Low sex drive and erection problems 2 months after vasectomy


Q: - age 40, height 5'10", weight 159lb
- physically fit - can do 20 push ups, 8 pull ups, 75 squats. can run 3 miles in 30 min
- i'm generally happy/satisfied, goal oriented, a bit aggressive in nature and love adventure sports
- no allergies, no major illness/condition, no medications
- if anything, heart burns is my usual complaint, but i never take any medication for it, just drink a glass of water or milk.
- non-smoker, 2-3 drinks once or twice a week (now stopped completely)
- cholesterol has been high/steady for the last 10+ years (total 236, LDL 162, HDL 56, TriG 95)
- non circumcised, not vegetarian (eat chicken, eggs, fish)
- i used to bike just about 1 mile a day, but have not biked in about 2 years
- never had any injuries to Penis or testicles
- i have always watched porn, but only regular stuff (nudes, doggy, anal; not a fan of any tools, or weird, bloody,sadistic stuff)
- vasectomy done on Nov 5, with my full consent
- after vasectomy I didn't take any pain killers, all the pain was gone within a week
- had normal sex life until Dec 1st (4 to 6 intercourse + 3 to 5 masturbations per week), rock hard erections no matter i was tired, lack of sleep or was doing 3rd time in 24 hours
- Measured this morning while erect, 6 and 1/4 inch long and 6 inch circumference (both numbers are half inch to 1 inch lower than normal)
- wife was away for 3 weeks, came back Dec 23rd

After about 3 weeks wife demanded sex and we had a fight, then she told me that the size has not been same, it's not hard enough.
then over the next 2 weeks i also noticed that i did not feel like having sex as frequently as i was used to.
After no sex or masturbation for 4 days, there was not much desire, no rock hard erection. it was just enough to penetrate, after a few mniutes it was even smaller and softer. sicne then it has been same or worst.

I visited Dr. on Feb 10, who tested my prostate by putting finger in the anus and said it feel soft and "baggy", he called it infected and prescribed anti-biotic for 4 weeks and 1 refill if there's no improvement in 4 weeks.
I didn't have any prostate infection symptoms or pain in that area or in penis/testicles.

During the first 2-3 weeks of Jan i was drinking 3-4 drinks 3-4 days a week, had a bit of work related stress and some fighting with wife.
Based on conversation with nurse, i stopped drinking completely, started work out /running 3-4 days a week, drinking more water, take more sleep and of course anti-biotics.
for the last 2-3 weeks i have also been doing Kegel exercise (10 reps, 3 times a day while urinating)

Now it's been 6 weeks since my last Dr visit. there's very low sex desire, i don't get erection just by thinking about sex, or watching porn. i have to touch my wife and see her private parts to get partial erection which is hardly enough to penetrate.
After a min or 2 i can pull out and put back in without holding in my hand. if i go close to ejaculaiton and a drop or 2 comes out, then i lose erection.
Ultimately i am able to ejaculate and semen volume is about same as before. i can ejaculate every day or even second time after an hour.
If i have no desire at all and i push myself to do it, i can do it for longer time, few days ago i could do for 18 minutes stopping few times for few seconds.

If i don't have sex in the evening/night then i get erection in the sleep which i can feel when i wake up for bathroom, not rock solid just hard enough to penetrate, still no desire to have sex at that moment.
only once i had so much desire in the night that i had to have sex even if my wife was asleep and not very willing (such nights were very common before).
Visiting Dr again soon, he said he'll do Testosterone test.

My questions are:
- is the issue more likely physical than psychological and how to decide ?
- If physical what could be the root cause and is it treatable ?
- does Vasectomy has any role in this?
- if testosterone comes in low, what could be the reason for a sudden drop?
- if psychological, can there be stress/perforance anxiety without the person realizing/feeling it?
- how likely is it that i got addicted to porn while wife was away, and hence lost interest in real stuff? (see above about my porn interest)

Symptoms:  Low sex drive and erection issues

A:   Hello,
Thank you for your medical query at AskTheDoctor.com
I understand your concern.
Thanks for the detailed history, it does make the whole situation very clear. Vasectomy is an extremely safe procedure and in 99 % of the cases there are no complications. Even those suffering some complications would complain of local infection and abdominal pain following the surgery. It does not have any impact on the erections or subsequent orgasms.

If it is physical or psychological, can only be decided after the testosterone test. Since it happened all of a sudden, it points more towards a psychological event. The first time you were about to have sex before your wife pointed out about the size, you were fine with intercourse and did not think there was something wrong with the size. Since she thought it seemed smaller, it left a huge impact on you and ever since you have difficulties getting a full erection or having intercourse. In most cases, psychological anxiety will bother the person, but it will only be during the real performance. Anything sexual will promote the anxiety and hence proper erection would not be achieved.

The phenomenon of erection and orgasm, is extremely complex, involving a lot of factors and hormones. Any issues psychologically, apart from medical issues like Hypertension, T2DM, low testosterone levels, can have a lasting negative impact. Porn addiction can also lead to similar results, however, it can't happen in such a short period of time. It is considered that years of watching porn frequently, the person can only be influenced by porn or other pornographic material, and the real stuff may seem boring. But this effect is reversible.

I will advise a few psychological sessions, and feel it will be helpful for you. You can talk to your physician and try a course of Sildenafil Citrate 25-50 mg, as per your physician's guidelines 40 minutes before intercourse. You can take it for a short duration, a week or two, and if the response is good, along with normal testosterone levels, the psychological anxiety driven loss of erection will be confirmed.

Hope this was helpful,
Feel free to discuss further,

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