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Having erectile dysfunction and inadequate sexual desire. Taking tadafil. Looking for proper cure

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Practicing since : 2003
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I am 34 years married male. I am engineer by profession. I am having problem in maintaining a healthy sex life with my partner. We got married last year. I am able to perform sex with my wife after taking tadafil (10mg) with a success rate of 50% (initially advised by urologist). But, on other half occassions I am not able to sustain my errection. Due to this, my sexual desire has also gone very low. I have got furstrated over this and even my partner is frustrated. We have fights over this as she now no longer wants a failure. I also want to mention that i was diagnosed with urethra stricture approx two years back and i got it operated through endoscopy. But, after two months of it, it re-appeared. Although my urologist mentioned that urethra stricture has nothing to do with erectile dysfunction, but I want a reconfirmation on that as well. Also, over the last two years, I feel my size of penis (when contracted) is going small and muscles are becoming weak. It is barely 2 inches now. I also feel embarassed due to that in front of my partner. Can you please help me with my problem and suggest so that I can sustain errections ?

Also want to mention that this is my second marriage. In my first marriage, I was not able to have sex all together. I use to prematurely ejaculate and never penetrated. Before my second marriage, I consulted one sexologist, who provided me some home-made medicines and i felt good after it. But, then after getting married (in 2 months) problem re-appeared.
Posted Sun, 10 Mar 2013 in Men Sexual Problems
Answered by Dr. Jonas Sundarakumar 3 hours later
Hello and welcome to Healthcare Magic. Thanks for your query.

I can understand that you have been going through a lot of distress due to your sexual problem. From your description of your symptoms, I can see that you are having two problems:
1) Erectile dysfunction
2) Inadequate sexual desire

Now, there can be a variety of causes for your sexual problems - both medical causes as well as psychological causes. So, the first and most important step in management 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, 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. In your case, since this your problems seem to be quite prominent and long-standing (you mentioned that you had major sexual problems even during your first marriage). So, in my opinion, first diagnosing the problem is more important, so that treatment can be targetted specifically.

I would advise you to have the following tests:
1) Basic blood tests - including lipid profile (cholesterol), blood sugar, urea, creatinine, etc.
2) Testosterone levels - total and free testosterone
3) FSH / LH levels
4) Thyroid function tests
5) Ultrasound doppler of the penis (to check for any blood flow problems)

These tests will give you a clear picture what your sexual problem is due to - any hormonal problems or any other systemic problems or local problems in the penis. According to the diagnosis, further treatment can be planned.

Having said this, I would also like to let you know that in more than 80% of cases of erectile dysfunction, psychological factors also play a major role in causing or aggravating the problem. Stress, anxiety, fears and doubts regarding sexual performance, feelings of sexual inadequacy, self-doubts, guilt, past negative sexual experiences, etc. can all affect sexual functioning and performance.

Often, persons who have had past negative experiences with sex develop what is known as a "performance anxiety". Basically the subconscious fears and doubts whether or not he will be able to perform well itself results in anxiety, and this performance anxiety itself then causes erectile dysfunction. In this case, counselling of the person as well as counselling of the couple will help in removing the person's doubts and fears, and improving his self-confidence levels.

So, I would advise you to have all the tests done and then consult a psychiatrist or a sexologist in person to have a systematic evaluation and sexual counselling. Don't worry, there are many options available to treat your problem. If there is a low testosterone level, the testosterone supplements will help. If the FSH / LH levels are low (indicating more of a sexual desire problem) then there are certain medication - dopaminergic anti-depressants - which can be helpful in boosting sexual desire.

Don't worry about the urethral stricture - if it is not causing any pain during erection, then this is not the cause of your sexual problems.

Wish you all the best.

Dr. Jonas Sundarakumar
Consultant Psychiatrist & Sexologist
Above answer was peer-reviewed by
Follow-up: Having erectile dysfunction and inadequate sexual desire. Taking tadafil. Looking for proper cure 4 days later
Based on the advise, I have got all the tests done and have uploaded the report on this site. Could you please analyse and let me know my problem.
Answered by Dr. Jonas Sundarakumar 23 hours later
Hello again,

I have reviewed your blood test reports. Among them, your lipid profile is slightly deranged and may require further treatment and diet control. Your testosterone levels (free and total) are in the lower part of the normal range. But since your FSH and LH levels are normal, this may not require definitive intervention right now.

Since a low sex drive seems to be the predominent problem in your case, you may benefit from a trial dopaminergic anti-depressants like Bupropion. For the erectile dysfunction, you can try Tadalafil, which promotes erection by increasing the blood flow to the penis. In addition, I feel that you will definitely benefit from sexual counselling by a psychiatrist, so that you will be able to get rid of any negative thoughts, anxiety and self doubt, and improve you confidence level. Practising yoga, regular physical exercise and relaxation techniques can also be helpful in improving your overall sexual performance.

