Decide your relative priorities among DD (intimacy duration) and CC( confidence-building)

Q: would we leave the regular (level-1) condoms forever unused?
A: no. We use them when testing VED or perseverant_foreplay

— scenario: Before a long /drought/ … DD is paramount.

I would take the pill for sure. Late pill is possibly less effective for DD.

I would also consider a thicker condom to reduce sensitivity. I think sensitivity is seldom important to me.

— scenario: I really want to stay at 25mg  and slow down the (inevitable?) escalation of dosage.

Sometimes CC is more important than DD, even when I face an upcoming week-long drought. In this scennario, I would consider no-pill, against multiple concerns:

• Wife is likely to complain of lengthy foreplay.
• DD could be very short

If I succeed with perseverant_foreplay, it could build my confidence and self-belief that “At least once a while I can do it without the pill, never mind the duration”.

I can also consider VED or late-pill.

[Extracorporeal shockwave therapy ] .. Dr Ng said ESWT is 50% effective but is the only treatment targeting the root cause (In contrast, pill/injection target the symptoms not the root.)

I told the SGH ESWT therapist that even if success rate is 30%, I would still want to try. By my age, my savings are more than sufficient, and my remaining “lease” is shrinking.

On 27 Sep, I decided to receive treatment on the spot, rather than waiting for TTSH response. The wait is a breeding ground for procrastination or mental pressure. The wait would /entail/ polyclinic visit, referral, TTSH consult,,,, Altogether they would cost me 2-3M of precious time.

I will maintain weekly frequency at SGH. After I consult with TTSH urologist, I can consider switch-over.

After a cycle, Maintenance sessions are often required.

— SGH cycle is 6 sessions. Up to 18 sessions are approved.

— TTSH cycle is 2 sessions for $310 according to 6889 4828. Need polyclinic referral.

Poly usually operates during my office hours 🙁 I can make appt at Outram for early morning then come to office.

— Zest is a Sgp clinic specializing in ESWT. Total cycle is $250 x 10 + GST. Most patients need 10 sessions.

— Polyclinic appt

• You can call automated hotline for same-day appt, but some appt slots are invisible to that system, and only an operator can pick them for you.
• If you call hotline to make regular appt, it is usually a few days out.

Backlog can be quite bad .. some patients exceed their allotted time, so the subsequent appt get pushed back —

• Aha … There is a lunch break. When doctor comes in at 2pm (or whatever morning start time), the backlog would be shortest. I think 2pm appt is probably a clever hack known to old hands.
• Now suppose your appt is 3.30. if you miss your appt by 15 minutes, then you might end up in the no-appt queue and wait for hours to see a doctor. I guess the no-appt queue is “popped” only when the backlog clears, perhaps at end of morning/afternoon sessions.
• what if you come too early, more than 15 minutes, at 3.10, and there is backlog? I guess system may put you in the backlog queue either before or after the 3.15-appt-holder.

— based on https://augustams.com/erectile-dysfunction-exercises-health/

For men who have been unable to achieve an erection for multiple years this (learning the pump) can be a two-week commitment to reconditioning blood vessels in the penis to handle blood.

Regular use of the Soma Therapy ED vacuum therapy device will create penile rigidity. Daily penile rigidity through erectile dysfunction exercise will duplicate the benefits of nocturnal erections, reversing penile shrinkage, reconditioning penile tissues with blood circulation and promoting a return to good penile health.

“If you don’t use it you lose it.”. My Chinese book (P159) also says “用进废退”.

For prostate cancer, other treatments (beside prostatectomy) can also cause ED as side effect (though prostatectomy has the highest chance). If you are serious about erection, then beware prostate cancer.

— https://augustams.com/physical-activity-to-improve-erectile-function/ described aerobic and other exercises

The term used by Urologist to describe erectile dysfunction exercises is penile rehabilitation.  Penile rehabilitation programs are like a form of physical therapy.  These programs help men recover their erectile function by inducing erections to “exercise” the penis.

