Am I ready for injections?

[Nocturne]

Ten years ago, I had my first lovely tangle with what was labeled “psychogenic ED”, although even then the urologist admitted that there was more to it than that (see my testosterone info below, plus I have extremely high Lp(a) and attendant heart issues).

It was a 3-4 month slog through that followed by maybe 2-3 years before I really started to trust my body again, and of course the anxiety over performance never really left completely. But I have been pretty happy overall for the last 7 years or so, even if clearly no longer 25 years old. Failed erections might have happened maybe once a year during that time. 5 mg Cialis daily has helped.

A bit over a month ago, I had a few days of failure together while on vacation with my wife - same basic situation as the first time. It’s clear to me now that vacation time alone with my wife is triggering to me and that’s just how it’s going to be.

Now I’m enjoying what feels like the same three month slog I did last time. Had successful sex yesterday, and was on top of the world - before trying again this morning and failing again no matter what we tried. Now I get to feel like shit until maybe next time things work. I shouldn’t have pushed myself this morning I guess, but even admitting to that feels like another failure.

Mentally I am ready for the goddamned implant already, but I know I don’t “need” it because I am still capable of getting and maintaining decent erections, so long as I am calm and relaxed and don’t think about it (“QUICK!!! Don’t think of a cat!!!”).

And if history is any indicator than in a “short” few years I’ll be back to feeling pretty good again.

But I really think I might be ready for the injections now. Not as a regular thing because I don’t think they would work well with our schedules, but I think I’d like to have them as backup for our rare vacations together to let us just have fun and prevent me from going into a tailspin like the one I’m in right now. And I’d like to be able to be a bit more acrobatic (sex in the shower, which she likes and I have grown to loathe because it often doesn’t work), and just sometimes be able to pause to change positions and let her arrange all of her pillows just the way she wants them. None of those things seem like unreasonable things for me to demand.

I’ve got until early August before finally being able to meet with my urologist, which feels like forever but is probably for the best considering I should have a much better idea of how I’m doing with the psychogenic stuff by then, again if history is any indicator (honestly I’m dealing with it better now than I did 10 years ago because now I know full well that I can recover given time). When I meet with him I plan to ask about the injections and request them. I also plan to start talking about a long term plan for an implant, just setting the groundwork for proof that I “need” one (although I’m prepared to just spend money out of pocket if it comes to that or living through five years of Hell while the insurance company shucks, jives, and dodges).

Does any of this sound unreasonable? Have any of you been through similar experiences? How might I best phrase things to get what I want?

I know a large part of my issue is performance anxiety, in the sense that I can get perfectly serviceable erections if I’m not worried about it (“QUICK!!! DON’T WORRY!!! DON’T *WORRY* OR IT’S ALL OVER!!!”). But my body is far less responsive than it used to be, my Doppler test showed low end normal results ten years ago, and nowadays I have a “severe blockage” of my right coronary artery - so it’s not like everything is hunky dory other than the anxiety.

[ElbowRoom]

Every case is different. Have you tried adding an additional 5mg cialis on top of the 5mg you take daily, when you're under more pressure to perform (like on vacation)? With a doctor's okay of course. That might be all you need to get you "over the hump". There's also things like PT-141 or even cannabis that you could use along with the Cialis.

While it doesn't sound like you *need* to go for the implant physiologically, if you can't reliably get erections with pills and it's causing you stress, then it's worth having the conversation. You could certainly try injections, you probably need a very low dose to get you a good erection. Some people understandably just hate the idea a needle to the dick and want to skip the injections and go right to an implant. There's nothing wrong with that.

But for you it sounds like you're on a low dose of Cialis right now and maybe all you need is a higher dose or something to supplement the Cialis. I'd try that first. The implant option will always be there, and if you can get some more years of good function from pills I'd 100% do that. YMMV.

[CanGetItUpButNotOff]

I do daily 10mg Cialis which sets a good baseline for injections. It's never perfect (anorgasmia on top of ED) but I have a pretty good success rate at about 70-80%. Without ICI, it was below 50%.

If, as it does with me, the injection gives you a long-lasting rock-hard stiffy that should help with the psychological factors. I'd find some way to accelerate the urologist appointment for an ICI Rx.

