The man in his mid-fifties had read an interview with me. In it I emphasized that there is a treatable explanation for almost every erectile dysfunction. He then made an appointment with me. During the consultation, he said that he had never had a real erection and therefore never had normal sexual intercourse – neither as a young man nor at any other time in his life. He had an agreement with his long-time girlfriend that he would satisfy her orally or with sex toys. And when he masturbated, he used a trick: he pressed his perineum with one hand. Then the erection was even enough for an orgasm. He had never talked to a doctor about it until now. It was just like that – he didn’t know any other way.

As he spoke, a possible diagnosis immediately came to mind.

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