Size loss before implant due to ED

[Dr.Menshchikov]

Being young and still having some response to pills, I don't want to jump immediately to an implant yet. On the other hand, I fear though that waiting with ED for too long might cause a loss in size, since I'm only very average to begin with and hence really want to avoid that!

I often read here that the key to not losing size is to maintain nocturnal erections. Currently, taking 5mg tadalafil every evening, I usually wake up with some morning wood (of varying rigidity and duration), and usually nothing when I don't take it. However, It seems that most people who lost size didn't just suffer from ED or a lack of nocturnal erections, but also had RP and/or PD, making me wonder whether ED alone can really be blamed.

Therefore, I have a few questions:

- Are there any men who experienced size losses purely due to ED (without having prostate surgery or PD)?
- In case you lost size, did you manage to recover it (either through a VED or after having an implant) or is the loss permanent?
- In your opinion, in situations such as mine, when should one consider an implant? Psychologically, I'm definitely willing to wait a few more years until I've really exhausted all other options (except for injections), while in the meantime doing VED therapy to keep everything healthy (a recommendation I got in a previous thread). Physically, however, I just fear that waiting a few more years with waning erections (I have no idea how "strong" and how frequently "morning wood" is necessary to avoid atrophy) would inevitably lead to size losses, even with VED therapy.

In erectile dysfunction with cavernous fibrosis, the size of the penis decreases quite quickly.

Thanks for your response. Is there any way to diagnose cavernous fibrosis?

Penile ultrasound, MRI

[Benjohn]

Being young and still having some response to pills, I don't want to jump immediately to an implant yet. On the other hand, I fear though that waiting with ED for too long might cause a loss in size, since I'm only very average to begin with and hence really want to avoid that!

I often read here that the key to not losing size is to maintain nocturnal erections. Currently, taking 5mg tadalafil every evening, I usually wake up with some morning wood (of varying rigidity and duration), and usually nothing when I don't take it. However, It seems that most people who lost size didn't just suffer from ED or a lack of nocturnal erections, but also had RP and/or PD, making me wonder whether ED alone can really be blamed.

Therefore, I have a few questions:

- Are there any men who experienced size losses purely due to ED (without having prostate surgery or PD)?
- In case you lost size, did you manage to recover it (either through a VED or after having an implant) or is the loss permanent?
- In your opinion, in situations such as mine, when should one consider an implant? Psychologically, I'm definitely willing to wait a few more years until I've really exhausted all other options (except for injections), while in the meantime doing VED therapy to keep everything healthy (a recommendation I got in a previous thread). Physically, however, I just fear that waiting a few more years with waning erections (I have no idea how "strong" and how frequently "morning wood" is necessary to avoid atrophy) would inevitably lead to size losses, even with VED therapy.

I share all of your concerns, just a bit older aged 31 now. Like you, I'm taking pills before bed to get nocturnal erections.

I am also worried about size loss, and trying to delay an implants until my 50s if possible. In an attempt to achieve this, I'm also giving myself a 20 minute erection each day through manual stimulation - I'm afraid of doing more damage by using a pump. It's a weak erection, but with enough stimulation I can get it to just about 100% and stretch things out.

I've been doing this for 6 months now and been taking careful measurements. I haven't lost any length since starting these exercises, so that's promising.

[noot1991]

"Without the palpable plaque of PD, how do you even know that your penis is dying? How do you know you are getting "enough" morning wood/oxygen into your penis to keep it alive?

Your size gains using the VED are very impressive though, and kind of give me hope that losses don't have to be permanent losses.
I'm looking into one as well now, because as you said I want keep my penis healthy and in the worst case be ready when an implant would be the next step. Mind sharing which one you used and what protocol you followed?[/quote

Very good question and here is a great answer. Have your uro do or schedule a Doppler test for scarring, plaque and venous leakage. But don't wait like I did until it becomes excessive. If you have any (3 or more) at all the hand writing is on the wall.
I bought cheap ones VED on Amazon under 20 dollars each. I did 5 minutes under pressure then 5 min off three times in the morning and in the evening.

Already had a Doppler. Didn't respond to the injection so I guess they could not really check for plaque/scarring.

