Brief Answer:
5- PDE inhibitor group of drug would help

Detailed Answer:
Hello,

Thanks for writing to us.

You have very well narrated your history.My answer is going to be long but read it carefully.

It is good that you have stopped alcohol and tobacco. They are responsible for sexual problems in many cases.Stopping Nicotex and lorazepam suddenly may lead to anxiety. It is possible that you failed initially in intercourse due to this anxiety. This initial failure made you apprehensive about your erection and later on due to performance anxiety you are not able to do successful intercourse likely.

Sometime due to fatigue, lack of mood, situational problem or environmental changes man can fail in sex. It is normal phenomenon. However when this failure makes person apprehensive about erection, sex life is affected. This is called performance anxiety. After such failure when person actively thinks about erection or success of intercourse during sex his mind is likely diverted to such thoughts. For constant erection continuous exciting/romantic/erotic feelings should be there in mind. If mind diverted to concern about erection, erection would not be possible.

To come out of this anxiety man must not think actively about maintaining erection while doing sex.
To get rid of performance anxiety help of partner is also an important aspect.
Whenever you go for sex, spare enough time in foreplay. You should not think actively about erection, your mind must be occupied with sexual/romantic feelings. During foreplay your partner should try to arouse you and note that your penis gets erection or not. When she feels that penis is sufficiently erect she herself should try to put erect penis in vagina gradually and you should continue your foreplay feelings without being conscious about erection. You must try to enjoy and only enjoy. Once penis is able to enter in vagina and strokes starts it is easy to complete successful sex.

If your partner is not aware about this situation you can do on your own. You just should try to do sex without being conscious about erection. Enjoy without thinking of your ability of maintaining erection and you will succeed or not.


Premature Ejaculation (PME) defined when male partner ejaculates early before the female partner reaches to orgasm. There is no absolute time by which we can diagnose PME. It is relative term and female partner is the best judge.From your history I do not think that you have PME as your penis loosen before ejaculation.If it is there let me know.

Treatment of Erectile Dysfunction(ED):

5- PDE inhibitor group of medicines like sildenafil or tadalafil are used for ED. One of them should be used 2 hours prior to sex. They cause headache, stuffy nose nausea and gastric discomfort like common side effects. Proper physical check-up of cardiac system should be done by a doctor before starting the same. These are prescription medicines and you need to consult doctor/psychiatrist/sexologist for the prescription.

You can use medicine cum vitamin supplement containing pyridoxal-5-phosphate, mecobalamin and l-methylfolate (trade name tetrafol plus)is very helpful in my patients. It has shown improvement in 50-60% patients of mine with ED. You may get this medicine over the counter as it is vitamin product.

There are some natural lifestyle measures which help to improve blood flow to penis and overall sexual performance.

- The most important factor is healthy heart. Blood is pumped in to body by heart. So regular exercise and avoidance of fatty fast food are important measures to prevent heart disease. Regular walking, swimming or running overall improves blood flow to whole body circulation including penis and keep the mind fresh.

- Good healthy food is also an important aspect. Bananas, Garlic, dry fruits(they contains vitamins), eggs, cow milk, cow butter are good food which may help in erectile dysfunction.

- Avoid smoking and alcohol. Low amount of alcohol can help in increasing blood flow but more amount can cause opposite effects. So better to avoid the same.


In CONCLUSION:

- If you have performance anxiety, try the approach as I mentioned above.

- Do not take alcohol or tobacco again.

- Take sildenafil or tadalafil after consulting doctor as it would help in intercourse and you can get your confidence back.

- No diabetes or hypertension suggest that your problem is more psychological.

- Absence of morning erection does not mean that there is physical problem always. But I recommend to go for serum testosterone level.If it comes normal and with treatment approach I mentioned if you do not feel improvement at all then only need of penile doppler.

- If you feel that you have PME you can clarify and I can suggest the treatment for the same.

Hope this answer clears your doubts, I will be happy to help further.

Regards,
Dr.Chintan Solanki.

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Brief Answer:
go for serum testosterone now

Detailed Answer:
Hi,

Thanks for follow up.

No need to consult sexologist right now but you should undergo testosterone level now.

I do not recommend any oil.
As you are likely form XXXXXXX I would like to also mention ayurvedic medicine option. Tentex forte is the medicine which is used for sex related problem. No side effects have been reported.

If I were your treating doctor I suggest one tablet of tetrafol plus after meal twice daily for two months and one tablet tentex forte daily at night with a cup of milk for 4 weeks. As well as go for other behavioral approaches I mentioned.

Take care.

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