Category: Erectile Dysfunction

ERECTILE DYSFUNCTION QUESTION:

My husband takes Allopurinol for gout. I think this is causing his ED. How can we treat gout and not have ED? Will pills help?

Thanks,
Pam

DOCTOR ALSAYES ANSWER:

Hello Pam
I’m sorry to hear that. Unfortunately, this a complicated issue, and the reason is; the gout disease itself -ED has been found to be more common in people with gout – there is no direct/causal relation between gout and ED, but diseases share many of the underlying causes such as aging, hypertension, obesity, and diabetes… Another connection is that in gout patients have higher uric acid levels, which themselves increase the risk for ED as some studies revealed. Therefore, treating gout and its underlying causes would be very helpful against the ED condition. On the other hand, allopurinol is known to increase the risk of ED in some men (especially the elderly), in that case, we usually try to adjust the treatment (doses of allopurinol) and we add oral medications for ED – if there is no contraindication – such as Viagra or Cialis to improve the erection. So, your husband should speak to his doctor about adjusting the allopurinol treatment, and prescribing ED oral medications such as Viagra or Cialis, if possible.

I hope this answers your question.

Thanks,
Dr. Alsayes

ERECTILE DYSFUNCTION QUESTION:

Do having kidney stones lead to Erectile Dysfunction?

Thanks,
Max

DOCTOR ALSAYES ANSWER:

Hello Max,
Kidney stone itself couldn’t lead to ED, however in severe cases or when these stones are because of underlying kidney disease or damage, then yes you may become less able to keep an erection for as long as usual, although you are still able to ejaculate. Many kidney patients lose the ability to get a hard penis at all over time, but that because of the underlying disease.

I hope this answers your question.

Thanks,
Dr. Alsayes

ERECTILE DYSFUNCTION QUESTION:

Take viagra, Begin foreplay and things start to shape up but not firm enough. Later in the night I wake with 3 or 4 extreme erections, whats going on?

Thanks,
Jon

DOCTOR ALSAYES ANSWER:

Hello Jon,
I’m afraid you have a delayed effect.
It is recommended to take the Viagra on an empty stomach or at least two hours after eating the last meal, and 1 hour before the intercourse. Abd that for a reason.
It takes around 30-60 minutes for Viagra to make the effect, but this duration can be affected by food or alcohol. You should know that eating any meal before you take Viagra would cause it to make the effect more slowly. Also, fatty meals are the enemy of Viagra, they can make it harder for the medicine to reach the bloodstream.
So if you take Viagra right before the sexual activity it won’t work very well, also if you had some wine or just had dinner or had fatty meal before taking the Viagra that will make it take more time to work so you will see the results later on at night.

I hope this answers your question.

Thanks,
Dr. Alsayes

ERECTILE DYSFUNCTION QUESTION:

how long does it take for the cialis daily (10 mgs) to take effect ?

Thanks,
Carlos

DOCTOR ALSAYES ANSWER:

Hello Carlos,
The effectiveness of Cialis can be noticed within 30 minutes typically, thus we recommend taking Cialis 30 minutes prior to sexual activity.
Generally, the effect of Cialis lasts between 24 to 36 hours after taking it. However, that effect can be affected by food or alcohol. For instance, fatty meals are the enemy of Cialis, they can make it harder for the medicine to reach the bloodstream. So make sure you avoid them just before taking the Cialis. Make sure you at least have 2 hours after last meal and before taking Cialis.

I hope this helps.

Thanks,
Dr. Alsayes

ERECTILE DYSFUNCTION QUESTION:

I am 59 year male under the BP medication of Lostran having ED problem. For the first time I want to use Viagra, should use 25 mg or 50 mg tablet.

Thanks,
Biswas

DOCTOR ALSAYES ANSWER:

Hi Biswas,
You should start with the minimum dose of Viagra (25 mg), if the effect was not noticeable, then you can try Viagra 50 mg the next time.
It is recommended to take the Viagra on an empty stomach or at least two hours after eating the last meal, and 1 hour before the intercourse.
It takes around 30-60 minutes for Viagra to make the effect, but this duration can be affected by food or alcohol. You should know that eating any meal before you take Viagra would cause it to make the effect more slowly. Also, fatty meals are the enemy of Viagra, they can make it harder for the medicine to reach the bloodstream.
So if you take Viagra right before the sexual activity it won’t work very well, also if you had some wine or just had dinner before taking the Viagra that will make it take more time to work so you see the results later on at night.
I hope this answers your question.

