Hello and welcome to Healthcare Magic. Thanks for your query.

I will certainly help and advise you regarding your problem. In order to guide you better, can you please provide the following clarifications...

- How long have you been having this problem?

- How frequently does this problem happen? Does it happen only in certain situations or everytime you are sexually aroused?
- How long are you able to perform sexual intercourse?

- Do you have a problem of pre-mature ejaculation?
- Are you married? Do you have any problems or stress in your relationship?

- Do you suffer from anxiety, negative thoughts or low mood?

- Do you smoke or consume alcohol or any other drugs?

- Do you have any other medical problems or are you on any medication currently?

Please get back to me with these details, so that I can advise you in a better way.

Regards,
- Dr. Jonas Sundarakumar
Consultant Psychiatrist & Sexologist

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Hello again and thanks for your clarifications.

You seem to be having a problem of Erectile Dysfunction. This is the most common sexual problem in men. Now, there can be a variety of causes for this problem - both medical causes as well as psychological causes. So, the first and most important step in management is proper evaluation. This will include a detailed medical, sexual, personal and social history, a thorough physical examination and certain investigations, as per the necessity. This is both informative to the doctor and serves as an opportunity to educate the patient and clarify his doubts.

Firstly, any medical causes (like diabetes, hormonal problems, blood flow problems, etc.) need to be ruled out. For this, you may need to undergo a few blood tests since cetain medical conditions like diabetes, high cholesterol, etc. can lead to sexual dysfunction. Sometimes, hormonal imbalances can also lead to low sexual drive and poor sexual functioning. So, certain additional tests like testosterone level, FSH, LH levels, etc. may be required. Similarly, in order to rule out any blood flow problem to the penis, which could be causing poor erections, a doppler study is sometimes advised to check for the blood flow to the penis. Rarely, a tumescence testing done as this test helps to differentiate between medical and psychological causes.

Having said this, I would also like to let you know that in more than 80% of cases of erectile dysfunction, psychological factors also play a major role in causing or aggravating the problem. Especially, in young men, physchological causes are more likely than medical diseases. Stress, anxiety, fears and doubts regarding sexual performance, feelings of sexual inadequacy, self-doubts, guilt, past negative sexual experiences, etc. can all affect sexual functioning and performance.

Treatment is targeted according to the findings on evaluation. If there are any underlying medical problems resulting in the erectile dysfunction, then those problems have to be first treated. If he problem is more psychological, then removing the person's doubts and fears, and improving his self-confidence levels will also definitely help in improving sexual performance. Also, there are certain medication which improve the blood flow to the penis and promote better erection, such as Sildenafil, Vardenafil and Tadalafil. But medication is usually advised only as the last resort and in severe cases.

So, I would advise you to consult a psychiatrist or a sexologist in person to have a detailed assessment and evaluation done. Also, avoid alcohol, smoking or any unnecessary medication and try to stay stress-free and positive.

Wish you all the best.

- Dr. Jonas Sundarakumar
Consultant Psychiatrist & Sexologist

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