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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

ERECTILE DYSFUNCTION QUESTION:

For the last year, my libido and sex life has been literally non-existent. I’m a 38 yr old male weighing 154lbs in relatively good health working out (calisthenics and weights) 3 times a week.

I’ve got my blood tests done and everything looks normal including my testosterone levels. I noticed that the start of this issue coincided with when I started actively working out and losing weight which is odd since it should have had the opposite effect.

The doctor prescribed a short course of Cialis and Viagra, but that did not help.

Please advise.

DOCTOR ALSAYES ANSWER:

First, yes, any physical activity training in your daily routine, such as exercise, or running can help with underlying conditions that play a role in erectile dysfunction in a number of ways, because exercising help to reduce the stress, and help you to lose any extra weight, additionally, it helps to increase your blood flow. All these effects together improve erectile dysfunction.

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, 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 maybe you need to see a psychotherapist to advise you on how to deal with any stress and/or performance anxiety, if any.

Oral ED medications like Viagra and Cialis can correct some of the mechanical reasons for erectile dysfunction, along with a healthy lifestyle of course (healthy diet and exercising), but these medications don’t work well for every case, 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.

I hope this answers your question.

The root cause impacts trauma/mechanical damage to my right hip and groin.

This started as a multivehicle car wreck over 10 years ago. Serious damage to my right side pelvis and right side genital muscles and scrotum (seat belt and steering wheel trauma).

Convalescence and home recovery for 7 weeks before I could get back to work. Then, had two corrective surgeries over the years, to repair damages to the groin. Surgeries were only partially successful.

Still, have minor pain and range-of-motion limits. Just have to live with it, adapt to the new circumstances.

Now, I am a 60-year-old white male, 155 pounds, no other medical problems. Other than 81-grain aspirin in the AM, I take no other periodic support meds.

Been using Vardenafil [20 mg] (Prescription on-line order, all I can afford) for over four years as of April. It works like a champ!

I would be happy to share details that I have found that makes Vardenafil work at its best. I have 4+ years of successful use.

And, yes, you have to make some serious changes in your lifestyle to enjoy the best of Vardenafil/Levitra.

My best regards to all. -Sam

Hi all, I have very low libido and it is hard to get visually aroused. This has been going on for about 4 years. I have been checked by a urologist, and all was good there.

My last blood test for testosterone was 810, and free testosterone was good too. I took Zoloft for 6 years, stopping about 4 years ago. I am thinking that this caused the low libido, but I guess it could be my age.

As a result, I am having trouble with ED with my girlfriend. She is 48 and expects me to just get hard without any stimulation. So I have relied on the ED meds, but these are not working so good lately.

I was thinking that it is because I went to Generic in order to save some money, but I hear some guys say that generic Viagra worked just fine.

I can get myself hard, so I know that it does work. I am thinking of trying muse. Oh, I did go to a male clinic about a year and half ago, and they gave me an injection.

Wow, it was hard for 4 hours. They then decreased the amount, and this worked good. But it so inconvenient, and would rather not do this. Any suggestions.

Erectile Dysfunction Question:

I have noticed lately that every time I get an erection,
my penis will go soft almost immediately, what is the reason for that?

Thanks, Dallas

DOCTOR ALSAYES ANSWER:

Hi Dallas,
That’s the typical definition of erectile dysfunction (ED)
First of all, 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.

However, I’d suggest first to check with your doctor for checkup and evaluation, and if all organic causes of ED were excluded then I’d suggest you try some ED oral medications such as Cialis or Viagra.

Usually, we start with oral medications (such as Viagra), but these medications don’t work well for every case, 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.

Also, it’s important to have a healthy lifestyle by exercising regularly, eating healthy food (low cholesterol), and stop or avoid alcohol and tobacco as they both contribute to ED.

Finally, try your best to let it go naturally when you are with your partner, don’t overthink it or stress yourself about any of it.

I hope this answers your question.

Injury Trauma and Erectile Dysfunction Question:

Hey there, I was in a head-on crash 18 years ago and was left ED due to trauma. I have tried ED pills, injections and have seen several unhappy women leave my life… it’s been 18 years since my near fatal accident.

I have orgasms but cannot get fully erect. I have pretty much given up unless she likes to play with toys. Is there anything that could be tried that may help?

Thanks, Andy

DOCTOR ALSAYES ANSWER:

Hi Andy,
I’m very sorry to hear that. Yes, there are many options for such a case.

Usually, we start with oral medications (such as Viagra) if the natural erection doesn’t recover on its own, but these medications don’t work well for every case, 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, and in this case, they may include:
• Uncontrolled bleeding after the surgery possibly leading to re-operation
• Infection
• Scar tissue formation
• Erosion (tissue around the implant may break down)
• Mechanical failure (The implants consist of many parts that could malfunction, however, the 10-year device survival is between 60 and 80 percent)

I’d suggest you speak to your doctor about penile implants and which type would be more suitable for you.

I hope this answers your question.

Cialis Dosage Question:

What would happen if I take 2 Cialis at the same time?

Thanks, James

DOCTOR ALSAYES ANSWER:

Hello James,
First let’s make something very clear, for Cialis, the maximum recommended dosing frequency is once per day, taking Cialis more than once per day or above the recommended dose will increase the risk of having side effects (such as headache, stomach upset, back pain, muscle pain, stuffy nose, flushing, or dizziness).

However, taking 2 tablets of 5mg at the same time is not considered as if you did take it twice a day, it would be the same as if you took 1 tablet of 10mg one time a day.

I suggest you start with 10mg. If you find that the 10mg tablet is too weak, you can ask your doctor if you can take the 20mg dose instead.
Likewise, if you find that you experience side effects when using the 20mg dosage you can switch to the lower 10mg dose to see if you tolerate it better.

I hope this answers your question.