Brief Answer: Follow below steps. Detailed Answer: Hello, Thanks for your query. I appreciate your efforts for medical consultation in so much distress. Important aspects of your query are: • 36 year old male • Known case of sexual anxiety • Complaints of: erectile dysfunction in front of female with heavy breathing. In treatment Erectile dysfunction (ED) first step is to identify cause of the problem. Erectile dysfunction can be a result of a psychological or physical problem. Psychological causes: Most common cause in young patients. These include performance anxiety, emotional weakness, inferiority complex, stress, marital or relationship problems, low mood, feelings of guilt, and the effects of a past sexual and emotional trauma. Men with psychological problem usually have normal nocturnal erections and erections upon awakening, whereas men with physical problem often do not (like in your case). Physical causes: Include neurological disorders, alcoholism, smoking, hormonal imbalances, diabetes, hypertension, blood vessel disease and chronic diseases. What I can understand from your query is that you are not able to sustain hard erection which is required for intercourse due to anxiety. You are 36 years of age and at this age, any difficulty in getting or maintain an erection is due to psychological reasons in most of the cases. I hope you are not taking any alcohol or smoking as sometimes these can also cause erectile dysfunction. I will describe some simple measures which you can incorporate and these should help you: -First of all, quit smoking and alcohol (if you are taking any) -Stop worrying excessively. -Eat a healthy diet rich in vitamins, minerals and antioxidants: fruits, milk and eggs -Have faith in yourself and do not take any stress. You can talk to your partner openly and indulge in plenty of foreplay before sex. As you will worry, your problem will increase further. You can also plan to some short vacation for honeymoon, which will relieve your stress. -Exercise, particularly aerobic exercise (like: Jogging, skipping and cycling) daily. It will increase blood flow all over body and will reduce stress. -The commonly prescribed drug by the doctors is sildenafil (Viagra) or Tadalafil (Megalis), which causes erections to be stronger and long lasting, but should be taken after prescription. It is important to rule out medical conditions specially related to cardiovascular system before starting such treatment. Both of these medicines have excellent result in physical causes of erectile dysfunction. There is also need to rule out certain medical conditions which can affect erection. These include diabetes, high blood pressure, heart or thyroid conditions, poor circulation, penile venous incompetency and neurological causes. For that comprehensive evaluation and tests, help of other specialist may also needed. First follow steps mentioned by me for 1 month, if there is no change, it is better to get evaluated and investigated by physician and psychiatrist to rule out above conditions. There is need for treatment for sexual anxiety, if symptoms cause significant personal distress or affect personal/professional life like in your case. Both drug and non drug treatment like cognitive behaviour therapy (form of psychotherapy) are used for treatment. Choice of treatment depends on severity of symptoms, personal preference and availability of treatment. In drug treatment two types of medicine used. For immediate relief of anxiety benzodiazepines group of medicines are used and for long term relief most commonly SSRI (selective serotonin reuptake inhibitors) are used. SSRI takes around 3-4 weeks to show its effect. Non drug treatment like cognitive behaviour therapy (form of psychotherapy) also takes weeks to show its effect. All these medicines are prescription medicine and given after in person examination by psychiatrist. I hope this information has been both informative and helpful for you. In case of any doubt, I will be available for follow ups. Wish you good health. Regards,

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Brief Answer: Hi Detailed Answer: Hello XXXXXXX Thanks for follow up. For me also your case is more of psychological ED. In planning treatment for ED, we need to focus on all possible causes of ED for treatment specially diabetes, hypertension and hormonal imbalance, as medical issues exacerbate anxiety. It is good that you are non addicted on substances and physically active. It is better to follow other steps also as mentioned in primary reply. Viagra is helpful primary in physical causes of ED. But it is also helpful in 20-30% cases of psychological ED, by boosting their confidence (which happen after seeing strong erection). For treatment of sexual anxiety: Both drug and non drug treatment like cognitive behaviour therapy (form of psychotherapy) are used for treatment. Choice of treatment depends on severity of symptoms, personal preference and availability of treatment. In drug treatment two types of medicine used. For immediate relief of anxiety benzodiazepines group of medicines are used and for long term relief most commonly SSRI (selective serotonin reuptake inhibitors) are used. SSRI takes around 3-4 weeks to show its effect. Non drug treatment like cognitive behaviour therapy (form of psychotherapy) also takes weeks to show its effect. All these medicines are prescription medicine and given after in person examination by psychiatrist. Please accept my answer in case there are no further queries and recommend our services to your friends too if you have found it helpful. Wish you good health. Regards

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