Performance Anxiety or Physical Issue

[frustratedguy2018]

Hello Everyone,

I am new here and this is my first post. Just looking for some opinions or other guidance as I have started struggling with ED for the past two years. I'm trying to figure out if my issues are more related to performance anxiety as the urologists suggest or if there is definitely a physical issue going on.

Here is a quick run down of my background. I'm 41 now and started having issues just after turning 39. I do not smoke, I'm not overweight at all, I do not have diabetes, I might have a glass of wine once or twice a week at the most, I do not take any other medications at all and exercise fairly regularly, I also eat really well and am not totally vegetarian but most of my diet does not include red or white meat. My work/family life can be stressful at times but most of the time its fairly calm. All of the immediate reasons that are found online described above don't really apply to me. The only thing that corresponds to the time this started happening from a psychological point is that I did have some marital issues right around the time this all started and some trouble with my sex life with my wife.

I went to the Urologist twice and they gave me a physical examination and asked me several questions to try and determine where the problem might be. They also tested my testasterone which came back in the normal range (although it was on the lower end of normal). I had it tested two other times and it was always normal when testing in the morning. There was one test I took in the afternoon that showed it was in the low range. I researched that taking it in the afternoon will not provide an accurate result though. according to the urologist from the physical examination, he did not say he could detect anything wrong. I do have morning erections quite regularly (almost every morning) that vary in intensity. I would say on a scale of 1 to 10 they are usually around a 6 or 8. They do not last long after I get up though and only occasionally do I still have it as I get up to go to the bathroom. typically after I pee it goes down or sometimes the minute I become aware of it, it goes away. I have also noticed that right before Im about to sleep I will get a random erection but its not a full erection, maybe a 6 or 7 on the scale out of 10. if I masterbate I can get an erection pretty much every time but it takes a little longer and I need both visual and physical stimulation to keep things going where as before I could get by with just mental or visual stimulation. I finally gave in and started taking some prescriptions drugs the Dr prescribed for erections (sildenafil) which works well. there was only one time it did not work when needed but I think it was because I took it too close to having a big meal.

When it comes to sex with my wife, it used to be that everything just automatically turned on and everything was fine. Now it is taking me a very long time using different approaches to become aroused at all and when I do become fully hard, we can have sex but i am very sensitive and have trouble not going fairly soon. The minute I try to stop myself from going, I start to have trouble keeping the erection. Also if I am not constantly aroused or stimulated (if I take it out) it goes away fairly quickly. There have also been sometimes where I have lost it all together during sex. When I take the Viagra I was prescribed (60mg but can usually get by with only 40mg) everything seems to fire up like it used to. I tried taking one pill one time (20mg) and it still worked but wasn't as potent.

So from looking at other posts on this forum and around in general I think my issues are either performance anxiety as sometimes I do not feel aroused at all and feel apathetic about having sex (especially since its a mixed bag now), or there is some physical issue that is causing my problems. The symptoms of a venous leak sound close to what I might have or the Hard flaccid issue. I do have morning erections though almost every day and Viagra seems to work just fine at keeping me hard. In fact if I take the drugs, it lasts in my system for quite a while, usually I can still feel it after a full day. In regards to the hard flaccid cause, I feel that might be the cause as my penis does feel sort of numb sometimes or I feel a lack of sensation down there and do have a little tightness feeling in my pelvic floor. However still not sure of this. The venous leak sounds close too as I do lose it quite quickly if not constantly stimulated. From what I know the only way to check that is with ultrasound. I asked the Dr if there was a test I could take to check blood flow and he was convinced I didn't need it based on my blood work and physical examination. The only thing that makes me worry its a venous leak is about the same time this started happening my wife was complaining that I was getting too sensitive and going too fast at times so I tried to stop myself from going by squeeing the base of my penis just before ejaculating. This was just a quick squeeze maybe for a few seconds but I tried this technique for about two or three months. Not sure that would be enough to damage tissue or other things down there but its the only other thing I can think of.

I appreciate any guidance or opinions someone might have for my problems. I followed up with another Dr recently and they said based on my questions it was performance anxiety but I am not totally convinced of that. I may call the urologist again and see if they can do the ultra sound to test but for now they seem unwilling to do this.

Thanks for any help. I appreciate it.

[Asdf1234]

This sounds almost identical to the issues I’m facing. I’ve had all tests and everything is clear. I still don’t get it after nearly two years of tests and going to urologists they tell me everything is fine. Do you ever get random or spontaneous erections throughout the day? Can you hold an erection whilst standing up?

[frustratedguy2018]

Since I have been paying attention to these things, I rarely get any spontaneous erections throughout the day. I do sometimes if I am relaxing or sometimes when I feel tired in the middle of the day (almost falling asleep) but they are far and few in between. Honestly not too sure about the standing question. I remember a few times in the last couple weeks where I still had an erection standing, but I don't remember for how long. I do know that it will go away pretty quickly without stimulation. Was maintaining an erection while standing a test the urologists had you do? have you or anyone who reads this post ever heard of pressure at the base of the penis causing a venous leak if its only there for a few seconds?

