Visiting an urologist, need advice

After nearly 5 years of erection problems, I finally decided to go to a urologist. My appointment is next week. My past experience when visiting doctors taught me one thing: you have to be annoying and ask every question you may have or else the doctor is just going to get rid of your case as fast as possible, move on to the next patient and you’ll exit his office with just as many questions as before your visit.

Any suggestions on what to ask, what tests or treatments should I ask about, etc? I’d like to get something more than just a prescription for Viagra or Cialis…

I personally suspect that I have venous leakage…

Here is some relevant info about my case:
-26 years old, better than average physical condition, I don’t take any medication at the moment, I took a lot of Accutane over the years (5 cycles since the age of 18)

-Started experiencing erection problems 5 years ago. At that time I had been taking Propecia for +-2 years. I was in great shape. I was a TOTAL caffeine addict (6-10 coffees/day). I lost all my sex drive (in about 1 year, I went from wanting sex 5 times/night to never really wanting any)
Had some pretty serious ED at the time (2 times I wasn’t able to get any kind of erection with my girlfriend of the time, had trouble getting an erection when masturbating, I needed a lot of stimulation, I wasn’t 100% erect when ejaculating and sometimes I just wasn’t able to get an erection at all.

-Since then things got better but still far from perfect: stopped taking Propecia as soon as I began experiencing these problems. Stopped taking any kind of caffeine for a year. Things got better. I never experienced another total ED episode with any girl I’ve been with and sex drive is way higher then before (When with a girl, I usually feel like having sex 2-3 times/night).

The problems that remain regard erection quality. I never get 100% erect. I get 95% at the very best (not often). Most of the time, a good erection is 90% and a bad one 75-80%. When I’m with my gf, I get a pretty good erection without any stimulation during foreplay.

During penetration, thrusting movements in positions where penetration angle is straight help me maximise my erection level but, once there’s been stimulation to my penis, I’ll often loose my erection in about 45 sec. if the stimulation stops. I have no problem gaining my erection back in these situations.
Grinding movements cause me to lose erection quality pretty fast.

-I feel like the base of my penis (first inch) is the part I have a tough time getting hard.

-I feel like I’m “addicted” to PE. If I go a few days without doing a PE work out that gives me a good pelvic muscles and lower abs a good work out (edging session can work as well), I get erections of lesser quality, my balls hang higher and come much faster.

-I suspect that caffeine intake has an impact on the quality of my erection. I try to limit my intake but sometimes I just don’t have the choice as I need it to get work done. It should be noted that I don’t directly link caffeine with erection problems since drinking moderate amounts of coffee at times where I can still get all the sleep I need seems to have no consequence.

Hey powpow

I guess the only thing you can really do is to be completly open and honest with the Urologist. Tell them you full history of ED (as above), and then let them find out what the source of the problem is and how to treat it. Don’t hold back any info because you think it might be embarrasing.

Good luck.

Wash your pee pee before you go.

Seriously, I think you need to give the doctor a chance and listen to his thoughts. If he seems to jump to the Viagra solution or any other solution right away, you could just ask, “What are the possible causes of this”? “What other options are there besides Viagra”? Are there any blood tests you could do?

Of course the more educated you are, the better questions you can ask. If you go to good medical web sites, you can learn pretty quickly the general course of action doctors should consider. Even Webmd will give you a good background. In this way, if you say “Why don’t you do a testosterone check”? and he says “That’s not necessary”. Then you can be smart enough to say “Why not. My understanding is that low testosterone is often a cause of this problem and I would like to know if that is my problem”. Be careful though. You don’t want to be one of those people who read 3 pages on webmd, and now you think you are an expert on the subject. Always treat your doctor with respect, and he will be more willing to make an extra effort to help you.

…taking notes…

:rolling:

Good advice guys, thanks. So far, what I know and what I’m probably going to ask about is:
-hormonal panel
-there’s a test where they give you a chemical erection and stick needles in your dick to see how the circulation is. That’s to test for venous leakage and it sounds like fun.
-The prescription for V could be fun too. I have this big party coming up in a few weeks at some ski resort. I have an hotel room with my girlfriend and, since we already paid for the open bar, I’m probably going to drink close to my own weight in alcohol…It could probably boost my performance a bit!

I’m also going to ask him (or her? I don’t know…)what he thinks about chemical treatments such as the chemical PE offered by the clinic in Toronto. They claim that their treatment can help with ED.

In addition to what mravg suggested: Without being too wordy, make a list of all your ED symptoms. If you don’t have nocturnal erections, say so. Important to mention that you lose your erections shortly after penetration when stimulation slows or is absent for a short time. List coffee intake and previous Propecia use. Coffee is a vasoconstrictor and Propecia has a track record for affecting erection quality in some men. Copy your list; keep one for yourself and give the other to him. You can go down it together. Making a list helps doctors focus on your specific issues; most of them appreciate that time-saver.

Unless you’ve had some PE injury in the past that has affected your erection quality, you don’t need to talk about PE.

Do ask him about venous leakage. In this connection, there is a pretty simple test called a Doppler Color Sonogram which is non-invasive and can locate leakage if it’s there. Doctors tend to pay more attention to venous leakage situations in younger guys than they do in us older farts because the corrective surgery for it gets better results in men your age.

If he insists on going the ED drug route with you - Viagra, Cialis, Levitra - at least try to get samples of all three because each works differently and one or another might be better in your case.

IMO, the Propecia angle should be investigated because your hormonal levels may have changed some since using it. Follow up on Accutane, as well. This drug can sometimes cause ED and libido loss which can persist long after you’ve stopped using it.

Good luck, and let us know how it goes with the doctor.

If you

Good thing I was prepared, this doctor was useless.

What did he tell me to do? Foreplay. No kidding.
If I had not suggested that it might be venous leakage or some hormonal disorder, he would not even have mentioned it and would have just sent me home with a prescription for some flowers and a very useful tip on how to tickle my girlfriend behind the ears.

Fortunately, I asked him if I should get checked for venous leakage and he referred me to another doctor to get a penile Doppler test. That’s the next step on my list.

The moral of this story: read and research! You need to know at least a little when you meet with a doctor.

Good going, powpow.

Did he at least have any good advice on foreplay?

Did he try foreplay on you or suggest it? :) I thought only BG knew all the fun urologists!

Yeah, his big move seemed to be that “tickle your girlfriend behind the ears” thing. I felt like I was receiving marital advice from a priest or something. This guy really treated me like a middle age guy who’s been married for 15 years and who’s bored of his wife. I’m 26, I’ve only been dating this girl 2 months and she’s amazing. I don’t think tickling her ears will give me back the last 15% of erection I lost a while ago…

We’ll see what the other urologist says!

He did tickle my ears in ways that made me feel uncomfortable…

So! let me get this right, tickling HER ears gives YOU a better erection?

Wow! the marvels of modern medicine.

Good luck Bro it was lucky you spoke up…..hmmmmm I wonder if this test will be able to pick up and PE activity and what will it determine it to be.

I don’t think it will. Well, at least, I don’t think it will point out that I do PE. This test verifies if circulation in the penis is ok so if one has some sort of PE injury, the test will probably show a there’s a problem with blood circulation. Now can it determine if that’s PE related, I think that would be a stretch. We’ll see!

Are you talking about the Doppler scan?