than you, because of our training and experience with many patients like you. Also, the information you read online is mistaken (as it often is), and erections issues are usually not the first sign of heart problems.

I know that may not be the answer you were looking for, but it is the truth, and eventually you will have to face the fact that this is caused by anxiety, and by focusing on potential physical causes, you are only making the anxiety worse. If you try to focus on other things, maybe exercise or something else you enjoy, and not think about this problem as much, I think over time you will find that your issues will improve and resolve.

Above answer was peer-reviewed by : Dr. Kampana
doctor
doctor
Answered by Dr. Aaron Branch (0 minute later)
Brief Answer:
You may need to treat your anxiety

Detailed Answer:
I was talking about medications like viagra, but if you feel that way about them, then I agree you probably shouldn't take them. You may, however, need treatment for your anxiety. The challenge is that many of the medications used to treat anxiety also can cause erectile dysfunction, so it may be best to deal with this with psychotherapy if you are able. Unfortunately, I am not a psychotherapist so I don't think I would be able to help you with this. My only advice would be to try not to think about this, but I realize that is easier said than done.

The reason your doctors don't want to do any more testing is basically because your report of still occasionally having spontaneous erections means that you already passed the test. There would be no point in doing the test, because whatever the test says, you have already shown that your penis is physically capable of having an erection. And doctors don't like doing unnecessary tests because it takes up resources that are needed for patients who really need the testing. This may seem unreasonable to you, but you have to understand we have a different perspective than you, because of our training and experience with many patients like you. Also, the information you read online is mistaken (as it often is), and erections issues are usually not the first sign of heart problems.

I know that may not be the answer you were looking for, but it is the truth, and eventually you will have to face the fact that this is caused by anxiety, and by focusing on potential physical causes, you are only making the anxiety worse. If you try to focus on other things, maybe exercise or something else you enjoy, and not think about this problem as much, I think over time you will find that your issues will improve and resolve.

Above answer was peer-reviewed by : Dr. Kampana
doctor
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Follow up: Dr. Aaron Branch (3 hours later)
That does sound reasonable. It's just that sex and masturbation is a big part of my life so just not thinking about it is going to be difficult (and has been difficult).

Yes, I do still get erections but not as frequently as I'd like or as I used to. Also, the firmness sometimes just isn't strong enough anymore. That is why I am asking for a test. To see if maybe there is a physical reason that the erections are inconsistent now. Maybe my blood isn't flowing to the penis because of other reasons. Like right now I tried to masturbate. I was totally calm and not anxious but still couldn't get a hard erection. Is this because it takes time for erections to go back to normal after being anxious?

Can you also explain the firmness of erections? If you masturbate or have sex too often does the firmness decrease unless you take a break? Or does the level of arousal cause stronger erections? Sometimes I get stronger erections than other times.

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Follow up: Dr. Aaron Branch (0 minute later)
That does sound reasonable. It's just that sex and masturbation is a big part of my life so just not thinking about it is going to be difficult (and has been difficult).

Yes, I do still get erections but not as frequently as I'd like or as I used to. Also, the firmness sometimes just isn't strong enough anymore. That is why I am asking for a test. To see if maybe there is a physical reason that the erections are inconsistent now. Maybe my blood isn't flowing to the penis because of other reasons. Like right now I tried to masturbate. I was totally calm and not anxious but still couldn't get a hard erection. Is this because it takes time for erections to go back to normal after being anxious?

Can you also explain the firmness of erections? If you masturbate or have sex too often does the firmness decrease unless you take a break? Or does the level of arousal cause stronger erections? Sometimes I get stronger erections than other times.

doctor
Answered by Dr. Aaron Branch (2 hours later)
Brief Answer:
You can have anxiety affecting erectile function even without being aware

Detailed Answer:
It is possible to have anxiety affecting your erectile function without being consciously aware of it. But at other times you seem to definitely be aware of it, so I would assume it is affecting your erections. Masturbating or having sex will affect the firmness of your erections for a certain period of time, sometimes hours to maybe a day, during which time you may find that it is more difficult to get an erection. And yes, the level of arousal definitely causes stronger erections.

Please let me know if you have any other questions, I'd be glad to help any way I can.
Above answer was peer-reviewed by : Dr. Nagamani Ng
doctor
doctor
Answered by Dr. Aaron Branch (0 minute later)
Brief Answer:
You can have anxiety affecting erectile function even without being aware

Detailed Answer:
It is possible to have anxiety affecting your erectile function without being consciously aware of it. But at other times you seem to definitely be aware of it, so I would assume it is affecting your erections. Masturbating or having sex will affect the firmness of your erections for a certain period of time, sometimes hours to maybe a day, during which time you may find that it is more difficult to get an erection. And yes, the level of arousal definitely causes stronger erections.

