Should You See a Urologist?

I think it’s a good idea to get a urological consultation unless it’s clear that the problem is totally psychological. Medical science has been quite active in the sexual arena in the last twenty years, and a number of new diagnostic tests and treatments have been developed and refined. You should know what options are available to you before making any decisions. Even if you choose sex therapy, it’s good to know what limits any physical problems you have may put on progress in that therapy.

You should get a consultation from a urologist if there’s any possibility that your erection problem may be due to physical causes. Although urologists by definition are specialists in the physiology and pathology of the urinary and genital functions, not all of them are experts in sexuality. You want someone who specializes in sex problems. The best way to find such a person is by getting a referral from your regular doctor or a sex therapist.

If any of the following items are true of you, you should see a urologist:

• You never or rarely have erections while asleep or upon awakening. When I say erections in this discussion, I mean of reasonable or satisfactory quality — that is, sufficient for vaginal insertion and intercourse. This does not mean that your penis has to be as hard as a rock.
• You never or rarely have erections in masturbation.
• You never or rarely can maintain an erection until ejaculation.
• You have a consistent pattern of your penis getting hard only a short time before ejaculation.
• You have already failed to improve the quality or quantity of your erections in a sex-therapy or self-help program.

If any of the following are true, you probably don’t need a urologist:

• You often have erections while asleep and on awakening.
• You usually get erections with masturbation and maintain them for a comfortable time before ejaculation. If you have erections on awakening or with masturbation, but not with a partner, that almost certainly means that something about you and the partner needs work. It would be a strange physical condition that manifested itself only in the presence of another person.
• You have and maintain good erections in certain situations but not others — say, with one partner but not with another, or when you’re on vacation but not at home.

If you’re going to see a urologist (or a therapist, for that matter), it’s important to be a wise consumer. You should review your sexual history, or at least the history of the problem, before seeing the doctor so you can present an accurate and comprehensive picture. You should also make a list of questions you want answered and make sure that you do indeed get the answers. If the doctor doesn’t seem comfortable dealing with you and your situation, isn’t willing to take the time you want to discuss your case with you, or won’t talk to you in language you can understand, go elsewhere. Don’t let your fear of looking stupid prevent you from asking all the questions you want. As far as I’m concerned, the only stupid questions are the ones you don’t ask.

If your consultation goes beyond tests and into possible treatments, I strongly suggest bringing your partner with you. Even though it’s your penis, she’s an integral part of your sex life and she should be there to hear the pros and cons of various treatments and to ask any questions she has.

Try not to be overly swayed by the doctor’s (or therapist’s) authority or certainty about what treatment you should have. Many doctors and therapists are anything but open-minded. They believe that whatever they do is the best treatment for everyone. While you should listen carefully to his or her opinion, remember that’s all it is. Every treatment costs money, and most also require time and effort; some, like penile implants, also involve pain and risk. You’re the one who will have to live with the consequences. You should get the best therapeutic and medical advice you can, and then determine (with your partner, if you have one) what course of action makes the most sense for you.

DRUG THERAPY FOR ERECTILE DYSFUNCTION

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