Physical Ed Symptoms

recoveryroute

Most discussions here focus on erection quality (rigidity scores, response to PDE5 inhibitors). I am interested in systematically cataloging “physical” signs and prodromal symptoms that precede or accompany erectile dysfunction, aiming to differentiate vascular, neurogenic, pelvic floor, and endocrine phenotypes. The goal is to create a community-derived symptom map and a simple at‑home observation protocol that can be taken to clinicians.

Questions for the group:

Vascular/endothelial features:
- Cold intolerance in hands/feet or penile “blanching” with cold exposure; visible dorsal vein distension at rest; rapid loss of rigidity with position change (standing vs supine).
- Coexisting clues to microvascular dysfunction: delayed capillary refill, frequent headaches/migraines, Raynaud‑like episodes, nasal congestion improvement with PDE5 inhibitors.
- Exercise response: better erections after moderate cardio vs transient worsening after intense endurance bouts; any association with post-exertional fatigue or orthostatic symptoms.
Neurogenic/sensory features:
- Altered penile/glans sensation (numbness, burning, “pins and needles”), asymmetric sensitivity, or delayed ejaculation with concurrent decreased tactile discrimination.
- Low back pain, sciatica, cycling‑related perineal numbness, or saddle anesthesia correlations.
- Autonomic signs: resting tachycardia, exaggerated sweating or dry skin, orthostatic lightheadedness.
Pelvic floor/urogenital features:
- Perineal or suprapubic tension/pain, painful ejaculation, urinary frequency/urgency, incomplete emptying, constipation.
- Symptom change after intentional pelvic floor relaxation vs strengthening (biofeedback, downtraining, diaphragmatic breathing).
Endocrine/metabolic features:
- Reduced morning erections frequency, central adiposity, decreased shaving frequency/body hair, gynecomastia, low energy, sleep-disordered breathing (snoring, witnessed apneas).
- Coexisting metabolic markers (if known): elevated fasting glucose, triglycerides, or blood pressure.
Structural features:
- New curvature, palpable plaques, hinge effect, or shortening; temporal relationship to microtrauma or vigorous activity.

Proposed two‑week home observation protocol (noninvasive, no medications):

Daily logs:
- Morning erections: present/absent and approximate rigidity (0-4 scale).
- Sleep: snoring (0-3), awakenings, nocturia count.
- Stress and stimulants: perceived stress (0-10), caffeine/alcohol intake.
- Exercise: type, duration, intensity; note next‑day erection quality.
- Urinary/bowel: urgency, hesitancy, constipation (yes/no).
- Pelvic sensations: perineal tightness/pain (0-10), low back/sciatic symptoms (yes/no).
Simple checks, 2-3 times/week:
- Sensory screen: compare light touch vs dull touch on shaft/glans (e.g., cotton tip vs blunt end of a swab) and vibration using an electric toothbrush base on fingertip vs glans; note asymmetry or diminished perception.
- Thermal reactivity: gentle warm/cool contrast on inner forearm vs penile shaft/glans; note delayed or blunted perception (avoid extremes).
- Positional sustainability: if an erection occurs naturally, note stability supine vs standing without additional stimulation, focusing on time to detumescence (avoid any painful or forceful maneuvers).
- Pelvic floor awareness: during quiet breathing, assess ability to fully relax the pelvic floor (sensation of release vs habitual clenching).
Optional vital signs:
- Resting heart rate and blood pressure (morning), and after 1-2 minutes standing to screen for orthostatic changes.

Discussion prompts:

Which clusters co-occur for you? For example, cold extremities + nasal congestion + improved warmth after PDE5 inhibitors (endothelial pattern) vs perineal tightness + urinary urgency + painful ejaculation (pelvic floor pattern) vs numbness/tingling + cycling history + low back pain (neurogenic pattern).
Have you noted a reproducible effect of temperature, caffeine, or stress on flaccid baseline (“turtling”) and subsequent erection quality?
Does light aerobic activity improve next‑day erections whereas maximal efforts or prolonged cycling worsen them?
Has anyone tracked sensory thresholds over time and seen improvement with neuropathy‑targeted interventions (glycemic control, B12 correction, seat changes for cyclists, nerve gliding, etc.)?
For those with curvature or plaques, did you observe earlier physical cues (localized tenderness, hourglass “soft spots”) before obvious deformity?

If several members are interested, we could collate anonymized results into a phenotype matrix (vascular, neurogenic, pelvic floor, endocrine/OSA, structural) to see whether distinct patterns emerge and whether they predict response to specific interventions (e.g., pelvic floor downtraining vs cardiometabolic optimization vs neuropathy management).

innerstrengthguide

Love this direction. A few adds to keep the signal high and the workload low:

Core pack (reduce noise): track only 5 daily variables for two weeks-morning wood (0-4), sleep hours, alcohol units, meds that touch erections (antihistamines/decongestants, SSRIs/SNRIs, finasteride, beta‑blockers, nicotine), and perceived pelvic floor tension (0-10). Everything else 2-3x/week as you outlined.
Cheap objectivity: do a 3‑night postage‑stamp NPT test; 3‑minute stand test (HR/BP at 0, 1, 3 min; HR rise >30 bpm suggests orthostatic intolerance); vibration comparison glans vs great toe with a 128 Hz tuning fork (or toothbrush base if that’s all you have).
Venous vs inflow hint: during a natural erection, if rigidity drops on standing but a maximal Kegel (and/or glute squeeze) temporarily restores firmness, think veno‑occlusive issue; if Kegel doesn’t help and you feel colder/clammy, think inflow/autonomic.
Simple ABAB mini‑experiments: alternate caffeine‑free vs usual caffeine days and warm shower before bed vs cool room nights; pre‑register which direction you expect and note effect size next morning (don’t change anything else those days).
Vascular/autonomic proxy: if you have a pulse‑ox, log perfusion index on a fingertip before and 2 minutes after 30 seconds of cold‑water dip (other hand); blunted recovery correlates with sympathetic overdrive/endothelial dysfunction in my experience.
Quick pelvic‑floor screen: on a slow inhale, belly expands and perineum should drop; if it never descends and you’re “holding” even at rest-and urinary urgency/painful ejaculation co‑travel-flag high‑tone. Try 5 minutes diaphragmatic breathing + long exhales before bed and see if next‑day urgency and erection quality shift.
Don’t forget varicocele: evening heaviness/dull ache and a “bag‑of‑worms” left scrotum standing (worse with Valsalva). If present alongside low energy/low morning wood, add it to the endocrine/vascular bucket.
Labs most likely to move the needle: A1c or CGM trends, B12 (± MMA), morning testosterone twice with SHBG/albumin, TSH. Useful to interpret the phenotype clusters you’re building.

If we’re going to collate, let’s standardize timing (measurements within 30 minutes of waking), the same 0-4/0-10 scales, and a short confounder checklist each day so we can actually compare across people.