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ERECTILE DYSFUNCTION QUESTION:

39 years old been using viagra 100mg for last 7 years, I hate having to take it, and recently it hasn’t worked causing performance anxiety what can I do

Thanks,
Tony

DOCTOR ALSAYES ANSWER:

Hello Tony,

The key to deal with this situation is to identify the cause and to treat it accordingly.

Erectile dysfunction has many factors and underlying causes, as you probably know. One of these aspects is the psychological aspect.

Your doctor must identify the source of this problem first—for instance, overweight or diabetes or being on certain medications—we must first address that problem.

For treatment options (assuming the underlying problem was addressed – if possible) usually, we start with oral medications (such as Viagra or Cialis), your doctor may suggest to change the dose or brand if the desirable effect is not achieved after a while, however these medications don’t work well for every case, and for some men they don’t produce the same effect over time, thus 2nd choice we may try is injections (such as Bi-Mix and Tri-Mix).

If these 2 options didn’t provide much improvement, we consider penile implants. There are 2 main types of these implants; semirigid and inflatable. Each type works differently and has various pros and cons. In most cases, patients report a satisfaction rate of 80%-90% with penile implants as they have erections suitable for intercourse.

However, you should know; the placement of penile implants requires surgery, and no surgery is totally free of possible complications or risks.

I’d suggest you speak to your doctor about the next treatment option that can be helpful for your current health condition.

I hope this answers your question.

Thanks,
Dr. Alsayes

ERECTILE DYSFUNCTION QUESTION:

Hello, I am a 28-year-old male and I am experiencing the same erectile problem for as long as I can remember. I don’t have a problem having or keeping an erection as long as it is the first one.

The moment I ejaculate, I am having a serious problem to keep or even have an erection and I am experiencing pain around my penis.

This situation lasts at least 2-3 hours, and even if I manage to have sex again(after at least 3 hours), the pain is still there and is growing stronger if I ejaculate again. For the pain to go away, I have to wait at least 6 hours after the first ejaculation. Is there any sufficient way to treat this(maybe pills?).

Thank you
Panos

DOCTOR ALSAYES ANSWER:

Hello Panos,
In most of such cases, the cause is related to a medical reason, although psychological issues can play a role as well, the most common causes include:
• Prostatitis (Inflammation and swelling of the prostate
• Prostatic tumor
• Being on some medications, such as antidepressants (e.g., amoxapine, clomipramine, imipramine, protriptyline), selective serotonin reuptake inhibitors (e.g., fluoxetine), venlafaxine, and MAOIs
• Emotional and relationship issues (usually no pain after masturbation)
• Life situations that cause depression, tension, or anxiety can have a negative impact on sexual performance
• Seminal vesicle problems such as deposits known as calculi form inside the seminal vesicle
• Sexually transmitted infections (STIs) such as; chlamydia and trichomoniasis
• Diabetes is likely the most common condition that can have an effect on the nervous system and damage the nerves, which in turn can impact ejaculation

You should see your doctor as soon as possible for an evaluation. Identifying the cause early can result in effective treatment and reversal of the problem.

I hope this answers your question.

Thanks
Dr. Alsayes

ERECTILE DYSFUNCTION QUESTION:

Can tadalafil drug cure erectile dysfunction permanently? Or regular usage of the same is required?

Thanks
Hardik

DOCTOR ALSAYES ANSWER:

Hello Hardik,
Tadalafil is used to treat erectile dysfunction (ED) by increasing blood flow to the penis to help you get and keep an erection (when sexual stimulation is there).

So basically, Tadalafil is treating the symptoms not the cause of the ED (regular use is required until the underlying cause is fixed – if possible)
To treat erectile dysfunction, there are 2 ways that tadalafil may be prescribed.

Your doctor will determine which is the best way for you to take tadalafil. The first way is to take it as needed, usually at least 30 minutes before sexual activity. The second way to treat ED is to take tadalafil regularly, once a day every day. If you take it this way, you may attempt sexual activity at any time between your doses.

I’d suggest first to check with your doctor for evaluation, and if all organic causes of ED were excluded then I’d suggest you see a psychotherapist evaluate the psychological aspect.

I hope this answers your question.

Thanks
Dr. Alsayes

ERECTILE DYSFUNCTION QUESTION:

Hi, I am 25 and suffering from erectile dysfunction, I have recently learned that I have low levels of testosterone, but the problem is I was told that even TRT wouldn’t help with my erections, so I don’t know what to do so solve this. What do you suggest?

Thanks,
Yad

DOCTOR ALSAYES ANSWER:

Hi Yad,
The key to dealing with this situation is to identify the cause and to treat it accordingly.

Even if your testosterone levels are low and you have symptoms, TRT is not always the first course of action. Your doctor must identify the source for declining levels first—for instance, weight gain or certain medications—we must first address that problem (and in most cases treating the underlying cause is the best option).

Some of the most common causes include; injury or infection, being on medications for a long time (especially hormones used to treat prostate cancer and corticosteroid drugs), chronic illness, stress, alcoholism, obesity.