— penis shrinkage (beside ED) due to aging, celibacy or other reasons

“If they don’t do anything to maintain normal erections, they will get shortening of the penis,” Kohler says. Without regular erections, penile tissue can become less elastic and shrink, making the penis 1-2 centimeters shorter.

If you don’t get frequent erections where your penis and its skin stretches you may lose some (perceived) length to the penis.

Research has also shown that long periods of impotence or celibacy can result in some loss of size to the genitals

Excess belly fat can …making it appear shorter. Can also create real barrier for penetration, exactly like ED.

Dr Teo was convincing — For patients recovering after prostatectomy, VED is routinely prescribed to give them erections. Dr Teo performed implant surgery on many patients, and had difficulty putting in a longer prosthesis for some unfortunate patients — their penis lost length permanently, because no erection for a “long time”.

— importance of nightly erections .. https://www.healthline.com/health/benefits-of-taking-viagra-daily

“The penis is a unique organ. During the day, there’s very little blood flow in the penis… All the other organs are getting the 100 mm of oxygen all day and night, but the penis doesn’t… The penis only gets arterial blood flow during erections and during sleep. So from the perspective of the penis, sleep is the real time when oxygenation occurs.”

Goldstein noted that having good nighttime erections can help “prevent the scarring of the penis” that normally occurs with age.

Ultrasound gives us the ability to assess the degree of scarring in an individual, Goldstein said.

“Taking a PDE5 inhibitor every night can magnify the night erections and increase the chance of oxygenation, which increases the chance of getting rid of that scar tissue.”

VED=vaccum erection device

See also https://www.medicalnewstoday.com/articles/erectile-dysfunction-pump

SomaTherapy might be the best documented product , and comes with clinic support if you buy therefrom. It’s a medical grade device, endorsed by doctors, well tested, perhaps safer than simpler sex toys.

(I have a tendency to believe U.S./UK/Japan/German products, over China products. This bias needs the spotlight and conscious, critical review.)

Q2: Looks like all the brands are virtually identical, and different only in branding and price?
%%A: Some users said many brands “didn’t work for me”. However, for me perhaps the cheapest brand also works, as proven in condoms, progressive lenses, bicycles, shoes,,,

Q2b: After some practice, what’s the probability that a given pump will be effective and convenient for me?
%%A: Less than 80%. I can buy a cheap but popular model to try. If ineffective, then go for the most trusted model.

Q3: water-based vs vacuum pump?
Dr Teo: vacuum models are more proven, safer, but you could try water-based.
A: SomaTherapy site said No “they are not commonly used for creating erections for sexual intercourse”.

Over longer run, much cheaper than pills.

It’s common for men to utilize a penis pump in conjunction with other ED treatments to improve partial erection or decrease dosage requirements when combined with oral medications… When vacuum constriction devices are used in combination with medication, a success rate of more than 90 percent is noted compared to less than 60 percent with medication alone.

Originally penis pumps required a prescription when introduced in 1982. Prescription requirements were removed in 1997 when the FDA determined the medical penis pump as safe and highly effective.

— [reconciliation] I now realized the cheap Shopee VED also works. I bought it with a singular goal to delay ED medication .. a noble goal. I bought it and tried it unsuccessfully, before I decided to try $350 VED. I think the Shopee buy is a good “buy without OT”.

• Good situation. I’d rather be in this situation than having to rely solely on a premium products [Situation 2]. In Situation 2, repairs, replacements would all become complicated.
• without the $350 VED, I would not know how to use the cheap VED
• The two VEDs feel different on the penis. After I learned to use both, I have come to appreciate the variations in design. Better than having nothing but a single design across all vendors.
• DataScientist view: The $350 model is actually superior in terms of clinic support, repairs, instructions, the (very tight) X/Y/Z ED_ring, easy assembly, the cone, lubricant,,

Q: Suppose there is a “best” device to be discovered. Do I wish to find out it is a cheap Shopee product or do I wish it is the VED [Situaion 2]?
%%A: the former. If the cheap product is effective, then I can use-without-care, carry with me etc.

