Brief Answer: Need to rule out organicity with tests Detailed Answer: Hello XXXX, Welcome to XXXXXXX ! I have read your question and it appears that you have erectile dysfunction (ED) and premature ejacualtion ( PME) for some time now, also you are hypertensive. It is not very clear form the question -- 1. If you developed erectile dysfunction before premature ejaculation or after it. This is an important point in managing many patients. 2. You have also mentioned that you have reduced interest in sex from past few months, if that is due to stress or already existing sexual problem, is not clear?? Any sort of stress / tension can also lead to such sexual problem ( EDamd PME) and when managed well, these complaints disappear. However, as you have mentioned that the morning erection has also reduced compared to pervious, it is more likely due to some organic factor. You are hypertensive, but it is not mentioned if you are any medicines for the same or not? In my clinical practice, I frequently see that such patients having comorbid hypertension or diabetes; which either is not treated at all or partially managed. And when these are treated well, ones sexual problem is solved to a great extent. So, I would advice you to go for proper blood checkup- sugar levels, blood pressure readings, and cholesterol levels & thyroid levels done. When there is erection problem, many times it is due to due to blocked blood vessels of penis, so, it helps to evaluate their status early in the course of mangment. This is done by getting a penile Doppler study ( it is a sort of ultrasound of penile vessels). Second test - is the invasive test , in which a drug is injected and the extent of erection is noticed. But, the above measure is better for you as you are hypertensive. The medication should be given only after getting the tests. if the Doppler study, blood pressure controlled and blood test are ok, then I have seen excellent results with medicines like: paroxetine, with or without dapoxetine in cases like yours. So, I would advice you to get your self investigated properly and start treatment . Hope the reply is useful for you, wish you good health! Dr. Manisha Gopal MD psychiatry

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Brief Answer: Reports are fine, do you have stress? Detailed Answer: I have read the follow up question, it reflects that you are on regular treatment for hypertension and your test done two months back were normal. As the reports are recent ones, we can rely on them now also, so you donot need to get them again. the SGPT is high, can be related to medicine, or may be alcohol ( if you take it; however, it is within normal range , as we treat SGOT / SGPT only when it reaches 4 times more than normal.). You have not written anything regarding your mood/ why do you feel less interest in sex now a days? Is it due to sexual problem or any other reason? As all these symptoms you are having can be related to stress, as mentioned in previous answer. The normal blood test and mild hypertension, reflect / indicate more possibility of psychological problem behind this. however, before confirming and anything and moving on to drugs, one must get penile Doppler study. This will at least tell you objectively that organ blood vessels are in normal condition, which should not be neglected at all. Moreso, when you say that the morning erections have also reduced. As mentioned before, the psychological sexual dysfunctions are completely manageable. Hope the reply is useful Please provide some information regarding any stress if you have, so that one can move in the direction of final management. Wish you good luck! Dr. Manisha Gopal MD psychiatry

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Brief Answer: Looks like organicity behind this, get tests Detailed Answer: From the reply- it is quite clear that there is no apparent stress, anxiety and sadness which is behind these symptoms. you have only on and off some problems with situations, which any normal living man does have, it is fine. You say - you think deeply, but till you or your family does not have issues with it, we take it to be normal. you had good results with Manforce tablets, which is sildenafil., it increases the blood flow and helps in erection. You also asked about royal gold tablets, I think they are herbal. I have not seen anyone having any bad reaction to them, you have to see if they suit you. now, when almost all psychological issues are ruled out, then we really need to see for organicity. Moreover, I remember you writing that even morning erections are been effected! this is usually seen. when there is some other cause related. So, it will be better that we get the penile Doppler done. You are very right in mentioning that one should not goon using sildenafil as and when needed basis without getting to the root of the problem. Sildenafil usually gives good result in erection problem and paroxetine with PME, but we must check what is causing it. Sildenafil when used continuously may lead to certain disturbing side effects. You are young, in 40's, so, it is too early for you to develop erection problem, so, I would advice you not to ignore it or for using sildenafil for long. Please get the desired tests done. Hope the reply is useful. feel free to ask more questions for clarification, if you are satisfied, please rate the answer. Dr. Manisha Gopal

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