Hello doctor,
I am a 29-year-old male and I am diagnosed with Crohn's Disease before 11 years and was taking Immuran 150 mg/day, and diagnosed with Streptococcus after semen culture at the beginning of this year. My main concern is ED and PE but the testosterone level is within the normal range. I want to know whether my problem is urology or neurology?
Hello,
Welcome to icliniq.com.
You have mentioned ED (erectile dysfunction) and PE (premature ejaculation). No details of medications tried so far. Can you elaborate on this?
Testosterone only indicates sexual drive, which you have not mentioned as a problem. So that being normal rules out nothing. There are no tests for ED and PE specifically. History is key. Better to discuss in person.
Immunosuppressive medications do not generally cause ED or PE. You have not mentioned any reason or symptoms for checking semen culture. In the absence of any such factors these semen tests can simply be a contaminant. Even if you have prostatitis, it is not likely to cause ED or PE. No need to treat semen culture unless you are symptomatic or in other words it will not help.
Have you checked fasting glucose, lipids, and thyroid function? In the absence of any such symptoms this is likely to be psychogenic especially because of age.
Treatment plan:
Please check the blood tests as above.
Preventive measures:Reassurance, correct the factors if abnormal in the mentioned tests.
Regarding follow up:Need a face to face/audio conversation to understand the issues in more detail.
Thank you doctor,
I took Cialis 5 mg (1 month daily) and supplements like L-arginine, Maca root, Ginseng, etc., but it did not actually work. I cannot maintain erection right before penetration. I did a semen culture because of a UTI (cystitis) and frequent urination (>9 times/day), smell in urine, and painful ejaculation.
Hello,
Welcome back to icliniq.com.
Thanks for the update. That is a lot of symptoms described.
Cystitis in men is abnormal but streptococcus is not a urinary bug. So atypical organism in urine needs evaluation. We need to check your flow rate also.
Painful ejaculation can be due to infection. Is this something new? It can be due to some issues like a stone in ejaculatory duct, etc?
Crohn’s disease generally does not affect large bowel especially rectum. Do you have any large bowel symptoms? We need to analyze this to see whether the infections are due to bowel issues. Again all these will not cause ED or PE.
Did you have premature ejaculation all your life or is it something new? Losing erection before penetration, is it because of ED or due to premature ejaculation?
I would suggest to use Cialis 20 mg an hour before intercourse, not daily dose. It gives better blood levels during performance. Try this for six to eight doses. If it alone does not help, try it in combination with 5 mg daily dose. There are some condoms with topical anesthetic inside it. It will prolong ejaculation and will help in PE. If your wife can understand, try masters and Johnson techniques which helps in prolonging PE.
Tramadol or Dapoxetine are drugs used for PE. I will recommend not to use them until you have tried the rest.
The Probable causes:
Psychogenic ED, primary PE.
Probable diagnosis:ED and PE.
Regarding follow up:Please bear in mind these are very common problems and do not get too stressed. It has the biggest negative effect in young age ED.
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