Please let me know if you have any other questions, I'd be glad to help any way I can.
Above answer was peer-reviewed by : Dr. Nagamani Ng
doctor
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Follow up: Dr. Aaron Branch (3 days later)
does a varicocele cause ED?
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Follow up: Dr. Aaron Branch (0 minute later)
does a varicocele cause ED?
doctor
Answered by Dr. Aaron Branch (14 minutes later)
Brief Answer:
No, a varicocele would be something separate.

Detailed Answer:
No, a varicocele would be something separate, that would only affect the testicle. It can cause a dull ache, testicular atrophy, and decreased fertility, but would not affect erectile function.
Above answer was peer-reviewed by : Dr. Kampana
doctor
doctor
Answered by Dr. Aaron Branch (0 minute later)
Brief Answer:
No, a varicocele would be something separate.

Detailed Answer:
No, a varicocele would be something separate, that would only affect the testicle. It can cause a dull ache, testicular atrophy, and decreased fertility, but would not affect erectile function.
Above answer was peer-reviewed by : Dr. Kampana
doctor
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Follow up: Dr. Aaron Branch (47 minutes later)
oh......i don't have any of those symtoms but i do have varicoecele.

is there a cure for this?

even after i told u my varicocele diagnosis do u still think my ED is psychological?
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Follow up: Dr. Aaron Branch (0 minute later)
oh......i don't have any of those symtoms but i do have varicoecele.

is there a cure for this?

even after i told u my varicocele diagnosis do u still think my ED is psychological?
doctor
Answered by Dr. Aaron Branch (13 minutes later)
Brief Answer:
Yes, a varicocele is not related

Detailed Answer:
Yes, a varicocele is not related to your erectile dysfunction. Usually nothing needs to be done, but you should be checked to make sure you have no testicular atrophy, and a semen analysis can also be done to see if you fertility is being affected. If any other those are abnormal, surgery or a procedure may be considered, though typically these are done in younger men (under 21 years old).
Above answer was peer-reviewed by : Dr. Kampana
doctor
doctor
Answered by Dr. Aaron Branch (0 minute later)
Brief Answer:
Yes, a varicocele is not related

Detailed Answer:
Yes, a varicocele is not related to your erectile dysfunction. Usually nothing needs to be done, but you should be checked to make sure you have no testicular atrophy, and a semen analysis can also be done to see if you fertility is being affected. If any other those are abnormal, surgery or a procedure may be considered, though typically these are done in younger men (under 21 years old).
Above answer was peer-reviewed by : Dr. Kampana
doctor
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Follow up: Dr. Aaron Branch (14 hours later)
so basically everything is physically correct with my erectile health? is it 100% guaranteed that i'll get good erections back if my counselor/therapy sessions work?

also, are varicoceles common?
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Follow up: Dr. Aaron Branch (0 minute later)
so basically everything is physically correct with my erectile health? is it 100% guaranteed that i'll get good erections back if my counselor/therapy sessions work?

also, are varicoceles common?
doctor
Answered by Dr. Aaron Branch (8 minutes later)
Brief Answer:
Varicoceles are common

Detailed Answer:
There's hardly ever a 100% guarantee in this life, but I would expect that once the anxiety is dealt with, your erections will return to normal.

Varicoceles are quite common, found in 15-20% of post-pubertal males, most of which do not require any treatment.


Above answer was peer-reviewed by : Dr. Arnab Banerjee
doctor
doctor
Answered by Dr. Aaron Branch (0 minute later)
Brief Answer:
Varicoceles are common

Detailed Answer:
There's hardly ever a 100% guarantee in this life, but I would expect that once the anxiety is dealt with, your erections will return to normal.

Varicoceles are quite common, found in 15-20% of post-pubertal males, most of which do not require any treatment.


Above answer was peer-reviewed by : Dr. Arnab Banerjee
doctor
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Follow up: Dr. Aaron Branch (1 hour later)
the lack of spontaneous erections and lack of morning erections are what are making me really worried since I keep hearing those don't have to do with anxiety. Some doctors tell me its fine not to have morning or nocturnal wood every day but others tell me at my age it would be strange not to have them daily.

