Hello from Balkans, E. Europe

[bureci]

I am writting from the eastern part of Europe, we have very low standards (avg salary cca 700 euros), so you can clearly imagine that managing ED is very expensive with current market prices of sildenafil (not to mention cialis!).
At the moment, ED is not recognized or treatable in my country. Couple of urologists I went to are completely ignorant to it, and their attitude is - either it gets erect or it remains flaccid. Nothing in between exists.
Medicines are not covered by insurance list so you have to pay them hefty, market is really bad, sildenafil pill is cca 5 euro, cialis cca 15-20.."Good" thing in this bad setting is that I am completely non-responder to PDE5 medicines, so it does not matters if they are covered.
So you can imagine that all I have learnt on this topic is coming from the pubmed and published researches, and thank to the God, this board!
Having struggles with ED whole of my life.
For the good part, PE was problem as well, until late 20-s. Even today, if the girl is on top, I must have almost all of the control, because it is really ease to climax in that position.

Needles to say, how much  damage was created in the field of self-confidence, self respect and fear for the future. Anxiety, depression, very bad mood, it just altered during puberty and adoloscence, and fear just grew as I moved towards the maturity since I knew there will be no longer way to avoid sexual contacts in romantic relationships.TBH i avoided girls at all during period from 15-18 years old.Unfortunately, they find me quite attractive, charming, handsome, and many of them drew a first move (which is VERY uncommon in our society at that time) so, having many of them "served on the plate" and not being able to consume it, was very very frustrating.
I was convinced that every girl would leave me because of ED + PE + not girty member (11,5 cm / 4.5 inch).
First girl I have had sex with was a complete disaster... 2+ years relationship, I was 20 when we first had sex... First couple of times I have used pump + rings... Penis was quite more girthy in those settings, and reached up to 17 cm of length pumped, BUT, it was cold, unpleasant for me, and very inconvenient, since i pumped in secret in other room, and had to use the tightest/harder rubber in order to maintaing rigid erection, which was VERY VERY difficult to set up on the device.
So, I decided to proceed naturally, with erection I can achieve, which was, in my approximation, some 60-70% of full rigidity.After initial euphoria, girl went cold quite quickly and started avoiding sex completely. At the end of the relationship, she admitted that she could barely feel me at all past the couple of initial thrusts (and tbh, she was wide so I could not enjoy myself too much, either!).This devastated me, and made me almost desperate about my future and completing myself as a parent...

Fortunately, I was lucky enough to find a smart and hot looking girl, sexually experienced, which was sporty and quite tight down there, and found my creativity under sheets relevating! Our sexual life thrived and continued to grow and develop for the past 15+ years, getting us to the point where we have intercourse of 3.5 hour in one piece (with like, 5 minute break just to use toilet and rehydrate)... Now we have 2 childern, happily married for a long time and amazing sexual life.
All of this with ED... A lot can be done even with partial erection, when there is love, understanding and compatibility in sizes.

The problem is, past 2-3 years (40 atm, completely fit and healthy) I can feel the erection quality is declining, to the point where lying positions are very diffucult - almost impossible to perform at.
Seated positions are problematic as well, allmost all of the time i have to thrust, us kegel muscles and pump my thighs in order to remaing rigid enogh, which is quite exhausting even for person strong and fit as I am.

During masturbation, sometimes it even gets quite soft, and if there is no thrill and stimulation from the encounter itself, sometimes it is very hard to climax at all when masturbating and I give up without finished job.
I have noticed that ejaculation is much poorer as well, only first and second shots fly the distance, remaining shots just drop in front of the penis.
For this, I have used Saw Palmetto, Rye Grass, and Yohiimbine as  alfa blocker, and seen quite a improvement in ejaculation strength (and orgasm intensity returned) and volume but ONLY when my wife finishes me by handjob, and only if we've had sex for at least  for 40 minutes (our average is 1h - 1h 15). When I am not horny (under 40 minutes of sex) or masturbating, ejaculation is not strong neither is orgasm itself.

When combining Yohimbine with L-arginine (https://pubmed.ncbi.nlm.nih.gov/15606445 ), I have noticed improvements of erection quality when sitting and laying on my back. Much better and usable, hovewer, far from being hard and rigid.
I am nonresponder to Sildenafil, so cant wait to try out bimix or trimix, because I had no idea about these medicines and was living in fear that implant was the only sollution  and it is way too expensice and costs somewhere between 2 or 3 yearly average incomes in my country...

[LGXDownunder]

Welcome bureci! Yes ED sucks. But you have a lot going for you with your wife being a very supportive and sexually compatible partner, and both of you having like minded libidos. I won't advise on injections as my experience with them wasn't great, but they do work for many guys as a long term solution. I appreciate the economic and medical difficulties you face in your country.

One thing you haven't mentioned is a vacuum erection device (VED). Vacuum pumps are a cheap solution that can work for many guys, usually in conjunction with using a cock ring. When injections failed that was all I used for 18 months until I got my implant. It was less than perfect but I could reliably get an erection. It just wouldn't stay up long enough for satisfying penetrative sex. But I had absolute zero erectile function, caused by a radical prostatectomy. You don't have that and are much younger than me, so it might be worth a try. It also won't cost much and there are very few ongoing costs, just when some parts wear out.