Dr. Gokul Vignesh Kandaswamy
Urology
The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.
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Patient's Query
Hello doctor,
I have ED problems for about a year. I am 22 years old, healthy, active, no other physical health problems. A possible reason for this is I had a bad case of blue balls on a night and was not resolved until the next morning. I believe this may have affected my veins in my testicles. My ED may be mentally too, like libido, but I do not think that as much as a physical problem with blood flow. Please help. I did a test with that gel stuff on testicles and x-ray type thing and they said nothing wrong.
Hello,
Welcome to icliniq.com.
I would like to know a few information about your general health. Is ED present all the time or noticing association with anything particular? Do you take any medications in general or anything for ED? The most common cause for ED in your age is psychological. Any undue stress in life? Any family history of medical problems diabetes, cholesterol, etc? Do you have a partner? Any change in partner recently? Any relevance you notice either this? Also, I am not very sure what blue balls exactly describe. But seeing that you have had an ultrasound of scrotum, I think it is unrelated to ED. Scrotal scans are not relevant for ED. So need more information on how and why you had this?
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Probable diagnosis
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Patient's Query
Thank you doctor,
My general health I would say is above average. I do regular exercise, mountain bike, basketball, and lift weights. I have not had a full 100% erection of any kind in the last 10 months. At best, I get about a 75 percent full erection and it only lasts for 10 minutes. This is why I am concerned and so emotionally stressed out more than anything. About two months ago, I tried Sildenafil from Roman, 40-60 mg dose. It is effective, still not 100% erection though. Yes, I do have stress for sure, but the fact that I never have a 100% erection concerns me. No family history of medical problems. Recently, I got a new partner, everything amazing except the fact my erection has not been enough for sex a couple of times, this is so degrading. Blue balls, i.e. one night I had an erection on and off for several hours, not always an erection but for sure on and off, this I feel may have damaged my veins inside testicles or something restricting blood flow. I got the ultrasound for a varicocele and they said no, but I think it is possible it still is. Please help.
Hello,
Welcome back to icliniq.com.
It appears that you are having a problem for the past 10 months. If you have had normal erections in the past and this has happened with no significant history, this is classically psychogenic. Bear in mind performance anxiety and stress will make it worse. You need psychosexual counseling for psychogenic ED. You can try 100 mg Sildenafil meantime, but again it will not work if stress is not sorted. Regarding your points, they are a sign of how stressed you are as that is simply not possible. You can be fully reassured that once USS is normal, unlikely to have any pathology.
The Probable causes
Investigations to be done
Probable diagnosis
Treatment plan
Preventive measures
Regarding follow up
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Urology
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