Though erection is achievable, I am unable to maintain it. Why?

Q. I am unable to maintain erection even after GAINSWave treatment. Why?

Answered by
Dr. Ganesh Prasad Sankara Pandian
and medically reviewed by Dr. Vinodhini. J
This is a premium question & answer published on May 11, 2020 and last reviewed on: Jul 24, 2023

Hello doctor,

I have had ED for several years now. I am able to get an erection but I am unable to maintain it. I have been going to a men's clinic for seven months now and they have done the GAINSWave treatment and implanted a testosterone pellet last week. After all this, there has been no improvement. I have been using the ICI injections and that maintains the erection. Sildenafil is effective sometimes, but not consistently. I have also improved my diet and exercise. I also have delayed ejaculation during this, but in the last 10 days, I am unable to ejaculate at all either through sexual intercourse or masturbation. I have been on SSRIs (selective serotonin reuptake inhibitors) in the past but stopped taking them six days ago. At this point, I am at a loss and would like to get another opinion and some direction.



Welcome to

Your lipid values and blood sugar values are absolutely normal (attachment removed to protect patient identity). I would like to say a few points here. Lisinopril HCTZ (Hydrochlorothiazide) is a combo of two drugs in which HCTZ has erectile dysfunction as one of its side effects. Hydrochlorothiazide need to be replaced with a different drug or removed. You are on three antihypertensives Lisinopril, HCTZ, and Amlodipine. Is your hypertension that severe? Testosterone implant may improve your libido but may not benefit ED (erectile dysfunction) always unless there is a gross hormonal dysfunction. SSRI group of medicines are prescribed to delay ejaculation. I do not know why were you prescribed one. That is the culprit which has stopped your ejaculation totally. Better to discontinue it. Instead of Sildenafil for erection, you can try tablet Tadalafil 10 mg (Cialis) after consulting your andrologist. The erectile effects of Sildenafil are short lasting whereas Tadalafil has prolonged effects and one pill on Friday will make you have a wholesome weekend. It may even stop the need to have intracavernosal injections. One investigation which I would suggest you is a penile doppler which gives an idea of blood flow to the penis. GAINSWave is an addon to cure you fast.

Investigations to be done:

Penile doppler study.

Probable diagnosis:


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