— usage techniques are make-or-break

Sit at edge of a stool. Upper body lean forward n follow the 45-degree rule. This is a crucial rule w.r.t. gravity  of the flaccid penis.

If the underpants block the VED, then undress fully.

You can hold the cylinder between the thighs.

Tip from quick guide: Do not press the rubber rim against your body (pubic hair region)

Tip from quick guide: penis start position : rest on the “cradle” inside.

Start at a faster pace [pump 3 times, rest 10sec]. Then slow dow — one slow “pumping” and rest longer. So when shall slow down or steop? Length is a poor gauge
* Shake and assess the flaccidity
* Penis lifting off from the “cradle” .. a sign of rigidity
* discomfort at the base .. as more tissues are drawn into the cylinder and squeezed around the penis base.

First cycle (till discomfort) may not be very good. Release and start second cycle. Could give a better erection. Third even better.

Biggest medical risk (misstep) with ED_ring — sleeping with the ring on.

“Some people with mild ED may benefit from using an ED ring on its own or with a [pump]… ED rings work by supporting the [weakening] tunica albuginea, which tends to thicken and harden with age… The International Society of Sexual Medicine recommends silicone or adjustable rings.”

I often get a (barely) adequate erection and start working hard to maintain it. Half the times I (win) get a penetration, and the other times it weakens before I could penetrate. Some website points out “Stressing about staying hard may prevent you from doing just that… Using a penis ring may help relieve some of that performance anxiety.” and help you relax and maintain the erection“.

ED_rings “work best when a man can achieve a partial or full erection but has difficulty maintaining it.”

“[Other cases] may require a vacuum pump in addition to a cock ring [rather than the ring alone]… Your penis holds seven times its normal blood volume during an erection!… Erections rely on consistent and strong blood flow. Strengthening your cardiovascular system can help improve the amount of blood flowing into your penis, as well as stamina [my xp].” .. aim at 40 minutes of aerobic exercise 4 times per week. I think 10min jog or climbing stairs are insufficient.

“You should always wait at least 60 minutes between uses[of an ED_ring]”

“Cock rings squeeze the base of your penis just enough to let blood flow into it, but they restrict the flow of blood out, keeping you hard. And if the cock ring fits properly you’ll stay hard until you decide to take it off.”

— longer intimacy with 1) thick condom 2)ED_ring .. My 2023 experiences show that the condom is more effective.

• thick condom reduces pleasure but prolongs intimacy .. net positive.
• ED_ring can be too tight. If not too tight, then the discomfort vs the duration enhancement is net positive.

— relative value of ED_ring w.r.t. pills, pumps etc
Rx pills get the most mindshare (than pumps or rings) because it is big business for pharmaceutical firms, clinics and online stores. ED_ring is much cheaper than pills or pumps.

Pills and pumps have more dramatic effects, esp for difficult ED cases. ED_ring is effective when combined with pump or pills. ED_ring alone is not seen as very effective but could be effective for some men, perhaps me ! If effective, this is much simpler and sustainable than pills or pumps… should be my first choice.

Why is ED_ring relevant/important? As men age, ED_ring (esp. with pump) will become instrumental to the fulfillment of a basic biological needs, rather than mere pleasure. Most cock rings out there are designed for pleasure, “delaying”, “harder”, elongated erection ,,,, but I’m mostly interested in ED treatment. That’s why I prefer the name ED_ring.

— ED_ring + ED pills together … After taking ED pill to get an erection, simply use a cock ring to maintain it.

— service life.. Eurex, EddieByGiddy, Maintain, Osbon all point out that after several uses, the ring would lose tension.

