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Molly Maloof, MD

Director of Clinical Content

Erectile Dysfunction.

I'm a 33 year male with erectile dysfunction. It began when I started masterbating and has been an issue with every partner. My urologist did and blood and urine tests. All came back clean, including testosterone levels. I've never had an injury to the area. My doctor states it's anxiety but seemed confused when I advised him I can always reach an orgasm, I just end up being too soft for penetration. Whether with a partner or by myself. What could it be?
  • Male | 33 years old
  • Complaint duration: 90 days
  • Medications: None
  • Conditions: Lymes disease

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This is a distressing problem. We need both good mental and physical health to achieve successful sexual activity. Anxiety is definitely a contributing factor to sexual dysfunction in men. Often medicine to help achieve good erections can be helpful as a short term solution but if there is anxiety that persists talking to a counselor or psychologist may be of use. I tend to use injections only for patients who fail oral therapy and treat anxiety related conditions first.
Aaron Grotas
Your erectile dysfunction may be physiologic, although not common at your age, or psychologic. It really doesn't matter which, since the bottom line is you have a problem. As long as you've had the appropriate blood tests to exclude any potentially reversible cause of your problem, there is no point in doing any additional testing as the results will not affect recommended therapy. You should start with Cialis 20 mg or Viagra 100 mg. I have found that many men don't respond to the lower doses. If one doesn't work, try the other. If one of them does work, then you can try lowering the dose so you can try to take the lowest dose that is effective. If the oral medication does not work, I would then go to what is known as intracavernosal therapy, which is medication injected directly into the penis when you wish to have an erection. I generally recommend starting with Prostaglandin, and if not effective, then moving into a formula known as "tri-mix." You will need to do this under the supervision of a urologist experienced in this treatment. There is almost a 100% chance that one of these will work. Last resort is a penile prosthesis, but this should be an absolute last resort.
The Barron Centers
I agree with previous answers. The best test is Doppler ultrasound to check blood flow.
William Livingston
YOu have definitely developed a condition known as erectile dysfunction or ED. Reaching orgasm with a soft , non erect penis is the first sign of impotence. Loss of blood from the penis is what causes problems with penetration. The many causes are listed below, but if anxiety is the issue, ED is psychological and can be treated with both an erection enhancer like Cialis, Viagra, Levitra or Stendra and psychotherapy. About 30% of ED is related to low testosterone levels and both free and total testosterone must be measured.
You are young so I would start with low dose cialis to see if that works. If not go to full strength cialis Viagra Levitra or Stendra. If no success ask for a penile Doppler with and without a pharmacological injection mix to rule out arterial insufficiency or venous leak. Good luck.
There are a number of possible solutions to the problem. The easiest and cheapest is to get a set of "confidence rings", which are applied to the well lubricated penis. These will help maintain the erection sufficient for penetration but may interfere somewhat with ejaculation. Oral drugs such as Viagra could also be used and should work. One other suggestion is to have sex in such a position as to bend the penis as far down away from the body as possible. This inhibits outflow of blood from the penis, helping to make the erection firmer.
James E. Moulsdale