Also, I don't know how to explain this sensation but the feeling that i would used to get of "pumping" my veins in the penis isn't not there anymore either.
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Follow up: Dr. Aaron Branch (0 minute later)
the lack of spontaneous erections and lack of morning erections are what are making me really worried since I keep hearing those don't have to do with anxiety. Some doctors tell me its fine not to have morning or nocturnal wood every day but others tell me at my age it would be strange not to have them daily.

Also, I don't know how to explain this sensation but the feeling that i would used to get of "pumping" my veins in the penis isn't not there anymore either.
doctor
Answered by Dr. Aaron Branch (3 hours later)
Brief Answer:
You should not expect spontaneous erections every morning.

Detailed Answer:
I'm not sure the reasons why someone would say you should expect to have spontaneous erections daily, but I have never heard of that, and I don't know anyone of any age who has erections every morning. Are you saying that before this all started you had an erection every morning?

Regardless, all I can tell you is that in my medical opinion, this is almost certainly anxiety, and the presence of any erections shows that there is nothing physical wrong. The sooner that you can come to peace with that, I think the sooner you will begin the process of getting your normal erectile function back.
Above answer was peer-reviewed by : Dr. Kampana
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doctor
Answered by Dr. Aaron Branch (0 minute later)
Brief Answer:
You should not expect spontaneous erections every morning.

Detailed Answer:
I'm not sure the reasons why someone would say you should expect to have spontaneous erections daily, but I have never heard of that, and I don't know anyone of any age who has erections every morning. Are you saying that before this all started you had an erection every morning?

Regardless, all I can tell you is that in my medical opinion, this is almost certainly anxiety, and the presence of any erections shows that there is nothing physical wrong. The sooner that you can come to peace with that, I think the sooner you will begin the process of getting your normal erectile function back.
Above answer was peer-reviewed by : Dr. Kampana
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Follow up: Dr. Aaron Branch (19 hours later)
Yes, absolutely. From puberty up until 4 months ago I woke up every single morning with a hard and rigid erection that would last util I get up out of bed and went to the bathroom. Not one day passed where I didn't have a morning erection so just imagine my shock and disbelief that I woke up a couple mornings with a completely flaccid penis. I read online from a handful of articles that if a man who does not have physical ED should have 5-7 erections every single night in his sleep with each erection lasting 15 minutes or so. Before any of this happened I even had erections before I even fell asleep. When I got in my bed I would sleep on my stomach and I would get aroused and get an erection and the erection maintained for the entire night (I know this because regardless of whatever time I woke up I always had an erection). So this one symptom alone with the lack of erections is concerning for me because if there wasn't something wrong why would my morning erections decrease so noticeably and drastically? I understand the older we get the less morning erections we have but I am only 27 years old and live a healthy lifestyle. Why would I experience this so early on? My guess is that, unlike men with performance anxiety who may only experience anxiety during intercourse, I literally think about my erection problems ALL DAY LONG. Even when I am distracted with work I bet it is aways in the back of my mind. It would be helpful to hear your medical opinion on this but just a guess is since I am anxious about my erections during masturbation and basically throughout the entire day it may cause lack of morning wood. Which is strange, since in these past 4 months I always got an erection when I was having intercourse (sometimes my erections aren't as big as other times but that is probably due to arousal. It's during masturbation and other times when I am alone and feel a lack of sensation in my penis that I have erection problems.

Also, would watching/masturbating to too much pornography cause this as well?

Remember, when I first panicked and felt anxious about my erections was on my way to work and I wasn't even trying to get an erection. So the lack of sensatio I was feeling in my flaccid penis made me nervous and led me to automatically think I had erection problems. So maybe erectile dysfunction isn't the correct word for this but maybe I am having a penis problem in general.

All of my doctors say this is psychological and all say the same thing and the science behind how it is impossible for me to have physical ED makes perfect sense but my body is saying something different.

