Patient's Query
Hello doctor,
I am a 25-year-old male, and for the past few weeks, I have been experiencing weak or no erections even during stimulation or fantasy, along with a numb or dull sensation in the penis and perineal area.
About two weeks ago, I masturbated while anxious and could not achieve a full erection, ejaculating in a semi-erect state. Could that have caused any injury, leading to difficulty achieving erections now?
My penis became flaccid and tight, and after seven days, the base tightness subsided, but the erection quality was poor. I stimulate it by hand, but it becomes erect in a flaccid state and does not improve. I still had morning erections for five to six days after that, though they were not fully hard.
I also notice mild pelvic tightness, occasional urine dribbling after voiding, and a slightly cold feeling around the glans or foreskin. All previous blood and hormonal reports are normal. My doctor advised against a Penile Doppler at my age.
Could this be due to psychogenic or pelvic floor factors? My LFT and lipid profile are normal. The pelvic and scrotal Doppler is normal. Testosterone is 340, and I consulted two urologists before, and they both suspected a psychogenic or hormonal cause after physical examination. I am concerned, and my libido has also dropped.
Kindly help.
Thank you.
Hello,
Welcome to icliniq.com.
I read your query and understood your concern.
Based on what you have described and your normal test results, this picture (attachments removed to protect the patient’s identity) most likely represents a functional (psychogenic and pelvic-floor–related) erectile issue, not a structural or vascular injury.
Since your testosterone (340 nanograms per deciliter) and Doppler findings are normal, and you still get partial or morning erections, the vascular and neurological mechanisms are intact.
The incident during masturbation and the anxiety that followed may have caused a temporary spasm or over-activation of pelvic-floor muscles, which can produce the symptoms you are describing. Anxiety and repeated “performance checking” can reinforce a psychogenic loop, further worsening erection quality and libido.
I suggest you follow the steps below:
Pelvic-floor relaxation training:
Avoid squeezing the perineal muscles unnecessarily, especially during urination or arousal.
Try warm sitz baths (10 to 15 minutes twice daily) and gentle diaphragmatic breathing.
If symptoms persist, a few sessions of pelvic-floor physiotherapy can help greatly.
Lifestyle changes:
Reduce pornography and self-performance, as checking it heightens anxiety and desensitisation.
Exercise regularly, prioritise sleep, and manage stress.
Avoid over-stimulation or frequent masturbation while recovering.
Medication support:
A low-dose PDE5 inhibitor (Phosphodiesterase type 5 inhibitor) such as Tadalafil (5 milligrams daily for three to four weeks) can be considered to restore confidence and penile blood flow.
If anxiety remains significant, short-term counselling or a session with a psychosexual therapist can accelerate recovery.
Most men in your situation notice improvement within three to six weeks. Full recovery is the rule, not the exception, once the mind-body feedback loop is broken. You are on the right track, and there is no sign of permanent injury. Continue focusing on pelvic relaxation, confidence, and gradual re-engagement with normal intimacy.
I hope that this answers your query.
Kindly follow up if you have more doubts.
Thank you.
Patient's Query
Hello doctor,
Thank you for the reply.
But my doctor did not perform my penile Doppler; only pelvic and scrotum USG was done, as they said there was no need for penile Doppler at this time.
I hope I get better soon, because many times I feel somewhat aroused, and although the penis is flaccid, it becomes slightly bigger and thicker, but not much in length, and does not become erect. This has been happening since that incident. I hope it improves because I have no history of any vascular disease, diabetes, obesity, or trauma.
Kindly help.
Thank you.
Hello,
Welcome back to icliniq.com.
I read your query and understood your concern.
I would also not suggest a penile Doppler at this stage, considering it is likely going to be normal. My suggestion would be to start Tadalafil 5 milligrams once a day, at night before dinner.
Let us monitor for symptom improvement and then decide what needs to be done going forward. Keep in mind, relaxation techniques and pelvic-floor exercises are just as important as the medication.
I hope that this answers your query.
Kindly follow up if you have more doubts.
Thank you.
Same symptoms don't mean you have the same problem. Consult a doctor now!
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