Thanks,
Dr. Alsayes

ERECTILE DYSFUNCTION QUESTION:

Throughout the first couple years of high school I’ve been experiencing problems keeping an erection. My first sexual experience was at the first party in the 10th grade. I got decently drunk throughout the night and my girlfriend and I snuck away and she wanted to do stuff but I couldn’t get an erection. I blamed it on “whiskey dick” but we broke up soon after before trying anything else for unrelated reasons. After that about a month later it happened again when I was sober,I got an erection and when we were about to take things further it went away. After that I was too embarrased to try anything with any girl again so I kinda just avoided taking things further with girls because I didn’t want to get embarrased again. Eventually I got over it and tried again several times. What happens is I can get an erection, but usually I’ll have to make the first move to take things further so while I’m doing stuff for the girl I sometimes lose the erection and it wont come back. Other times if im grabbing a condom it will go away or just randomly it will stop working. Recently I’ve had no trouble getting an erection just it goes away before I can do anything sexually. I don’t know why, I’ve researched and I know its not something physical because I’m able to finish and keep an erection during masturbation and I often get them when I’m with girls just never seems to work out. I’m very confident in my body and in my looks, and I’m not nervous about having sex so I didn’t feel it was performance anxiety. I’m content with my penis size too so I don’t understand what’s holding me back. I’m generally a typical “horny teenage boy” in that I’m often in the mood but once I lose an erection I lose my want to have sex and I just get sad or angry. I’ve stopped watching porn all together cause I thought maybe it had something to do with that and I masturbate less to see if that could help somehow but nothing seems to work. I tried listening to a guided relaxation video every other day and it definitely made me feel a lot more calm but it didn’t help with my situation. I’m 17 6’2 195 and in good shape I drink once a week or less and I dont smoke or use nicotine. I understand that I’m young but I feel like I’m ready and want to have sex I’ve been successful keeping an erection a few times but I’m around 2/10 and I haven’t fully had sex just oral. It’s hard to hear your friends talk about it and to see how easy it is for them and I don’t want to avoid those situations but its happened with 5 different girls and it’s very embarrassing. Thankfully most of them understand but I dont want it to happen again and start going around. I just want help and everywhere I’ve looked and everything I’ve tried hasnt worked. I dont want to bring it up with my family doctor or my parents because its a very uncomfortable thing to talk about. Hopefully theres something I’m missing cause I dont know what else to try.

Thanks,
Austin

DOCTOR ALSAYES ANSWER:

Hello Austin

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, 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 also be a reason, and it might be in form of anxiety or pressure to perform under heightened anxiety, or acute stress disorder, or Low sex drive due to the underlying cause (as a bad memory from a previous relationship). And even if you think it’s not the cause in your case – just based on reading your story – I beg to differ and I wouldn’t exclude that as a possible cause.
We must first address that problem.
Some people my advice you to use ED oral medications (such as Viagra), and it may help or not, but trust me that’s not the way to solve this issue, you should feel totally fine talking about to your doctor and finding the reason behind it first.
I’d suggest you speak to your urologist, first for some tests and a complete evaluation of your health and identifying the underlying cause for your issue, and then to determine the best treatment option.

I hope this helps you.

Thanks,
Dr. Alsayes

ERECTILE DYSFUNCTION QUESTION:

Hello everyone,
I’m new here and I need your help. I’m a man, I’m 26 years old.
I have been suffering from sexual dysfunction for several years (I would say since 2009-2010). I took for many years and in high doses drugs that are known to induce this kind of problem (Prozac, Risperidone).
Although it has been four years since I stopped all these drugs, the problems persisted.
Here is everything I took:
-Prozac 40mg (2006 to 2014)
-Risperidone 1.75mg (1999 to 2014)
-Concerta 90mg (1999 to 2014)
-Minocycline 50mg (2012 to 2013)
-Finasteride 0.25mg (2014 to 2016)
-Minoxidil 5% (2014 to 2017)

Here are all my symptoms:
-Decreased libido
-Difficult to initiate and maintain an erection (I only have semi-erections, never more than that)
-Orgasm shuttlecock
-Reduction of pleasure during orgasm
-Lower penis sensitivity
-Loss of response to sexual stimulation
-Reduction of ejaculated semen volume
Also:
-I was circumcised in 2010. I was also removed a fibrous ring during the same operation.
-I have a skin disease on the penis (Psoriasis or Eczema).

