Hi Defiant, thanks for the PM. Thought I would answer here in your thread.
It's hard to know what to say. You don't have a nice, clear diagnosis - but of course many men suffering ED don't get one. The causes are, to this day, poorly understood in many cases. VL is real, but I get the distinct feeling it is used occasionally (or more than occasionally) as a euphemism for "we don't know what the hell is going on with you". The other favourite for that scenario is the common "it's all in your head" diagnosis. Psychogenic ED is very real but once again I get the distinct impression some guys with real, physical problems get lumped with this diagnosis when the physician can't ascertain what the actual problem is.
My personal feeling is that once you add intractable psych issues (performance anxiety and loss of self esteem) to even a minor real physical issue, that's a recipe for disaster. I do not think it is automatically invalid to consider settling the issue with an implant, although I would be very cautious especially at your age. In the end though, implants are there for when all else fails. I would personally include longterm failure of a psych issue to remit as just as valid a reason to proceed as longterm failure to treat a physical cause as long as you make the decision rationally and with your eyes open. The end result is the same, disability, possibly for years. If you have truly done all possible to treat any psych cause then you have unremitting ED and the cause becomes a bit irrelevant I guess. The lived reality and quality of life is what is relevant.
I was diagnosed with VL by doppler ultrasound at 32. I got a 2/3 erection with injection at that visit, and had diastolic outflow of 5cm/s. The uro had already empirically concluded that VL was the likely culprit, based on my history and symptoms; the test was more to confirm or dispel that diagnosis.
I had my first failure to maintain erection at 18 or 19. This got progressively worse over time, with pills becoming not just helpful but mandatory by the time I had the ultrasound. Their job was to keep inflow higher than outflow. I did not occlude properly, so brute force inflow was the only thing that allowed maintenance of erection. At this stage I could still be about 70-80% confident (not enough!) that I could perform, but with a new partner it was nerve wracking. That person will almost always assume it is a problem with your attraction to them. This damages their self esteem - which is why you got the response you did when it first happened to you. No amount of explanation makes any difference to this.
Over time the response to the pills dropped further. A small amount of viagra or cialis became larger amounts, and then combos of half doses of cialis and viagra or levitra. Eventually response became so unpredictable that I gave up exposing myself to the risk of shame. I kept taking the pills to maintain blood flow and tissue health. I tried a lot of different expensive herbal crap and other desperado measures before I knuckled down and accepted it was implant time (and had been for quite some time). Had that installed 9 May 17, not activated yet.
The net result was the destruction of the prime years of my sex life. It is difficult, as I said, to advise you but I do advise this: don't spend years and years in the struggle. You may regret that sorely. It is really tempting in a case of possible psychogenic ED to just say "hell no, don't implant, fix your head". Now all of us know that is one of those things far easier said than done. If there are other avenues to pursue yet, I would say pursue them but put a deadline on those efforts. 12 months, 24 months, whatever you choose. Do your best to adhere to recovery efforts in that time. If at the end you are still in grief, then yes I would consider implantation to just make the issue moot. In saying that, I would not advise this without you first spending some quality time with a very good shrink - to work on the psych issues causing the problem (if that is indeed the cause) but more importantly to make sure your head is in the right place for making an irrevocable decision.
It may help just to know that a definitive, if imperfect, resolution is available to you at any time. As a young man, the option was raised tentatively with me by one doctor, who was kind enough to be honest and tell me flat out that VL does not, generally, resolve but only gets worse with time and that I should seriously consider an implant. They are sometimes reluctant to tell young men that, or suggest implant. As it was, I rejected this at the time. I thought it was nothing short of bloody outrageous that this was the best response medical science had to offer. I wanted my issue treated and cured, not bandaided with some contraption.
In hindsight, and even though I have yet to inflate my new implant let alone put it to use, I am already convinced that I should have listened to that man a decade ago. My 30s would have been very different. Unfortunately it takes each of us as long as it takes to reach a point of clarity where emotion gives way to rationality, even for people such as myself who have a naturally rational personality type. If anything can turn a rational into an emotional basket case, a non-functioning dick will do it. Unfortunately selecting a treatment option is not a decision you can crowd source - certainly not an implant. You have to be ready psychologically and not likely to fall into a depression after the fact if you have a serious "wtf have I done" or "why did I do this" moment. You will not be able to go back, and as a young man you may ask yourself whether, with a little more time and effort, the implant could have been avoided. If you allow that line of thinking to occur, you may be in for grief. You need to have that argument with yourself before any surgery, not after, and be comfortably sure that you will be able to live with the decision. Your attitude sounds good though. Better than mine was at your age.
defiant wrote:1) Do you feel not having the natural arousal response anymore has had a detrimental impact on you and your mental state? Do you feel somewhat emasculated? Does it impact love-making in the opening salvos?
