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. So, the first and most important step in management of this problem 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.

Firstly, we need to find if there are any medical problems which could be resulting in this problem. Sometimes, a mild (grade 1) ED may be obvious only during sexual intercourse, and may not be present during masturbation or fantasizing. So, probable causes like penile blood flow problems, high cholesterol, side effects of medication, hormonal problems, vitamin deficiencies, etc. need to be ruled out. For this, you may need to undergo a few blood tests.

However, I would also like to let you know that in a large proportion of cases of erection problems, psychological factors also play a major role in aggravating the problem. Stress, anxiety, depression, relationship problems, etc. can all influence sexual functioning in a negative way.

In your case, considering your young age and considering the fact that your erection problem is situational, it is most likely due to a psychological cause. Very often, the scenario is that the when a person develops erection problems suddenly, he starts getting excessively worried and anxious about this. During the subsequent sexual experiences, this anxiety and pressure whether he will be able to get an erection or not, whether he will be able to perform well or not (called "performance anxiety") itself results in further erection problems. So, soon, this becomes a repeating cycle, thereby leaving the person distressed.

Regarding treatment, this should 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 corrected or controlled. If there are psychological factors as well, then addressing them and improving the person's self-confidence levels will also be helpful in improving sexual performance.

Through masturbation and watching porn are common and part of normal human sexual behaviour, still, in certain cases (especially in married men), it can lead to lack of arousal in real life. This is because 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.

I would advise you to see a Sexologist for a basic evaluation. If all basic investigations are fine, then you should stop worrying too much about this problem. The less you worry, the sooner will this problem get solved. You should avoid stress and practice relaxation techniques like XXXXXXX breathing, yoga, meditation, etc. Sometimes, taking some medication like Sildenafil or Tadalafil for a short period (till you get your confidence back) can help.

Also, avoid alcohol, smoking or any unnecessary medication and try to stay stress-free and positive. Eating a healthy, nutritious diet and doing regular physical exercise is also important.

Wish you all the best.

Regards,
Dr. Jonas Sundarakumar
Consultant Psychiatrist & Sexologist

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