[noot1991]

In erectile dysfunction with cavernous fibrosis, the size of the penis decreases quite quickly.

Thanks for your response. Is there any way to diagnose cavernous fibrosis?

Penile ultrasound, MRI

Can these diagnose fibrosis without an injection? I already had a Doppler, but the injection didn't do anything for me. Would prefer not to have another one because I'm afraid it will fail again, and injections themselves are known to cause fibrosis, Unfortunately, it seems this can happen even with only a few injections: https://pubmed.ncbi.nlm.nih.gov/11549511/ -- also read some horror stories here and on a forum for Peyronie's disease where people experienced issues after such a single injection.

[noot1991]

Being young and still having some response to pills, I don't want to jump immediately to an implant yet. On the other hand, I fear though that waiting with ED for too long might cause a loss in size, since I'm only very average to begin with and hence really want to avoid that!

I often read here that the key to not losing size is to maintain nocturnal erections. Currently, taking 5mg tadalafil every evening, I usually wake up with some morning wood (of varying rigidity and duration), and usually nothing when I don't take it. However, It seems that most people who lost size didn't just suffer from ED or a lack of nocturnal erections, but also had RP and/or PD, making me wonder whether ED alone can really be blamed.

Therefore, I have a few questions:

- Are there any men who experienced size losses purely due to ED (without having prostate surgery or PD)?
- In case you lost size, did you manage to recover it (either through a VED or after having an implant) or is the loss permanent?
- In your opinion, in situations such as mine, when should one consider an implant? Psychologically, I'm definitely willing to wait a few more years until I've really exhausted all other options (except for injections), while in the meantime doing VED therapy to keep everything healthy (a recommendation I got in a previous thread). Physically, however, I just fear that waiting a few more years with waning erections (I have no idea how "strong" and how frequently "morning wood" is necessary to avoid atrophy) would inevitably lead to size losses, even with VED therapy.

I share all of your concerns, just a bit older aged 31 now. Like you, I'm taking pills before bed to get nocturnal erections.

I am also worried about size loss, and trying to delay an implants until my 50s if possible. In an attempt to achieve this, I'm also giving myself a 20 minute erection each day through manual stimulation - I'm afraid of doing more damage by using a pump. It's a weak erection, but with enough stimulation I can get it to just about 100% and stretch things out.

I've been doing this for 6 months now and been taking careful measurements. I haven't lost any length since starting these exercises, so that's promising.

I assume you are taking it at 3am because of the 4 hour half-life of sildenafil? Doesn't seem very practical (unless you actually go to bed at that time). Any reason for preferring sildenafil over tadalafil there? (because with tadalafil timing is not really an issue)

Giving yourself a 20min erection every day sounds like a very good idea! Unfortunately, I'm not sure if I would be able to do that. Is this without any pills/injections? I hope that nocturnal erections (with the help of pills) by themselves should suffice to prevent atrophy. But then again, I have no idea how frequent / rigid / long these should occur.

About the implant: I understand, and would also prefer to postpone such a surgery until my 40s, or at least late 30s. At times it seems way too radical to even be thinking about that at our young age. Then again, what's the point of adhering to these protocols, trying to "survive" and hold out as long as possible until we inevitably get this surgery if the ED ruins all the years until that point anyway... For myself, I've decided to keep doing this for at least another year or so. Then, I'll re-evaluate, and if I can manage decently with just pills in a way that a satisfying and mostly stress-free sex life is possible, I'll keep waiting.

[Benjohn]

Hey. Yes, I originally took it at 3am because of the half live. More recently I've been taking it just before bed and I'm still seeing a bit of 'life' down there in the mornings. I just prefer Sildenafil to taladafil, nothing more than that.

The manual stimulation is without pills or injections. The moment I stop I lose my erection within like 15 seconds... So as long as I keep going it stretches things out.

Good idea to wait another year and see what happens. Not sure if you're from the UK? If so, you could try Invicorp... Probably very good for VL as it works on constricting the veins.

Hope it works out for you.

[noot1991]

Hey. Yes, I originally took it at 3am because of the half live. More recently I've been taking it just before bed and I'm still seeing a bit of 'life' down there in the mornings. I just prefer Sildenafil to taladafil, nothing more than that.