Here’s everything I’ve tried so far:
-Best habits of life (better diet, physical exercise, yoga, better social life, I stopped watching pornographic films)
-Cialis 20mg
-Viagra 100mg

None of this helped me.

What is the solution(s) that could help me? As you can see, there are several angles to attack. Even if the Cialis would have been effective, it would attack only one angle, the problems of erection. Moreover, it would have been temporary and would have cost me dearly.
I’m going to see an urologist this fall (possibly in November). I would like to try as many things as I can before seeing him and knowing what to offer him.
Also, I intend to go see a private urologist shortly to speed things up. It’s expensive and I want to make sure I make the right choice.
I read that since it is the drugs that induced me these problems, “Antidepressants increase the release of serotonin by inhibiting the reuptake of this neurotransmitter.The sexual dysfunction related to SSRIs would be due to the activation of certain receptors serotonin, particularly the 5HT2A and 5HT2C receptors, which would decrease the release of dopamine and cause Parkinsonian disorders and an increase in prolactin. “
I am tempted to try shock wave therapy, PRP, or others, but it seems that it is for those with vascular problems, which does not seem to apply to me.
Can someone advise me? I am ready to put the package to solve my problems.
And finaly, Since my testosterone is low, my family doctor prescribed Androgel 1% at 2.5g / d. However, there are some notorious side effects that scare me: hair loss, weight gain, prostate problems, etc.
Because of Prozac and other medications I was taking, I was overweight for many years (I regained my normal weight 6 months after weaning, but I have facial skin that has lost its elasticity) , I have a big alopecia (still in progress even after more than 4 years of weaning), etc.
I do not want to risk having these side effects again, especially since this treatment to go up my testo will be p-ê long term.
I appeal to your help to find an alternative to Androgel, even if it is not reimbursed by the security. On the one hand, I take care of having healthy habits at all levels. But I also want something that will boost my testosterone. Preferably a natural product. I know there are herbs, things that are not over-the-counter.
Reassign my testo is the first step of my fight and I want the best “booster” possible without the side effects.

Thanks,
William

DOCTOR ALSAYES ANSWER:

Hello William,
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, 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 also be a reason, and it might be in form of anxiety or pressure to perform under heightened anxiety, or acute stress disorder, or Low sex drive due to the underlying cause (as a bad memory from a previous relationship).
We must first address that problem.
In your case, there are many factors that contribute to ED;
• History of being on medications such as antidepressants, which are known to contribute to ED
• Being overweight
• History of watching pornography (may lead to losing sensitivity)
• Low testosterone levels.

Now for the antidepressants part, if you stop taking them, your erection should back to normal – if there is no other underlying cause – which is not the case here, and that explains why you didn’t notice an improvement after stopping the medications, mostly it will be due to the weight gain and the low testosterone (these 2 aspects should be addressed as well)
Now for the testosterone level, 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.
As you can see, you have a multifactorial issue, and some of these factors contribute to one another.
There may be certain lifestyle changes to help increase testosterone levels naturally, such as resistance exercise and losing weight.
Some herbal supplements claim to be testosterone boosters, however, there isn’t enough research to support their effectiveness.
The best way to address this issue is to identify the underlying cause first.
For ED 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 desired 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 urologist, first for a complete evaluation of your health and identifying all the underlying causes of your issue, and then to determine the best treatment option for your current overall health condition.

I hope this helps you.

Thanks,
Dr. Alsayes

ERECTILE DYSFUNCTION QUESTION:

Can Cialis daily be taken with Korean ginseng?

Thanks,
Richard

DOCTOR ALSAYES ANSWER:

Hello Richard,
Yes, they can be taken together, there are no known interactions between them, so they can

be taken together safely.

I hope this answers your question.

Thanks,
Dr. Alsayes

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