The Truth About Impotence - Trouble Maintaining an Erection

Written by Krista

Question (from a 38-year-old Oregon woman): My fiance, who is 37 years old, has trouble maintaining an erection for more than a minute or two. Commonly, he ejaculates after his erection has faded. When we do succeed in having intercourse, he ejaculates (and loses his erection) with very little stimulation. In any case, ejaculation for him rarely FEELS like an orgasm. He is not sure when this trouble started, because before meeting me last year, he had not had a sexual partner for 10 years. When my fiance sought medical treatment, the urologist took urine and blood samples and later told him that he was physically "OK." He prescribed an anti-depressant (Paxil (Paroxetine)), which only made my fiance giddy. What do you recommend? How can we find a doctor in our geographic area who is knowledgable and up-to-date in this field? Also, is there any research into what can cause or prevent male orgasm? It seems that erection, orgasm, and ejaculation are three separate, though related, functions. In our case, none of them seem to be working properly. Thank you for any help you can give us!

DR. GOLDSTEIN:
Your fiance has a common erectile quality problem - inability to maintain the erectile rigidity. Because the problem is consistent and affects his satisfaction with sexual intercourse he has met the criteria for having "erectile dysfunction." The usual evaluation would consist of a history, physical examination, and laboratory tests, followed by education, modification of lifestyle etc, and initiation of first line therapy such as sildenafil citrate (Viagra). However, if your fiance wishes, because he is young, he would be considered a candidate for more sophisticated erectile function testing to gain a better understanding of the nature of the dysfunction and to see if he can be cured of his impairment. He should consider

advertisement

seeing a urologist who specializes in this field for more detailed advice. Perhaps calling the American Foundation for Urologic Diseases in Baltimore can help you locate this physician. You fiance could then be assessed for all the sexual dysfunction issues such as erection, orgasm and ejaculation.

Question (from a 53-year-old Texas man):
I am on blood pressure and diabetes pills and cannot get an erection. My doctor said Viagra would not work for me. Why not?

DR. GOLDSTEIN:
Actually sildenafil may work quite well for you. It is indicated for men with erectile dysfunction who have a physical basis for the impairment - a likely scenario in your case. The only contraindication for use of sildenafil is concomitant use of nitrates - pill for treatment of chest pain (angina). If sildenafil does not work, you could try a vacuum device or try intraurethral pellets, self-injections or a penile implant.

Question (from a 59-year-old California man):
My dysfunction started with diabetes and is now further complicated by Peyronie's (bent penis). It has been several years since I have been able to have a normal erection. I have tried the injection in the Drs. office...it proved quite painful due to the bend in the penis. I have been given Viagra to try. If the pill helps with the erection there will still be a severe 90-degree turn in the shaft of the penis, caused by scar tissue (Peyronie's) Is there a surgery available to remove the scar tissue, allowing the shaft to remain straight - and still responsive to the Viagra? I have been told that there is damage to the one side and I will need a graft to fill in space once scar tissue is removed. (At this time, my diabetes is controlled with pills and diet. ) I do have fears of undergoing surgery with a potential for infection due to diabetes.

DR. GOLDSTEIN:
Your problem is unfortunately common and consists of two problems - 1) erectile dysfunction and 2) penile curvature from Peyronie's disease. Management should be linked to close communication with your urologist.

Specifically to manage the impotence, treatment may be initiated with simple things first. New first-line therapies include sildenafil or vacuum constrictive devices. If these fail, second line therapies include self-injection or intra-urethral pellets. Such treatment focus on erection quality is designed to identify if the enhanced erectile function and improved rigidity would allow for functional sexual intercourse despite the penile curvature. If so - then no attention need be given to the penile curvature - which would be simpler.

If attention is needed to correct the penile curvature, based on the above observation, there are traditional simpler medical therapies including vitamin E. Surgical procedures to achieve penile straightening include: 1) excision of the scar tissue and replacement by graft, 2) "a tuck" procedure or 3) insertion of a penile implant can achieve two purposes - penile rigidity and penile straightening. It is important to discuss all these issues with a urologist. There are important risks ad benefits with each treatment. Perhaps calling the American Foundation for Urologic Diseases in Baltimore can help you locate this physician.

Question (from a 50-year-old California man):
At $10 per tablet, Viagra is expensive. What good reasons can you offer for *not* sparing myself the expense of an office visit and simply getting a small supply from Mexico? Are there real dangers to this? I feel capable of reading and understanding the PDR. All drugs have contraindications to beware. What are those of Viagra?

DR. GOLDSTEIN:
Sildenafil citrate (Viagra) has been approved as safe and effective for the treatment of male erectile dysfunction. If you have compaints consistent with erectile dysfunction, you should see a physician. Erectile dysfunction may be caused by prostate cancer, unrecognized diabetes, hypertension, renal failure, hypogonadism, depression, other psychologic conditions, aortic aneurysm, lumbo-sacral disc disease, use of medications, etc. The evaluation consists of a history (medical, sexual, psychosocial), physical examination and laboratory tests. If needed a psychologic assessment may be added. Education and modification of lifestyle issues or changes in medication may be instituted under physician care. If appropriate, Viagra may be initiated. There are few contraindications other than concomitant use of nitrates.