Technically speaking, just an example (not saying this is my case) but lets just say in the past month I was having no nocturnal erections, no spontaneous erections, trouble getting an erection most of the time but was able to get a perfectly good and rigid erection only one time in the past month is that proof enough to rule out anything physical? Just want to see if there is such an erectile disease or dysfunction where you are only able to physically get an erection specific times.
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Follow up: Dr. Aaron Branch (0 minute later)
Yes, absolutely. From puberty up until 4 months ago I woke up every single morning with a hard and rigid erection that would last util I get up out of bed and went to the bathroom. Not one day passed where I didn't have a morning erection so just imagine my shock and disbelief that I woke up a couple mornings with a completely flaccid penis. I read online from a handful of articles that if a man who does not have physical ED should have 5-7 erections every single night in his sleep with each erection lasting 15 minutes or so. Before any of this happened I even had erections before I even fell asleep. When I got in my bed I would sleep on my stomach and I would get aroused and get an erection and the erection maintained for the entire night (I know this because regardless of whatever time I woke up I always had an erection). So this one symptom alone with the lack of erections is concerning for me because if there wasn't something wrong why would my morning erections decrease so noticeably and drastically? I understand the older we get the less morning erections we have but I am only 27 years old and live a healthy lifestyle. Why would I experience this so early on? My guess is that, unlike men with performance anxiety who may only experience anxiety during intercourse, I literally think about my erection problems ALL DAY LONG. Even when I am distracted with work I bet it is aways in the back of my mind. It would be helpful to hear your medical opinion on this but just a guess is since I am anxious about my erections during masturbation and basically throughout the entire day it may cause lack of morning wood. Which is strange, since in these past 4 months I always got an erection when I was having intercourse (sometimes my erections aren't as big as other times but that is probably due to arousal. It's during masturbation and other times when I am alone and feel a lack of sensation in my penis that I have erection problems.

Also, would watching/masturbating to too much pornography cause this as well?

Remember, when I first panicked and felt anxious about my erections was on my way to work and I wasn't even trying to get an erection. So the lack of sensatio I was feeling in my flaccid penis made me nervous and led me to automatically think I had erection problems. So maybe erectile dysfunction isn't the correct word for this but maybe I am having a penis problem in general.

All of my doctors say this is psychological and all say the same thing and the science behind how it is impossible for me to have physical ED makes perfect sense but my body is saying something different.

Technically speaking, just an example (not saying this is my case) but lets just say in the past month I was having no nocturnal erections, no spontaneous erections, trouble getting an erection most of the time but was able to get a perfectly good and rigid erection only one time in the past month is that proof enough to rule out anything physical? Just want to see if there is such an erectile disease or dysfunction where you are only able to physically get an erection specific times.
doctor
Answered by Dr. Aaron Branch (1 hour later)
Brief Answer:
Underlying anxiety can cause problems with erections at any time

Detailed Answer:
I have not done a lot of research on this, but from my understanding, anxiety (as well as depression) causes chemical changes in the brain, that would persist even when you are not feeling anxious (or you may have become so accustomed to it that you don't notice it all the time). These chemical changes may take days to weeks to completely resolve, and would be exacerbated anytime you are worried or feel pressure about having an erection.

Yes, there has been some research that viewing pornography can affect erectile function, and even young people are having erectile dysfunction who look at excessive pornography.

Basically, if you are able to have an erection at all, even for just a few seconds, it shows that physically you are able to have an erection. There is nothing wrong with the hardware (physical components), it is just the software (the thinking, psychological aspect) that is not able to get the message to the hardware right.
Above answer was peer-reviewed by : Dr. Kampana
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doctor
Answered by Dr. Aaron Branch (0 minute later)
Brief Answer:
Underlying anxiety can cause problems with erections at any time

Detailed Answer:
I have not done a lot of research on this, but from my understanding, anxiety (as well as depression) causes chemical changes in the brain, that would persist even when you are not feeling anxious (or you may have become so accustomed to it that you don't notice it all the time). These chemical changes may take days to weeks to completely resolve, and would be exacerbated anytime you are worried or feel pressure about having an erection.

Yes, there has been some research that viewing pornography can affect erectile function, and even young people are having erectile dysfunction who look at excessive pornography.

Basically, if you are able to have an erection at all, even for just a few seconds, it shows that physically you are able to have an erection. There is nothing wrong with the hardware (physical components), it is just the software (the thinking, psychological aspect) that is not able to get the message to the hardware right.
Above answer was peer-reviewed by : Dr. Kampana
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Follow up: Dr. Aaron Branch (1 hour later)
I did (do) watch a lot of porn. Wouldn’t porn related ED mean that I wouldn’t get an an erection during intercourse? Cause if that’s the case then we can rule out pornography as the cause because I still get aroused when I’m physically with somebody.

I don’t know if you have personal had this feeling or if you know any patient that had this feeling but since the loss of sensation in my penis is what prompted my anxiety and thoughts then I guess I can start there to figure out what that symptom means. I have regained the sensation and feeling of my penis but have election issues now. I’m thinking maybe sitting on an uncomfortable office chair for too long would have temporarily caused a numbing feeling in my penis?