[68CatFan]

As with many of the men here I struggled with the same issues throughout my forties. Doctors often offer little to no help. Unfortunately, once doubt and anxiety set in oral medication will no longer work. If I can make a suggestion to save you some frustration, fear and depression. Go to RXBUYERSCLUBUSA.com. Pay the fee and get a prescription for T-105 Trimix. Also get a vial of phenylephrine to counter Trimix if you get a 3+ hour erection. Start with a low dose (maybe 5-10cc) and see what reaction you get. Trimix is not affected by emotions. I started with 15cc and 5 minutes later I walked out of the bathroom with a towel rack. Been having sex all summer better then the wife and I did in our twenties.
I'm sure you can't imagine sticking a needle in your little buddy but you go long enough without sex and I promise you you won't hesitate. Come back and ask for some additional tips to learn how to inject if you do go this route.

[Asdf1234]

Since I have been paying attention to these things, I rarely get any spontaneous erections throughout the day. I do sometimes if I am relaxing or sometimes when I feel tired in the middle of the day (almost falling asleep) but they are far and few in between. Honestly not too sure about the standing question. I remember a few times in the last couple weeks where I still had an erection standing, but I don't remember for how long. I do know that it will go away pretty quickly without stimulation. Was maintaining an erection while standing a test the urologists had you do? have you or anyone who reads this post ever heard of pressure at the base of the penis causing a venous leak if its only there for a few seconds?

I’ve never heard of pressure thing at the base causing venous leak no. My urologist said that a degree of venous leak is somewhat normal and even sometimes the test can show venous leak and the person doesn’t actually true venous leakage. I’ve had two Dopplers an mri and all my blood tested for testosterone etc. And all came back normal. Well The first Doppler I had it showed a degree of venous leak but they weren’t 100% so they done it again and it was clear. The test I done wasn’t whilst standing no but was told it doesn’t matter if done standing or lying down. I do know I never get any erections throughout the day and find it almost impossible to maintain any standing up but then I too am thinking about it 24/7 and think this has something to do with it. I asked the andrologist why can’t I maintain standing and he said he has never heard anything like this and it’s probably because I’m thinking about it all the time. I don’t really have any problems when I masturbate or when I’m with a woman. Unless I’m thinking about it and then it seems to be a chain reaction. I still get them at night and wake up with them also. I’m now at a psychosexual counsellor to see if this helps. They have found no physical cause and so after 2 years I still don’t have an answer to my problem. I think I have an anxiety disorder though and suffer major depression so this could be the direct cause I suppose. But my mind doesn’t want to believe this.

[Flavio]

[...] I followed up with another Dr recently and they said based on my questions it was performance anxiety but I am not totally convinced of that. I may call the urologist again and see if they can do the ultra sound to test but for now they seem unwilling to do this.

Thanks for any help. I appreciate it.

Why are they unwilling to do the ultra sound?

Maybe you should get a second or third opinion but don't underestimate anxiety. Most men seem to think that anxiety is not really important but it is quite the opposite. Anxiety and depression are major causes of ED and can have a drastic impact on your sex life.

Erections start in the brain, which is your #1 sex organ - it really is. If the brain isn't working properly, there is no way you can get an erection and perform.

Last week I was extremely depressed because of a conflict at work and I couldn't get erect. Manual and visual stimulation were useless, there were no nocturnal erections, my penis was completely unresponsive. Now that the conflict is solved and the weight is off my shoulders, I've regained my sexual function.

Psychogenic ED is a major theme on FT, I suggest you read those threads and do some research on this subject: read books, talk to doctors, consult FT an other good websites. The more you know about ED, the less stressful it will be.

[Frank Talk Admin]

The truth is, you probably do not have a venous leak. It sounds as if you need to go to a sexual medicine specialist. I can't say this enough – a urologist is a surgeon. They got no training in sexual medicine. It doesn't matter if your testosterone is over the magic 300 level, your body may need a higher testosterone level than that. Do you have a baseline from 10 years ago? What other symptoms do you have? Excess body fat? Difficulty gaining muscle? Feeling tired in the afternoon? Brain fog, difficulty concentrating, lethargy, depression? All of those are symptoms of low testosterone as well.
The feeling of a dead penis can also be low testosterone because you simply are not becoming chemically aroused (not at all to do with an erection). If you have pelvic floor issues, you might have symptoms of urinary urgency, frequency, stop start, dribbling, pain in your drawing, painting or penis, scrotum, perineum etc.
When it comes to sexual medicine it is rarely an either/or when it comes to psychological or medical. The minute you have a problem, there are psychological ramifications. What is your anxiety or stress level. It sounds like sex with your wife is a little bit tenuous and not exactly free and playful. It sounds to me that it is not entirely psychological if it is difficult to get fantastic erections with masturbation.
Where do you live?
Paul

[frustratedguy2018]

