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Suffering from erectile dysfunction and premature ejaculation. Which specialist should i need to consult?

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Practicing since : 2004
Answered : 1835 Questions
I am 26 years old and have following symptoms

(1) A morbid preoccupation with the loss of semen
(2) Sexual dysfunction or perceived dysfunction – erectile dysfunction and premature ejaculation.
(3) Unhappiness about the size or the shape of his penis. A conviction that his penis is shrinking.
(4) Fatigue, lassitude, tiredness, weakness, anxiety, depression and classically guilt about masturbation.
(5) Worry about future potency, fertility and an ability to father children.
(6) A preoccupation with pre-ejaculation discharge.
(7) An attitude of helplessness and dependency.

i heard that these symptoms are Dhat Syndrome via net. but no one have discussed about Dhat Syndrome in Television shows by doctors ?

Should i need to consult physiatrist or sexologist or Urologist?
Posted Tue, 31 Jul 2012 in Mental Health
Answered by Dr. Ashish Mittal 13 hours later
Thanks for your query.

It is nice to see such a nice and precise description of your current suffering.

Sexual dysfunctions can be a result of a psychological or physical problem.

Psychological causes: Most common cause in young patients. These include performance anxiety, emotional weakness, inferiority complex, stress, marital or relationship problems, low mood, feelings of guilt, and the effects of a past sexual and emotional trauma. Men with psychological problem usually have normal nocturnal erections and erections upon awakening, whereas men with physical problem often do not.

Physical causes: Include neurological disorders, alcoholism, drug abuse, hormonal imbalances, diabetes, hypertension, blood vessel disease and chronic diseases.

Regarding Masturbation: Masturbation is not harmful for health and more than 80% man and woman masturbate in some point of the time. In present situation if you are not masturbating more than 3-4 times per week than there is no problem. If you are masturbating more even then it is not harmful but it is better to decrease the frequency of it.

Weakness after masturbation usually last for 1 hr but if masturbation is associated with guilt of masturbation then it can last longer because of psychological reasons.

Even past history of excessive masturbating does not affect patient condition, but if you have guilt then it can increase your worry and anxiety.

As most common reasons for sexual problems in young population are psychological, so psychiatrist is best person to treat these problems. Apart from that Endocrinologist (for hormonal imbalance), Urosurgeon (for structural defect), Dermatologist (for skin problems in genital area and sexually transmitted disease) and Gynaecologist (for infertility related issues) also treat these patients and appropriate referral should taken in presence of such problems. But patient should avoid non medical persons (quacks) for treatment.

With this background from your detail history, it is clear that you have following symptoms:

•     Low mood, anxiety
•     Loss of interest in previous pleasurable activities (anhedonia)
•     Tiredness, fatigue
•     Loss of confidence
•     Ideas of hopelessness, worthlessness, guilt of masturbation
•     Excessive worry related to: perceived dysfunction of erection, early ejaculation, shrinking penis, loss of semen, potency and fertility

All these are symptoms of depression and need attention.

Depression is not always situational (because of stress). Many times it is biological due to biochemical changes in brain. Such Depression does not improve by exercise or guidance or lifestyle modifications only but all these measures help in recovery with medicines. Your depression appears to biological to me due to its severity.

Depression occur due to neurotransmitters imbalance in brain most commonly involving serotonin neurotransmitter. You need treatment with psychiatrist urgently to treat your depression.

In drug treatment two types of medicine used. For immediate relief of anxiety symptoms benzodiazepines group of medicines are used and for long term relief most commonly SSRI (selective serotonin reuptake inhibitors) are used. SSRI takes around 3-4 weeks to show its effect. Non drug treatment like cognitive behaviour therapy (form of psychotherapy) also takes weeks to show its effect.

All these process is complex. I have just simplified it to make you understand it. We can not write drug name directly because of ethical reasons and treatment is highly individualized.

Apart from above advice following simple measures will help you slightly:
-Decrease worrying about symptoms as they will cure after treatment.
-Healthy diet: Milk and fruits in diet.
-Daily morning walk and breathing exercise.

In last for treatment first visit psychiatrist and later you can visit other specialist according to his advice.

I hope this information has been both informative and helpful for you. In case of any doubt, I will be available for follow ups.

Wish you good health.
Above answer was peer-reviewed by
Follow-up: Suffering from erectile dysfunction and premature ejaculation. Which specialist should i need to consult? 2 days later
Thanks Doctor for your very descriptive explanation

i have below query
1) how long it will take depression to be cured completely?
2) what is difference SSRI and CBT treatment? will SSRI have side effect?
3) what is DHAT syndrome ? is it different from Depression?
Answered by Dr. Ashish Mittal 11 hours later
Hello again,

Thanks for follow up,

1) how long it will take depression to be cured completely?
Ans: Duration vary patient to patient. After initiation of treatment averagely it take 1-2 month for improvement.

2) what is difference SSRI and CBT treatment? will SSRI have side effect?
Ans: SSRI is medicinal treatment and CBT is a method of counseling.

3) what is DHAT syndrome ? is it different from Depression?
Ans: It is excessive concern for penile secretions.

Wish you good health.
Above answer was peer-reviewed by
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