I’d suggest you visit a specialist for a check-up to identify the underlying cause of this issue.
I hope this helps.

Thanks
Dr. Alayes

ERECTILE DYSFUNCTION QUESTION:

I am 69 started having ED problem 3 or 4 years ago. Consulted my Doctor, started taking 5mg Cialis it worked for a couple of years, then started taking 10 & then 20 mg it did not have any effect. Just recently I was given as a trial Stendra 100 mg then Staxyn 10 mg both did not work. What can be done to cure this problem?

Please advise.
Habib

DOCTOR ALSAYES ANSWER:

Hello Habib,
The key to dealing with this situation is to identify the cause and to treat it accordingly.

Erectile dysfunction has many factors and underlying causes, as you probably know. One of these aspects is the psychological aspect.
Your doctor must identify the source of this problem first—for instance, overweight or diabetes or being on certain medications—we must first address that problem.

For treatment options (assuming the underlying problem was addressed) usually, we start with oral medications (such as Viagra or Cialis), but these medications don’t work well for every case, and for some men they don’t produce the same effect over time, thus 2nd choice we may try is injections (such as Bi-Mix and Tri-Mix).

If these 2 options didn’t provide much improvement, we consider penile implants. There are 2 main types of these implants; semirigid and inflatable. Each type works differently and has various pros and cons.

In most cases, patients report a satisfaction rate of 80%-90% with penile implants as they have erections suitable for intercourse.

However, you should know; the placement of penile implants requires surgery, and no surgery is totally free of possible complications or risks.
I’d suggest you speak to your doctor about the next treatment option that can be helpful for your current health condition.

I hope this answers your question.

Thanks
Dr. Alsayes

ERECTILE DYSFUNCTION QUESTION:

My age is 41 and I have problem erectile dysfunction which is the best medicine for my problem.
Kindly advise

Thanks
Amit

DOCTOR ALSAYES ANSWER:

Hello Amit,
The key to dealing with this situation is to identify the cause and to treat it accordingly.
Erectile dysfunction has many factors and underlying causes, as you probably know. One of these aspects is the psychological aspect.
But generally, erectile dysfunction could be due to many underlying causes, such as; Anxiety, diabetes, high blood pressure, alcoholism and smoking tobacco, acute stress disorder,…etc.

For the best treatment option, we need to identify the cause of your erectile dysfunction.

A psychological aspect can in form of anxiety or pressure to perform under heightened anxiety, or acute stress disorder, or Low sex drive due to underlying cause (as a bad memory from a previous relationship).
In addition, watching pornography and masturbation more frequently can also lead to erectile dysfunction during actual sex relations.

Some studies have found that frequently masturbating to porn can contribute to ED by desensitizing you to certain imagery and physical intimacy.

And keep in mind that making good lifestyle choices is a very important factor along with the medical treatment, and that should include:
• Avoid smoking because it can lead to or worsen erectile dysfunction.
• Lose any excess weight. Being overweight can cause or worsen erectile dysfunction.
• Include physical activity in your daily routine. Exercise can help with underlying conditions that play a part in erectile dysfunction in several ways, including reducing stress, helping you lose weight and increasing blood flow.

Now regarding the medical treatment, many options are available, some of them have side-effects while others don’t, but that also depends on your condition and overall health:
• Oral medications like Viagra or Cialis (but these medications are not preferred to be used when you have a heart problem)
• Platelet Rich Plasma (PRP Therapy)
• Intracavernous injection therapy
• Penile implants

Please see your urologist determine the best treatment for your current condition after an evaluation.
I hope this answers your question.

Thanks
Dr. Alsayes

ERECTILE DYSFUNCTION QUESTION:

I am a 70-year-old uncircumcised man who is taking Tri Mix Injections for ED. I take 1 ML compounded in the following strength DS 35.2 mg/ml Papaverine /1.16 Phentolamine Mesylate/ 11.6 mcg/ml Prostaglandin E1 (alprostadil). However, each time that I use this I have the following problem.

Several hours after I use it blood collects in my foreskin causing a fluid (blood) filled large blister. I must then use a sterile 14 gauge needle to drain it. Can you please tell me why this is occurring? Thank you for your help.

Thanks
Dale

DOCTOR ALSAYES ANSWER:

Hi Dale,
This is not normal, you should stop taking the injections for now. I’m afraid if you are giving yourself the injections that you might cause some injury to your penile tissues.

Please check with your doctor, he should review the instructions again with you and probably training you again.
I hope this answers your question.

Thanks
Dr. Alsayes

ERECTILE DYSFUNCTION QUESTION:

I’m turning 43, my cholesterol is 201 (LDL 124, HDL 27, Triglyceries 342) Since 2017, I noticed my erections getting softer and eventually I have difficulty getting it up.

I talked to my doctor about it in January and he suggested I start with diet and exercise and might have hardening of the arteries. Is it possible to bounce back from this? I’m working on my exercise and am trying harder on my diet now. I’m just constantly thinking about the constricted feeling I have in my penis, a lack of morning wood, and the difficulty in getting it up.