You’re explanation about having a feeling of anxiety for so long that you feel accustomed to it makes sense since I literally have been having a different perspective of lifeboat in these past 4 months and it’s been constant. A very negative and unfair perspective but hopefully if my anxiety counselor is good I can get rid of this view and my anxiety overall and see if that helps.
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Follow up: Dr. Aaron Branch (0 minute later)
I did (do) watch a lot of porn. Wouldn’t porn related ED mean that I wouldn’t get an an erection during intercourse? Cause if that’s the case then we can rule out pornography as the cause because I still get aroused when I’m physically with somebody.

I don’t know if you have personal had this feeling or if you know any patient that had this feeling but since the loss of sensation in my penis is what prompted my anxiety and thoughts then I guess I can start there to figure out what that symptom means. I have regained the sensation and feeling of my penis but have election issues now. I’m thinking maybe sitting on an uncomfortable office chair for too long would have temporarily caused a numbing feeling in my penis?

You’re explanation about having a feeling of anxiety for so long that you feel accustomed to it makes sense since I literally have been having a different perspective of lifeboat in these past 4 months and it’s been constant. A very negative and unfair perspective but hopefully if my anxiety counselor is good I can get rid of this view and my anxiety overall and see if that helps.
doctor
Answered by Dr. Aaron Branch (20 hours later)
Brief Answer:
The research on porn is still developing

Detailed Answer:
The research on porn is still developing, but I think it would at least make it harder to get aroused, but if you are still aroused when you are physically with someone, then it may not be a major issue.

I have not heard of just sitting on any kind of chair causing this problem, but there is some concern that bicycling can cause erectile dysfunction because of the pressure on the nerves and arteries going to the penis. However, this is controversial and really only applies to serious cyclists, so I doubt your chair issue would be causing any major problems.

This might be an opportunity for you to focus on other things in your life, whether it is a relationship, or a hobby, or something else. The truth is, making something like this too important in your life is a setup for anxiety, because your sexual health will change as you get older, and if you are dependent on that for your emotional well-being, you will have trouble adjusting.

I would try to find something else in your life that you find worthwhile and willing to live for. It may be that only then when you have accepted that even if you never have erections like you used to have, and you're ok with that, that they will come back like they were before.


Above answer was peer-reviewed by : Dr. Arnab Banerjee
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doctor
Answered by Dr. Aaron Branch (0 minute later)
Brief Answer:
The research on porn is still developing

Detailed Answer:
The research on porn is still developing, but I think it would at least make it harder to get aroused, but if you are still aroused when you are physically with someone, then it may not be a major issue.

I have not heard of just sitting on any kind of chair causing this problem, but there is some concern that bicycling can cause erectile dysfunction because of the pressure on the nerves and arteries going to the penis. However, this is controversial and really only applies to serious cyclists, so I doubt your chair issue would be causing any major problems.

This might be an opportunity for you to focus on other things in your life, whether it is a relationship, or a hobby, or something else. The truth is, making something like this too important in your life is a setup for anxiety, because your sexual health will change as you get older, and if you are dependent on that for your emotional well-being, you will have trouble adjusting.

I would try to find something else in your life that you find worthwhile and willing to live for. It may be that only then when you have accepted that even if you never have erections like you used to have, and you're ok with that, that they will come back like they were before.


Above answer was peer-reviewed by : Dr. Arnab Banerjee
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Follow up: Dr. Aaron Branch (1 hour later)
and what would you say causes fast ejaculation now even during masturbation? I never had this issue before. I would be able to masturbate/have sex for 30 minutes until an hour if I wanted. Now, sometimes (not always) I feel like ejaculating anywhere between 1-4 minutes which never happened before. Is it because since I retracted my foreskin for the first time recently that my penis is till sensitive?

I don't care about getting older and having declining sexual function because I know that at east then it is normal and other men my age are having the same issue. I am just really unhappy that this is happening to me at 27 and I am not 100% sure other guys my age or even in their 30s and 40s are not having this same problem.

I am trying to keep my mind off of it and going to see a sex therapist. This may not be in your specialty but do you know what kind of excersizes they'll have me do to go back to normal?
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Follow up: Dr. Aaron Branch (0 minute later)
and what would you say causes fast ejaculation now even during masturbation? I never had this issue before. I would be able to masturbate/have sex for 30 minutes until an hour if I wanted. Now, sometimes (not always) I feel like ejaculating anywhere between 1-4 minutes which never happened before. Is it because since I retracted my foreskin for the first time recently that my penis is till sensitive?