The truth is, you probably do not have a venous leak. It sounds as if you need to go to a sexual medicine specialist. I can't say this enough – a urologist is a surgeon. They got no training in sexual medicine. It doesn't matter if your testosterone is over the magic 300 level, your body may need a higher testosterone level than that. Do you have a baseline from 10 years ago? What other symptoms do you have? Excess body fat? Difficulty gaining muscle? Feeling tired in the afternoon? Brain fog, difficulty concentrating, lethargy, depression? All of those are symptoms of low testosterone as well.
The feeling of a dead penis can also be low testosterone because you simply are not becoming chemically aroused (not at all to do with an erection). If you have pelvic floor issues, you might have symptoms of urinary urgency, frequency, stop start, dribbling, pain in your drawing, painting or penis, scrotum, perineum etc.
When it comes to sexual medicine it is rarely an either/or when it comes to psychological or medical. The minute you have a problem, there are psychological ramifications. What is your anxiety or stress level. It sounds like sex with your wife is a little bit tenuous and not exactly free and playful. It sounds to me that it is not entirely psychological if it is difficult to get fantastic erections with masturbation.
Where do you live?
Paul

Hello Paul, thank you for all the reply and replies from everyone else on here. This really makes me feel better. In regards to the question on testosterone, I had my levels checked many times in 2019 but have no baseline before that. The first time I took it from kaiser it was 351ng/dL for total and 6.0 for free. For their scales this was in the normal range but just barely and the free reading was just under. My Dr had me take some TRT for 2 months and we tested it again and the second reading was 473 total and 9.3ng/dL. I stopped taking the TRT after that because I was worried about the side effects and I wasn't really noticing a difference, maybe I didn't do it long enough? I had it taken from another private clinic and they said my reading was in the low range and that was definitely my issue. however this private clinic had me take it in the afternoon when levels are usually lower. I then had it tested by an online company and those results came back at 66.8pg/Ml. they had a different range on their site but it was just above what they consider "normal". After that I abandoned the idea that it was testosterone because I read that testosterone does not effect erection quality and thought that it was another physical issue.

However, in regards to your other questions, yes! when this all started I also definitely started feeling lower energy, low libido, trouble concentrating, etc. Everything you mentioned except the extra body fat. my weight last time I checked was 162. I went to a nutritionist for the low libido and low energy and got on some supplements which have helped with the energy a little but not the libido or sex. My life can be fairly stressful with work and my kids at times but it varies, however for the past year and a half sex with my wife has been very stressful since at first she was pretty frustrated with me. Now she has realized that was not helping at all and is a lot more understanding, patient, and trying to work with me on this problem. The only other thing I can think of that started happening with all this is that I felt like I would have to pee right before sex. That is why I thought it might be the pelvic floor issue since I do have some discomfort and a little pain in my perineum but its usually not too bad. Its a little sore down there sometimes but not unbearable by any means. in regards to masturbation, there are times when everything seems fine, it just takes longer than it used to. Sometimes though its difficult to get going and I just stop.

The other thing that makes me feel like its psychological or a hormonal imbalance of some type is that I used to be able to just think about sex and I would at least start to have an erection. Now its very difficult to get my body to respond like it used to. I have to focus very intently for anything to start lighting up down there. However, like I mentioned I wake up with an erection almost every morning but it varies in intensity and as soon as I become aware of it, it goes away pretty quickly.

Sorry for the long reply here just trying to add in any honest detail I can. I live in Southern California.

[frustratedguy2018]

Why are they unwilling to do the ultra sound?

Maybe you should get a second or third opinion but don't underestimate anxiety. Most men seem to think that anxiety is not really important but it is quite the opposite. Anxiety and depression are major causes of ED and can have a drastic impact on your sex life.

Erections start in the brain, which is your #1 sex organ - it really is. If the brain isn't working properly, there is no way you can get an erection and perform.

Last week I was extremely depressed because of a conflict at work and I couldn't get erect. Manual and visual stimulation were useless, there were no nocturnal erections, my penis was completely unresponsive. Now that the conflict is solved and the weight is off my shoulders, I've regained my sexual function.

Psychogenic ED is a major theme on FT, I suggest you read those threads and do some research on this subject: read books, talk to doctors, consult FT an other good websites. The more you know about ED, the less stressful it will be.

Not sure why they wont give me any other tests which is really frustrating. My care provider is through Kaiser so im not sure if its a money thing or what but the Urologist said that there wasn't any other testing. Obviously that is not the case so my guess is they only want to do it if they feel its necessary. Not sure. I will probably inquire with them again though to see if this can be done or why they wouldn't suggest it.

[Lost Sheep]

[...] I followed up with another Dr recently and they said based on my questions it was performance anxiety but I am not totally convinced of that. I may call the urologist again and see if they can do the ultra sound to test but for now they seem unwilling to do this.

Thanks for any help. I appreciate it.

(edited for focus)
Psychogenic ED is a major theme on FT, I suggest you read those threads and do some research on this subject: read books, talk to doctors, consult FT an other good websites. The more you know about ED, the less stressful it will be.

I can testify that not only will knowledge dispel stress, it also will gain the respect of your medical providers. Not necessarily "respect" as in friendship, but "respect" as in "This guy knows accurate facts and I should listen to him better and give his wishes more regard."