[Nocturne]

Every case is different. Have you tried adding an additional 5mg cialis on top of the 5mg you take daily, when you're under more pressure to perform (like on vacation)? With a doctor's okay of course. That might be all you need to get you "over the hump". There's also things like PT-141 or even cannabis that you could use along with the Cialis.

While it doesn't sound like you *need* to go for the implant physiologically, if you can't reliably get erections with pills and it's causing you stress, then it's worth having the conversation. You could certainly try injections, you probably need a very low dose to get you a good erection. Some people understandably just hate the idea a needle to the dick and want to skip the injections and go right to an implant. There's nothing wrong with that.

But for you it sounds like you're on a low dose of Cialis right now and maybe all you need is a higher dose or something to supplement the Cialis. I'd try that first. The implant option will always be there, and if you can get some more years of good function from pills I'd 100% do that. YMMV.

Good call on the Cialis, but I took 10 mg the night before the first mishap while on my recent vacation, took 10 mg every day after that, and formally switched to 10 mg every day when my urologist’s assistant told me to when I put in for the meeting. It may have given me really bad upper back pain because I had that for about three days straight and switched back to 5 mg just in case.

[Nocturne]

I do daily 10mg Cialis which sets a good baseline for injections. It's never perfect (anorgasmia on top of ED) but I have a pretty good success rate at about 70-80%. Without ICI, it was below 50%.

If, as it does with me, the injection gives you a long-lasting rock-hard stiffy that should help with the psychological factors. I'd find some way to accelerate the urologist appointment for an ICI Rx.

I think if I had a 30% chance of not being able to get it up I would go insane. I am just not put together to deal with that.

For the last 7 years, I’ve only had a handful of failures prior to this month; maybe 8? 12? That’s total.

That, I can handle. Don’t like it and think about the implant every time it happens, but I can handle it.

I dread coming to a place where I’m failing 20% of the time and then get strung along by the system for 10 years with waiting, trying endless half-measures, and being told things like “Just let it happen” and “Try harder not to try so hard…”

[Bambino09]

Ten years ago, I had my first lovely tangle with what was labeled “psychogenic ED”, although even then the urologist admitted that there was more to it than that (see my testosterone info below, plus I have extremely high Lp(a) and attendant heart issues).

It was a 3-4 month slog through that followed by maybe 2-3 years before I really started to trust my body again, and of course the anxiety over performance never really left completely. But I have been pretty happy overall for the last 7 years or so, even if clearly no longer 25 years old. Failed erections might have happened maybe once a year during that time. 5 mg Cialis daily has helped.

A bit over a month ago, I had a few days of failure together while on vacation with my wife - same basic situation as the first time. It’s clear to me now that vacation time alone with my wife is triggering to me and that’s just how it’s going to be.

Now I’m enjoying what feels like the same three month slog I did last time. Had successful sex yesterday, and was on top of the world - before trying again this morning and failing again no matter what we tried. Now I get to feel like shit until maybe next time things work. I shouldn’t have pushed myself this morning I guess, but even admitting to that feels like another failure.

Mentally I am ready for the goddamned implant already, but I know I don’t “need” it because I am still capable of getting and maintaining decent erections, so long as I am calm and relaxed and don’t think about it (“QUICK!!! Don’t think of a cat!!!”).

And if history is any indicator than in a “short” few years I’ll be back to feeling pretty good again.

But I really think I might be ready for the injections now. Not as a regular thing because I don’t think they would work well with our schedules, but I think I’d like to have them as backup for our rare vacations together to let us just have fun and prevent me from going into a tailspin like the one I’m in right now. And I’d like to be able to be a bit more acrobatic (sex in the shower, which she likes and I have grown to loathe because it often doesn’t work), and just sometimes be able to pause to change positions and let her arrange all of her pillows just the way she wants them. None of those things seem like unreasonable things for me to demand.

I’ve got until early August before finally being able to meet with my urologist, which feels like forever but is probably for the best considering I should have a much better idea of how I’m doing with the psychogenic stuff by then, again if history is any indicator (honestly I’m dealing with it better now than I did 10 years ago because now I know full well that I can recover given time). When I meet with him I plan to ask about the injections and request them. I also plan to start talking about a long term plan for an implant, just setting the groundwork for proof that I “need” one (although I’m prepared to just spend money out of pocket if it comes to that or living through five years of Hell while the insurance company shucks, jives, and dodges).

Does any of this sound unreasonable? Have any of you been through similar experiences? How might I best phrase things to get what I want?