— Maintain .. medical grade adjustable ED_ring

MAINTAIN® Constriction Loop for ED and PE – Made in USA

— EddyByGiddy is a medical grade ED_ring designed for ED. Rather expensive for many people. I can consider this product if the simpler products don’t work.

Can put on before or after erection starts.

I think the SomaTherapy tension device is much tighter as it doesn’t have a “INflow” requirement. Designed for more severe ED.

This site compares this product against similar products

— girth [inside diameter] .. DurexPleasureRing 155 mm is designed to fit most men.

The SomaTherapy tension rings are much narrower, perhaps for medical reasons, perhaps because some patients are very old.

It may take some trial and error to find the right fit. If you have difficulty getting the initial erection, then an adjustable might be better. I suggest buying one ring (not two), try it out, then decide the next type to buy.

— condom .. Some people prefer to put on the ring before full erection, and “Place a condom on after the ring” presumably because the ring prevents deflating when wearing condom. However, Dr Teo suggested ED-ring over condom.. echoes https://www.durex.co.uk/blogs/explore-sex/the-durex-cock-ring-buying-guide. There is no correct or incorrect, healthy or unhealthy, so you can try for yourself.

https://www.forhims.com/blog/sex-toys-for-ed article is more “medical”.

— My Q&A with Dr Teo was mostly about devices. Therefore I keep this section in this bpost.

Q: After 30m (wearing the ring), I still want to hold longer before ejaculation?
A: remove ring. Use pump if flaccid, then go back in without ring.

— — vacuum pump
— — ED_ring .. extracted to a separate bpost
— — fake vagina .. could help me get over the hump. After that, I will try to penetrate the real vagina.

Q: how many percent of the days would this device help?
%%A: Currently, I think 40~60% of the days [decreasing 🙁 ] I don’t need any device; on most [increasing 🙁 ] of the difficult/needful days this device could be insufficient; perhaps 3~10% [decreasing 🙁 ] of the needful days it would help

Once the penis is inside, it often gets enough stimulation to stay firm. That’s why I won’t take the chance to come out. Once I came out to adjust the radio or something, I sometimes found myself unable to firm up to go back in (Pump is the answer). This is a growing risk as we age.

Q: fake vagina with a hard cover, to be held between her thighs. Not sure if she would find it uncomfortable.
Dr Teo: harmless to try.

— — Lubricant .. relieves some men’s penetration struggles.

Apply on condom? Dr Teo said no need, but with some men this bit of lubrication might be the final push to help the individual get over the hump.  Also, the “oil” on my low-cost condoms are supposedly low quality, and can dry up easily during foreplay.

k_potency

This is my unscientific theory.

Potency := limited amount of erection energy within your “system”. It replenishes some hours after fully spent.

During foreplay, if you use up too much potency, then your erection will be difficult to come, difficult to keep.

Eg illustraing 過度刺激: Even as a young husband, when I had too much “boob” play, potency was  often used up very quickly, leading to ED.

Eg: if I try no-pill for x minutes of perseverant_foreplay, i often use up scarce potency, and experience ED issues. Usually, the pill can help reboost potency, but over a relatively long period.

Eg: longer interval (lower frequency) like 2w?…. can replenish a potency “reserve”, but this effect becomes less consistent as we age. After a long interval, we often hit ED + PmE.

Eg: 2007 in Boston Tufts hospital, I was asked to collect semen, using erotic videos + magazines in a private lab. Some young men presumably had enough potency to “do it” in this very poor setting, but my potency was way too low.

— pills .. doesn’t create potency, but it can amplify/boost the energy to achieve erection.

A dwindling potency can still give erection, thanks to the magical pill

— VED .. doesn’t use up potency. Potencan can help VED do its job.

— morning erection .. is somewhat related to potency. I have regular morning erections but still experience ED when awake.

— sexual drive aka libido .. is the force behind potency, but look at young male sex workers. They don’t always have sexual drive while doing their job, but they have potency [energy].

Now look at an older playboy with multiple sex partners. He has plenty of desire but limited potency [energy].