2) At 33, would I likely need revision surgery?
3) Are orgasms and ejaculations really as they were naturally? Is it true that in some cases, orgasm feel even better? (This may seem like a very stupid question, I apologise)
4) Were any of you in a state of depression after your surgery?
5) To what extent has it improved your quality of life?
6) Lastly but most importantly – to me – what do you think, having read my story, I should do?
1. Have not pumped up yet or attempted intercourse but I think for me the answer will be no. Sex has not been spontaneous in a very, very long time. Taking pills is not spontaneous. Injections (which were not successful / acceptable for me) are certainly not spontaneous, or fun. The fact of the matter - again, for me - is that I have to accept that I have a disability in that department and that I simply will not be having spontaneous responses again, implanted or not. There was therefore little to lose in that regard. I will still get turned on mentally, I will show my affection and state of horniness to my partner in some other way, and when we go for it I will know my dick will work. That will have to be enough - and the gain will outweigh any loss in that respect (especially since it was already, effectively, lost).
2. Yes. Likely multiple. Device lifetime is in the range 5-15 years. Each surgery will come with an attendant (if overall very low) risk of infection. Revision (replacement) carries higher risk than original surgeries. I expect to need one to three replacements depending on luck with device life and my own life expectancy. Things to consider as a young man: number of revisions and the cumulative risk attached. Potential (if remote) for permanent complete loss of function if something goes terribly wrong. Risk attached to rising antibiotic resistance and the effect this may have on the safety of future revision surgery (in the absence of new antibiotics - which may not or may not turn out to be a problem). Risk that something magical will come along within a few years that could have cured you. Risk that an organic cure in future could kill the implant manufacturers, leaving some of us stranded without options. I think most of these are very low risks unlikely to eventuate. They are however the main serious risks I see for a young man choosing to go prosthetic.
3. I have yet to pump up or use the device for sex, but I have masturbated gently and the orgasm was just fine. Not better, not worse. This was not a stupid question, by the way. There aren't any stupid questions with this stuff.
4. I am at nearly three weeks post op, and no, I am not experiencing depression. I am experiencing relief in the decision having been made and a great sense of anticipation for the future. The irrevocable nature of the decision has also, perversely, provided relief rather than distress. The uncertainty about what to do is gone. It's a nullity. The deed is done.
I know what depression is. I have had one episode of major depression. Took 3 different anti-depressants to find one that worked. It porked me up from 75kg to 106kg before I could get off it (took 3+ years - long after the cause had gone - to get off these powerfully addictive drugs), and it took many months to withdraw. You do not want to be on these things if you can avoid it. Now 70kg and feel great. The key with depression caused by situational stressors is to fix the stressor (if that is within your power). For me, at that time, it was an abusive rotten long term relationship (contributed to by ED) and a rotten workplace. I packed my crap up, ditched both and moved. My mood recovered rapidly. Antidepressants are a good band-aid for people who simply cannot do anything about the cause of the depression, but my feeling is that for many others they can serve to make people more content to stay in a rut / bad place when they really should be changing their lives. Care for your mental health and do all in your power to stay out of that black hole. It is easier to avoid falling in than it is to climb out of it. Don't sleepwalk into the hole like I did. I was suicidal before I realised what had happened and snapped around to seeking treatment.
You do need, I think, ongoing therapy before you take further steps. I would say not less than six sessions with a well qualified practitioner you connect with. Maybe (many) more. You may have to go through a few before you find one you connect with. I suggest a psychiatrist to start with, they are medical doctors. My highly biased personal view is that most (NOT all - but far, far too many) psychologists and "counsellors" are ex or current nutjobs who believe this uniquely qualifies them to treat others. I've wondered whether some got their diploma out of a cereal box.
5. Stay tuned! Mentally I am already seeing benefits as set out above. Might go a bit forwards and a bit backwards over time during the coming months, but I'm very positive about it at this stage. If my dimensions are greatly changed I will probably go backwards. I will also probably recover and get on with things. Hard to say at this point.
6. I think I've given my perspective as best I can above. You are not in an easy situation. If you had a clear diagnosis and a clear comprehension, as I did, that things were buggered and not realistically going to improve, I would think that would be much easier (and even then, it was not easy - I still delayed things ten years longer than I should have). My main advice I think at this time is to get a good shrink you connect with, and who is willing to take as long as it takes to work through these issues with you. I do not know how much of this you will be able to get via the NHS but even if you are out of pocket, I would spend that money if I were you and not for one second think it was wasted.
Good luck mate.
44yo, venous leak since late teens. Destroyed 2 relationships and all self confidence. Implanted 9 May 2017 by Dr Chris Love, Melbourne Australia - Titan 23cm. Looking forward to a new life.