I don't care about getting older and having declining sexual function because I know that at east then it is normal and other men my age are having the same issue. I am just really unhappy that this is happening to me at 27 and I am not 100% sure other guys my age or even in their 30s and 40s are not having this same problem.

I am trying to keep my mind off of it and going to see a sex therapist. This may not be in your specialty but do you know what kind of excersizes they'll have me do to go back to normal?
doctor
Answered by Dr. Aaron Branch (22 hours later)
Brief Answer:
Premature ejaculation can also be related to stress/anxiety

Detailed Answer:
Premature ejaculation is also often related to stress and anxiety, and is often a problem that comes with erectile dysfunction. I do hope you will be able to keep your mind off it and see improvement.

As for as the sex therapist, I really don't know what they would do, as that is very much out of my expertise.
Above answer was peer-reviewed by : Dr. Raju A.T
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Answered by Dr. Aaron Branch (0 minute later)
Brief Answer:
Premature ejaculation can also be related to stress/anxiety

Detailed Answer:
Premature ejaculation is also often related to stress and anxiety, and is often a problem that comes with erectile dysfunction. I do hope you will be able to keep your mind off it and see improvement.

As for as the sex therapist, I really don't know what they would do, as that is very much out of my expertise.
Above answer was peer-reviewed by : Dr. Raju A.T
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Follow up: Dr. Aaron Branch (6 hours later)
when you say that premature ejaculation is often a problem that comes with ED do you mean physical ED?

I would say 70% of the time I ejaculate just fine but other times I feel my ejaculate coming out faster than I want.
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Follow up: Dr. Aaron Branch (0 minute later)
when you say that premature ejaculation is often a problem that comes with ED do you mean physical ED?

I would say 70% of the time I ejaculate just fine but other times I feel my ejaculate coming out faster than I want.
doctor
Answered by Dr. Aaron Branch (43 minutes later)
Brief Answer:
Psychological ED, not physical ED

Detailed Answer:
No, I meant psychological ED, not physical ED. We have already established that you do not have physical ED, so whatever else I say, I am not going to contradict that. Premature ejaculation is also often caused by psychological factors and its presence also supports a psychological basis for your ED.
Above answer was peer-reviewed by : Dr. Vaishalee Punj
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doctor
Answered by Dr. Aaron Branch (0 minute later)
Brief Answer:
Psychological ED, not physical ED

Detailed Answer:
No, I meant psychological ED, not physical ED. We have already established that you do not have physical ED, so whatever else I say, I am not going to contradict that. Premature ejaculation is also often caused by psychological factors and its presence also supports a psychological basis for your ED.
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Above answer was peer-reviewed by : Dr. Vaishalee Punj
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Dr. Aaron Branch

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Hi Doctor, I Am A Young 27 Year Old Seemingly

Hi doctor, I am a young 27 year old seemingly health male. I have been having erection issues for 4 months now. Basically, my erections are inconsistent. Sometimes I am able to get really hard and rigid erections and other times it is very difficult to do so. Before these 4 months, I was having normal erections just like any other male in their 20;s. I was able to get an erection without even thinking about it and didn't even think twice about losing them since they were such a normal every day part of life. These days, I am not even getting nocturnal erections daily. I only get them maybe 3-5 times a week. Some mornings I wake up with an erection, other days I wake up with no initial erection but as soon as I wake up I feel my penis getting erect and other days I wake up with no erection at all. I do not have any medical conditions that I am aware of. The only autoimmune disease i have is psoriasis and I am pretty sure psoriasis is not linked to erectile dysfunction at all. I spoke yo several doctors and all of them said that this is a psychological issue but I am not 100% convinced that this is a psychological issue because if it were then I would still get morning erections daily just like how I used to and I would also be able to get a rigid erection when I masturbate. From my understanding, performance anxiety would be the only type of anxiety that would cause ED and that would only occur in the moments when I am intimate with somebody. It wouldn't be an ongoing daily issue. From your studies and your knowledge in urology, what are some things you would assume would physically be wrong with me? Is there something wrong with blood circulation? injury to my penile arteries? The only test my doctors have taken was a testosterone test and other blood tests such as glucose levels and everything from my blood and urine analysis came back normal, including normal testosterone. I asked my doctors to do further testing such as an ultrasound of my penis as well as some tests for my heart but they refused to do so and are seeming to only blame my anxiety as the issue which I find strange since if I really do have severe anxiety wouldn't I have more physical symptoms other than just erection problems? Why would my anxiety only focus on my penis area?