Wish you all the best.

Dr. Jonas Sundarakumar
Consultant Psychiatrist & Sexologist
Above answer was peer-reviewed by
Follow-up: Having erectile dysfunction and inadequate sexual desire. Taking tadafil. Looking for proper cure 1 hour later
Which specialist doctors should i XXXXXXX for this who can provide me prescription on medicines ? Should i visit endocrinologist ? Or should i XXXXXXX urologist ?

Second, does anti-depressants (like bupropion) and Tadafil have any negative impact on testosterone levels ? Will it help increase it ? What are the different ways I can increase my testosterone levels (any medicine) ?
Answered by Dr. Jonas Sundarakumar 18 hours later
I think it would be better to XXXXXXX a psychiatrist, specialized in sexology. This is because he will be able to prescribe the medication as well as give you sexual counselling. Bupropion and Tadalafil definitely don't have a negative impact on testosterone levels.

Regarding the testosterole levels, there are medication / supplements which can be used, but in your case, since the levels are just borderline, you can try the other medication first and then consider that option.

Best wishes,
Dr. Jonas Sundarakumar
Consultant Psychiatrist & Sexologist
Above answer was peer-reviewed by
Follow-up: Having erectile dysfunction and inadequate sexual desire. Taking tadafil. Looking for proper cure 6 hours later
Besides the medication, are there any natural ways to boost the testosterone levels from the levels I have ? I read on some of the sites that diet and exercise plays a important role towards it. Can you suggest some changes in diet plan which can help increase T levels ?

Also, in your previous response you recommended Bupropion which will benefit me against low sexual desire. When and how much of it has to be consumed ? Is it on need basis or can i take it on regular basis ? Does it have any side effects ?
Answered by Dr. Jonas Sundarakumar 17 hours later

Yes, diet, exercise and lifestyle modifications can help balancing testosterone levels and improve sex drive. There are many claims for "natural" supplements of testosterone precursors and amino acids to boost testosterone production, but these are hardly natural and many have been reported to have long term side effects. So, the safest way is to try dietary modifications and exercise.

- If you are more than your ideal weight, then plan a weight loss regimen
- Cut down on carbohydrates, especially starch and direct sugars
- Take a protein-rich diet
- Modify your fat consumption to healthy fats like olive oil, almonds, fish liver oil
- Certain minerals (like Zinc) and certain vitamins (like Vit. C, D) are important for hormone production, so beans, sprouts, cheese, yoghurt, etc. have to be included more in your diet

Weight training exercises in a proper regimen can prevent declining levels of testosterone.

Avoid alcohol, smoking as they have an adverse impact on testosterone levels.

Bupropion has to be taken on a daily, regular basis. It is better to start at a low dose first, 75mg, and then increase it gradually, if necessary. Like every medication, Bupropion can cause some side effects in a few people, but they are usuaaly mild and self-limiting. It's very unlikely that you would experience any significant side effects on a 75 mg dose.

Best wishes.
Above answer was peer-reviewed by
Follow-up: Having erectile dysfunction and inadequate sexual desire. Taking tadafil. Looking for proper cure 2 days later
I had taken appointment with Endocrinologist so I met him over weekend. After analyzing my case, he has asked me to reconfirm TESTOSTERONE level with another blood test one month later. And, in meantime, he has advised me to take the following two tablets for one month (one tablet each day after dinner)

1. Ignitor tablet
2. Rozavel tablet

Do you agree with him ? What is your opinion on the same.
Answered by Dr. Jonas Sundarakumar 18 hours later
Hello again,

I do agree with your endocrinologists line of thinking and management.

Like I had mentioned earlier, though your testosterone levels are on the lower side, it is still not below the normal range, to necessitate testosterone replacement right away. So, it would be a good idea to recheck the testosterone levels before taking a call on further treatment.

Ignitor is a supplement with minerals (like Zinc, Magnesium), vitamins (vitamin B6) and fenugreek extracts. The fenugreek extracts are claimed to contain chemicals which facilitate hormone production. It is a safe medication and is worth trying.

Rozavel (Rosuvastatin) is a cholesterol-lowering medication. Your blood test reports showed elevated cholesterol levels, and as I had mentioned earlier, this is one of the medical causes contributing to erectile dysfunction. So, yes, I think this medication is appropriate in your case.

Dr. Jonas Sundarakumar
Consultant Psychiatrist & Sexologist
Above answer was peer-reviewed by
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