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

Erection problems can be due to various causes - both medical causes as well as psychological causes. In such a situation as yours, the first and most important step in the management of your erection problem is a thorough evaluation. This will include a detailed medical, sexual, personal and social history, a thorough physical examination and certain investigations, as per the necessity.

Firstly, any medical causes (like diabetes, hormonal problems, blood flow problems, vitamin deficiencies, etc.) need to be ruled out. For this, you may need to undergo a few blood tests. But, considering the fact that you are able to have normal erections during masturbation, it may be unlikely that there is major medical cause for your erectile dysfunction.

I would also like to let you know that in more than 80% of all cases of erectile dysfunction, psychological factors also play a major role in causing or aggravating the problem. Moreover, in almost all cases of "situational" erectile dysfunction, psychological factors are always involved. Stress, anxiety, fears and doubts regarding sexual performance, relationship issues, feelings of sexual inadequacy, guilt, past negative sexual experiences, etc. can all affect sexual functioning and performance.

Now, coming to the treatment part, this has to be 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 the problem is more psychological, then alleviating the person's anxiety and fears, and addressing any other specific emotional issues will definitely help in improving sexual performance.

You have mentioned that you have tried medication like Viagra and Cialis unsuccessfully. If these medication have not made any difference at all, then I'm not sure whether Caverject would work for you, since all these medication have almost a similar action - increasing the blood fow to the penis. So, in my opinion, it would be worthwhile to consult a psychiatrist or a sexologist to have a detailed assessment and evaluation done before trying any other treatment options.

Wish you all the best.

Regards,
Dr. Jonas Sundarakumar
Consultant Psychiatrist & Sexologist

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You're welcome. Take care...

Regards,
Dr. Jonas Sundarakumar
Consultant Psychiatrist & Sexologist

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Hello again,

Though pornography and masturbation do not have a direct effect of causing erectile dysfunction, still, it is quite possible that these practices could be resulting in a lack of proper sexual arousal in real life.

Like I had mentioned before, your problem with erection appears to be psychological, since, you are able to have and sustain normal erections during masturbation. Sometimes, when the mind gets tuned to a different mode of sexual arousal through pornography and sexual fantasies, it may result in problems with sexual arousal through normal means. So, I feel that it would be worthwhile trying to abstain from pornography and masturbation, and to "re-orient" your sexual arousal to practical ways with your partner.

If you do seek professional help, then it sure is a better idea to include your partner on your visit, because therapy will often include both partners.

Best wishes,

Dr. Jonas Sundarakumar
Consultant Psychiatrist & Sexologist

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