I know a large part of my issue is performance anxiety, in the sense that I can get perfectly serviceable erections if I’m not worried about it (“QUICK!!! DON’T WORRY!!! DON’T *WORRY* OR IT’S ALL OVER!!!”). But my body is far less responsive than it used to be, my Doppler test showed low end normal results ten years ago, and nowadays I have a “severe blockage” of my right coronary artery - so it’s not like everything is hunky dory other than the anxiety.

5 milligrams is very low.
Cialis didn't do anything for me until I tried sildenafil.
I suggest you continue taking 5 mg of Cialis and 50 or 100 mg of sildenafil 1 hour before intercourse!!
The injections could make your situation worse!!
If you're able to have intercourse occasionally, I would continue like this.
5

[Nocturne]

5 milligrams is very low.
Cialis didn't do anything for me until I tried sildenafil.
I suggest you continue taking 5 mg of Cialis and 50 or 100 mg of sildenafil 1 hour before intercourse!!
The injections could make your situation worse!!
If you're able to have intercourse occasionally, I would continue like this.
5

5 mg per day is the maximum dose if you take it every day. 10 would be double that. I know you can take a lot more (20 mg?) right before sex if you are taking it just for that, but I’m on it daily.

Did not realize you could take sildenaful with Cialis. Don’t they basically just do the same thing?

[Bambino09]

5 milligrams is very low.
Cialis didn't do anything for me until I tried sildenafil.
I suggest you continue taking 5 mg of Cialis and 50 or 100 mg of sildenafil 1 hour before intercourse!!
The injections could make your situation worse!!
If you're able to have intercourse occasionally, I would continue like this.
5

5 mg per day is the maximum dose if you take it every day. 10 would be double that. I know you can take a lot more (20 mg?) right before sex if you are taking it just for that, but I’m on it daily.

Did not realize you could take sildenaful with Cialis. Don’t they basically just do the same thing?

They're two different drugs.
You take Cialis during the day and sildenafil one hour before sex because it's more potent and lasts longer! Good luck.
My advice is to exhaust all options before starting with injections.
I have an acquaintance who takes 10 or 20 mg of Cialis and 200 mg of Viagra, but that's an extreme case.
I take 100 mg of Viagra without Cialis!
You should do your own experiments. Good luck, and always try low doses until you find the ones that work!

[Nocturne]

5 milligrams is very low.
Cialis didn't do anything for me until I tried sildenafil.
I suggest you continue taking 5 mg of Cialis and 50 or 100 mg of sildenafil 1 hour before intercourse!!
The injections could make your situation worse!!
If you're able to have intercourse occasionally, I would continue like this.
5

5 mg per day is the maximum dose if you take it every day. 10 would be double that. I know you can take a lot more (20 mg?) right before sex if you are taking it just for that, but I’m on it daily.

Did not realize you could take sildenaful with Cialis. Don’t they basically just do the same thing?

They're two different drugs.
You take Cialis during the day and sildenafil one hour before sex because it's more potent and lasts longer! Good luck.
My advice is to exhaust all options before starting with injections.
I have an acquaintance who takes 10 or 20 mg of Cialis and 200 mg of Viagra, but that's an extreme case.
I take 100 mg of Viagra without Cialis!
You should do your own experiments. Good luck, and always try low doses until you find the ones that work!

Something for me to think about. Thanks for the advice!

[CanGetItUpButNotOff]

5 milligrams is very low.
Cialis didn't do anything for me until I tried sildenafil.
I suggest you continue taking 5 mg of Cialis and 50 or 100 mg of sildenafil 1 hour before intercourse!!
The injections could make your situation worse!!
If you're able to have intercourse occasionally, I would continue like this.
5

5 mg per day is the maximum dose if you take it every day. 10 would be double that. I know you can take a lot more (20 mg?) right before sex if you are taking it just for that, but I’m on it daily.

Did not realize you could take sildenaful with Cialis. Don’t they basically just do the same thing?

5mg daily Cialis is commonly prescribed but I don't think it is the maximum. My urologist, who specializes in aggressive sexual medicine modalities, upped me from 5mg to 10mg, saying that 5mg is really just a placebo and 10 is necessary for actual effect. I know that's not commonly understood but that was his opinion.

He also highly encouraged me to combine Cialis with sildenafil, but in moderation.