Dear Doctor, this is a problem about Erectile Dysfunction I

Patient : Dear Doctor, this is a problem about Erectile Dysfunction. I am 34 years now. Currently, my erections are not as strong nor controllable as it used to be 8 months ago or less. Firstly, I can only get an erection either by manual stimulation or when I think about my ex girlfriend who is someone I have strong emotional attachment and sexual addiction to. Secondly, when an erection comes on, although my shaft is hard, and points slightly more than 45 degree upwards, the erection is floppy. That is, I can quite easily push it down to a 90 degree, i.e. parallel to the ground, and urinate from position, and it could also easily be dangled, whereas it used to be difficult a few months ago. I can actually force a hardening in the erection, force it to stay stiff by exerting some muscles in my penis, but only when I do that. When I relax, the floppiness comes on. Connected to this problem is - I used to be able to feel fullness/swelling in the penis bulb area of the corpus spongiosum, but now it seems depleted; only when I exert the muscles then do I feel the fullness/swelling. Thirdly, the erection can now be easily brought down. The erection becomes 30% softer immediately, if I shift my thoughts away from the stimulating matter (when the erection was brought on by mental stimulation), or if I stop touching my penis (when the erection was brought on by manual stimulation. Fourthly, I can no longer be stimulated purely through graphical means, like, looking at a naked woman, or porn. In fact, I believe I would not even be able to manage an erection in a casual sex setting, i.e. sex with someone I don't know or has no emotional attachment to. Lastly, I have nocturnal and morning erections, but I think those erections might have the same problem. Hard and feels hard, but the penile base is still weak, at least for the morning erections. I am afraid the cause of my ED is not purely psychological but something permanent like venous leak or tissue damage. I should give you my history and the possible causes: 1. I believe for the period of 2012-2014 I already had ED, but it was either hormonal or psychological. If I were to have sex with casual partners, erection would be difficult. Porn could bring on erections, if I were in the mood. But porn with a storyline, would definitely give me erections. But the erections were hard and as strong as ever been. For that period, possible physical causes of ED might be smoking, and male pattern hairloss (mpb) treatment drugs and supplements. I took propecia for 3 months when I was 25. Then I stopped. When I was 29 I took it for one week and because it made me look and feel tired I stopped. Throughout 2014 I took evening primrose because I read it could help mpb. But I noticed a change in my erections and hence I stopped it as well. I take other supplements like ginkgo biloba, dha and ginseng. Ginkgo and ginseng seemed to make my erections strong, because I notice the difference in the few weeks when I stopped them. 2. Towards the end of 2014 I was drinking quite often, like perhaps average of 3 mugs of beer every night, and I smoked like one pack of cigarettes every day. 3. From since end of 2014 I met my ex girlfriend and that exacerbated my condition. I caught her cheating and ever since I have serious problems attaining erection for intercourse with her. I was taking natural herbs like tongkat ali which helped a little. 4. Then I sought help from cialis and levitra. At first I took levitra. I had to take a lot to get a strong erection. Like 2 tablets, 8 times of what was initially contemplated by the doctor. Then I took cialis, and I had to take 2 tablets of 20mg at one go. 5. On one occasion, I took 2 x 20mg cialis and 2x 100mg viagra, because the erection wouldn't come. Now that had worrying consequences. I don't know whether it could be considered priapism. Right after intercourse the erection subsided. But the next morning, the erection sustained even when I was walking around the streets. I was worried it was priaprism, so I masturbated to try to ease the erection. It soften. But what happened was erection would come on with the slightest arousal, mental arousal or movement which agitated the penis. I don't remember how long this went on exactly, but it went on for a few hours. After that, Through out the week, due to the effect of the cialis, erections would come on very easily. 6. Due to relationship stress with this ex girlfriend, I kept smoking and drinking every night for a couple of months. I have however cut down on smoking, and stopped drinking. After cutting smoking, erections seems to improve, but the problem of the floppy erection still persist. 7. Taking cialis and viagra eliminates the floppy erection problem, but I have to take 2x (100mg viagra +20mg cialis), and it was supposed to be an interim measure, and I really hope I dont have to rely on it! Now I am worried, whether the "weak base" the "floppiness" of my erections has been caused by damage of the corpus spongiosum, venous leakage, or tissue damage, that is, something permanent? Is the flatness/depletion of the penis bulb area of the corpus spongiosum a symptom/sign of such permanent damage?? Can it be possible for one to have BOTH psychological and physical ED? If there is permanent damage, is there any way to treat it WITHOUT using implants/prosthetics?
Symptoms:  Weak erection base
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