The manual stimulation is without pills or injections. The moment I stop I lose my erection within like 15 seconds... So as long as I keep going it stretches things out.

Good idea to wait another year and see what happens. Not sure if you're from the UK? If so, you could try Invicorp... Probably very good for VL as it works on constricting the veins.

Hope it works out for you.

That doesn't sound too bad. I sometimes have issues getting it up with manual stimulation now even when on the 5mg tadalafil. Started to notice morning wood is less frequent as well. The problem is that psychologically, I'm getting stuck in a negative feedback loop now: the declining results increase my worries, making me panic, which probably makes this whole issue worse. Therefore, at this point I have no idea how much of this is physical vs psychological. I just don't understand how 2 months ago, 5mg tadalafil made me semi-hard even without any sexual arousal (just touching in while laying in bed was enough), whereas yesterday, even with arousal and manual stimulation I could barely summon a semi. Building up a tolerance perhaps? In that case, sildenafil might be safer because it doesn't stay in your body as long as tadalafil. No idea.

I'm from Belgium, not sure if Invicorp is available here. But anyways, I would prefer to avoid injections, because I fear they could cause further damage (fibrosis etc.).

[DougAnd]

Noot said "Already had a Doppler. Didn't respond to the injection so I guess they could not really check for plaque/scarring.
Noot, I had 2 Dopplers. The first was for venous leakage at my request. The doc injected me but no joy. They did the test anyway. Twice. First after 5 min and then when nothing happened ie no erection again 10 minutes later. Both tests showed leakage both sides at 6. and by the way my insurance which then paid for everything did not cover the shot. I assume it was not needed? anyway cost me 80 bucks out of pocket.
The second Doppler was for plaque and scarring. My doc ordered it last second before my IPP surgery. No shot. The doc's face turned white as a sheet when he saw the results. Severe plaque and scarring. Peyronies in Spades. So no you do not need the shot to get results. And by the by if you have waited until your plaque and scarring becomes severe the doctor needs to all but chisel through your tissue to make room for your cylinders. If I were to have a do over then at age 50 I would have had a Doppler and every few years thereafter. Just as soon as plaque and scarring began to show abnormal, bam next week I would have been on schedule for IPP surgery. Just a word to the wise.

[noot1991]

Noot said "Already had a Doppler. Didn't respond to the injection so I guess they could not really check for plaque/scarring.
Noot, I had 2 Dopplers. The first was for venous leakage at my request. The doc injected me but no joy. They did the test anyway. Twice. First after 5 min and then when nothing happened ie no erection again 10 minutes later. Both tests showed leakage both sides at 6. and by the way my insurance which then paid for everything did not cover the shot. I assume it was not needed? anyway cost me 80 bucks out of pocket.
The second Doppler was for plaque and scarring. My doc ordered it last second before my IPP surgery. No shot. The doc's face turned white as a sheet when he saw the results. Severe plaque and scarring. Peyronies in Spades. So no you do not need the shot to get results. And by the by if you have waited until your plaque and scarring becomes severe the doctor needs to all but chisel through your tissue to make room for your cylinders. If I were to have a do over then at age 50 I would have had a Doppler and every few years thereafter. Just as soon as plaque and scarring began to show abnormal, bam next week I would have been on schedule for IPP surgery. Just a word to the wise.

Well, I was first examined while flaccid, for like 15min.. He told me everything looked fine (I guess he was looking for plaques?). Only then did he try the injection. Then again, the doctor doing the examination was a radiologist. Perhaps I should ask for a second examination with a more specialised urologist.

[noot1991]

Also something I don’t understand at all: when I started taking daily tadalafil 5mg about 2,5 months ago, it worked almost too well. I would literally be laying down in the sofa watching TV with almost a semi, without any stimulation at all (and even minor sexual thoughts would turn that into an erection). My flaccid also appeared to be hanging longer and softer. Always woke up with morning wood.

Now, it seems that the tadalafil is barely doing anything at all. Had difficulty masturbating yesterday despite arousal & heavy stimulation. Morning wood becoming sporadic and less frequent. Even if plaques are the issue, I can’t understand the situation becoming so much worse in just 2,5 months time…