Hello XXXXXXX,

Thanks for writing to us. I am trying to give answer according to your query.

According to your history, your partner is unable to initiate/ maintain erection of penis (called erectile dysfunction) on 2nd time intimacy despite of your desire for sex.

Here, I can tell you one thing that as he penetrated in your vagina little bit at first time sex, then possible causes of erectile dysfunction on 2nd time is mostly due to psychological problem like stress/ anxiety/ nervousness (that you already mention) and low possibility with any type of underlying organic disease. Though it is quite common in some men for first/ second time sex, it needs a definite investigation.

There are several reasons of erectile dysfunction besides psychological factor and needs to be ruled out like Hypogonadism, Smoking/alcohol, Some drugs, Prostate Hypertrophy/Prostatitis, Varicocele/hydrocele, Arthritis or Autoimmune disorder, High BP, Diabetes, Thyroid problem, Neurological causes etc. In addition, thinking of premature ejaculation may temporarily cause erectile dysfunction.

In that respect, a complete clinical examination is needed by urologist/sexologist to confirm diagnosis. Some initial investigation like blood for testosterone level, blood sugar, thyroid profile, ultrasound of scrotum may be needed. Therefore, please consult with any one of them who can help him in guidance through tests and suggestive measures if required.

Do some initial things which are quite helpful like close discussion about his/ your problem, give assurance & support which are much needed, try to relief his stress/ anxiety by more talk & traveling outside or some place for short period, give time more on foreplay and prefer to sex in complete relaxed way, may arrange bed/ light to elevate mood level etc.

Some life style modification & measures may be needed for your partner to control erectile dysfunction in future. These includes:

1) Quit smoking & alcohol if he has the habit. He may need a simple psychotherapy.
2) Decrease frequency of masturbation if he does. It may cause thinking of premature ejaculation at the time of intimacy.
3) Take healthy diet with Vitamin D & calcium supplements, do physical exercise regularly and maintain personal hygiene.
4) Do regular XXXXXXX breathing/ yoga to avoid stress/ psychological upset/depression.
5) Using Intracavernous Therapy with injecting vasodilator substance to control premature ejaculation & maintain erection (in extreme cases)
6) Drug like Sildenafil may be helpful in treating erectile dysfunction. It is short acting & should be taken 1/2 to 1 hr before actual sex. Discuss with his doctor.
7) May need Testosterone Depot Inj / Androgenic drug to increase testosterone level.
8) Need proper sleeping, avoid hot working place and tight underwear.

Now in your case, a high blood level of prolactin often causes low estrogen with anovulatory cycle and a decrease in period. It may causes amenorrhoea or irregular period. In non pregnant state, breast milk may be secreted. Some women may experience a loss of libido (interest in sex). Intercourse may become painful due to vaginal dryness.

Here, you should continue above prescribed medication as per your doctor's recommendation to regularize period and enhance libido. You should take healthy diet with more vegetables/ fruits, drink more water, do light exercise, avoid stress/ emotional upset, maintain genital hygiene properly & need adequate sleeping.

I think that above said information are very much helpful to you. If you have any further questions I will be happy to help.

Wish your good health & take care yourself.

Regards,
Dr Soumen.

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Hello XXXXXXX,

Thanks for follow up query. I am happy to help you.

First time sexual intercourse is always painful in most of the couples. Vaginal dryness or narrow/ tight vagina are associated factor. In the initial stage, using water based lubricant is quite helpful for smooth penetration.

Men may ejaculate without complete penetration and it varies in different circumstances like he wants to avoid unwanted pregnancy by ejaculation outside the vagina or he has premature ejaculation that occurs soon after/ before complete penetration or he likes to ejaculate on other body parts other than vagina etc.

In this scenario, I can suggest that both of you first follow all above said measures for at least 3 months to improve quality of life. And if you do not get any result or improvement, then you need to consult with urologist/ sexologist to rule out underlying causative factor that I describe earlier and need proper treatment accordingly.

If you do not have any clarifications, you can close the discussion and rate the answer.

Be well & stay healthy.

Regards,
Dr Soumen

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Hello XXXXXXX,

Thanks again for your relevant query.

No, you should not avoid sex but you do it in regular interval.

In earlier reply, I want to mean that both of you should follow my suggestive measures (means you must obey my advice for initial things/ life style modification) for at least 3 months that I already describe in the last portion of my first answer. Those are very much helpful to control erectile dysfunction for your partner or increase libido for yourself. Also you should continue prescribed medication.

After completion of 3 months, if your partner faces same problem like erectile dysfunction or your libido decreases with other associated factors, then you need to consult with urologist/ sexologist for proper investigation & treatment.

I think that I am able to clear your confusion. If you do not have other query, you can close the discussion and give me a feedback.

Regards,
Dr Soumen

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Hello XXXXXXX,

Thanks for your query. I am happy to help you.

Thyroid disorder or hypothyroid state may cause low libido or decreased sex drive in women. High prolactin level is also another factor. So you continue both thyroid medication & dastinex pills once a week (as you mentioned) according to your doctor's recommendation to enhance libido or treat sexual dysfunction.

In addition, you should improve quality of life to increase libido by the means of taking healthy diet with more vegetables/ fruits, Vitamin-E supplements, drink more water, do light exercise regularly, avoid stress/ emotional upset, maintain genital hygiene properly, use water based lubricant during intimacy & need adequate sleeping.

Hope this will be very much helpful to you. You can close the discussion & rate the answer.

Be well & take care yourself.

Regards,
Dr Soumen.

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