I did get my wife pregnant this summer and the last time we had sex a couple of weeks ago, I had a pretty good erection once I got up. I talked to a guy that said he was close to dying from blocked arteries and came back, so he inspires me, but I get frustrated at times like right now.

Thanks
Jason

DOCTOR ALSAYES ANSWER:

Hello Jason,
I’m very sorry to hear that.
Yes, you must know that your erection can back to normal with the right lifestyle. And it can happen sooner than you expect, depending on how much effort you make in the right direction.

Eating healthy foods reduces your risk of common vascular problems caused by high cholesterol, high blood sugar, high triglyceride levels, and being overweight, which are all factors leading to ED eventually I advise you to establish a healthy lifestyle by exercising regularly, eating healthy food (low cholesterol), and stop or avoid alcohol and tobacco (if any) as they both contribute to ED. These steps will help you regain your normal erection faster.

Diet alone can’t cure ED, healthy lifestyle changes are a must when dealing with ED. These include:

• Regular exercise
• Maintaining low blood pressure
• Eating a healthful diet
• Maintaining a healthy weight
• Avoiding alcohol and cigarettes

Also, there are some foods and supplements that have shown promising effects against ED;
• Eat plenty of fruits, vegetables, and whole grains, and avoid red meat and processed grains.
• Flavonoids increase blood flow and the concentration of nitric oxide in the blood. Chocolate, particularly the dark variety, is rich in flavonoids. (be careful; Milk chocolate is lower in flavonoids and contains higher amounts of sugar and fat).
• Pistachios also improved cholesterol levels and blood pressure with no notable side effects.
• Watermelon contains a compound called citrulline, which helps to relax blood vessels. It also improves blood flow, much as ED medications do.
I hope this answers your question.

Thanks
Dr. Alsayes

ERECTILE DYSFUNCTION QUESTION:

Hello! I need advice. It is about my boyfriend. We are a relatively new couple and in the beginning, we have very nice experiences in the bed but now occurs some issues and we do it very rarely.

He doesn’t want to speak about it but once he mentioned that recently he doesn’t have an erection on a daily basis like before. He doesn’t get turn on because of me but he has to support the erection with the hand.

May be is good also here to say that he abuse with alcohol almost twice a week. That what I worry the most is that he is not attracted by me any more…

I don’t know if there is a reason to worry or not. I would be happy to hear your opinion.

Thank You
Kameliya

DOCTOR ALSAYES ANSWER:

Hello there,
I’m very sorry to hear that.
Apparently, you are healthy, and you have a temporary ED with this partner in particular. It seems you have a psychological problem related to cheating.

That being said, you should know that the vast majority of cases of ED problems we see in our clinics are due to psychological problems and what makes them harder to treat is that many of these patients refuse to believe it’s just a psychological issue.

Also, you should know that watching too much pornography can lead to ED.

The key to dealing with this situation is to identify the cause and to treat it accordingly, in your case, I advise you first to visit your doctor again and make some evaluation tests to exclude any medical/physical causes, and if all tests came up negative then you need to see a psychotherapist to advise you on how to deal with any stress and/or performance anxiety related to the cheating issue, because it’s not just about forgiveness.

I hope this answers your question.

ERECTILE DYSFUNCTION QUESTION:

Hi… I’m a 25-year-old male. Never had this problem before.. never have this problem with porn or with my ex… so a while back I was seeing a girl that I’m very much in love with. She cheated on me with her ex at the start of the relationship and it started.

I’ll be perfectly fine.. hard as a rock till I take off my underwear… then it’s kist gone… and won’t come back.. she thinks it’s cuz of the cheating… I do too. but I’ve forgiven her.. how do I stop this…

I’ve had sex with my ex in the time she and I were apart cause of the cheating and no issues. I’ve been hard watching porn minutes before trying to satisfy her.. the night before I even was hard and tried to wake her up with some foreplay it didn’t work but I laid there hard for a good 20-30 minutes counting the before and after time.

I feel miserable… and I feel like if I can’t fix this I’m gonna lose her… please help me
Thanks
Chance

DOCTOR ALSAYES ANSWER:

I’m very sorry to hear that.
Apparently, you are healthy, and you have a temporary ED with this partner in particular. It seems you have a psychological problem related to cheating.

That being said, you should know that the vast majority of cases of ED problems we see in our clinics are due to psychological problems and what makes them harder to treat is that many of these patients refuse to believe it’s just a psychological issue.

Also, you should know that watching too much pornography can lead to ED.

The key to dealing with this situation is to identify the cause and to treat it accordingly, in your case, I advise you first to visit your doctor again and make some evaluation tests to exclude any medical/physical causes, and if all tests came up negative then you need to see a psychotherapist to advise you on how to deal with any stress and/or performance anxiety related to the cheating issue, because it’s not just about forgiveness.

I hope this answers your question.

Thanks
Dr. Alsayes