shrunken_dick wrote:@Fed ; Thanks for helping. My doctor says no sign of venous leak. I wonder what is causing this severe erectile dysfunction in me. I can barely get hard and I have loss of length and girth. My flaccid looks a lot smaller.
Well I think you have essentially excluded vascular causes with your doppler results which is a great start!
Given your age and USS doppler result, I would imagine you can also exclude structural causes (i.e. peyronie's, corporal fibrosis, penile fracture) as these would normally show up on an USS doppler and corporal fibrosis would be unlikely at your age (unless you had suffered with severe, long-lasting priapism which I imagine you haven't).
Therefore, you are essentially left with a few other possible causes:
1. neurological - I don't know if there is any reason for this in your case but typically this is seen in post-prostatectomy patients who have had their neural bundle damaged through surgery. Other groups may be those with chronic degenerative neurological disease such as MS (multiple sclerosis), those with spinal cord injury or small fibre neuropathy/damage in diabetes for example. I imagine none of these really apply in your case either.
2. psychological - truly a lot more significant than people think and can mimic physical causes (even in severe cases) until the underlying psychological issue is resolved.
3. Hormonal - e.g. low testosterone but usually not significant enough to cause severe ED and more likely to affect arousal and libido. Over time, due to a lack of good erections can potentially lead to structural changes but this would happen over years to decades most likely.
4. Muscular - CPPS/prostatitis/hard flaccid, whatever you want to call it, is a real entity and gaining traction in the medical world. Especially in younger patients who suffer with ED and struggle for months and years looking for a diagnosis I think this is worth looking in to. I truly believe there may even have been young patients with normal USSs, MRIs but with persistent ED with no identifiable cause. They may have gone on to have penile implants when in actual fact they were suffering with pelvic floor dysfunction, sympathetic hyperactivity and concomitant psychological distress - all correctable albeit over time albeit with hard work and commitment.
In my case, I have been suffering on-and-off with ED since using a VED in mid-2020. For many months I believed I had caused permanent structural damage/scarring and would never recover. Nevertheless, in the subsequent months I started to work on stretching and then pelvic floor work with a physio and began to notice improvements; I believed I had potentially over-exerted some of the pelvic muscles involved in erection by applying external pulling forces with the VED (i.e. ischiocavernosus and bulbospongiosus). Incrementally, my erections improved and then I started to have weeks where they felt almost back to normal. Basically, once I started having normal erections again I knew it couldn't be something permanent or structurally wrong with my penis itself because the body doesn't work like that - i.e. oscillate between abnormal function and normal function within a matter of days. So, in my case, I will continue working with pelvic floor physio and on reducing my stress/anxiety and improving my mental health. I am not saying this will work for you or everyone, I just think it should be considered high up on list of possible causes in younger patients. I have a horrible feeling that many younger guys (without vascular or structural abnormalities on USS and MRI) could go through irreversible surgical procedures when they potentially have a curable condition secondary to pelvic muscle dysfunction and co-existing psychological distress!