Brief Answer: Advised detailed evaluation to find out the cause. Detailed Answer: Hello and welcome to Healthcare Magic. I can understand that you have been going through a lot of distress due to your sexual problem. Your sexual problem with erection is the actually the most common sexual problem in men. Now, there can be a variety of causes for this problem - 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. This is both informative to the doctor and serves as an opportunity to educate the patient and clarify his doubts. 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 your young age, it is unlikely that you may be having a major medical cause for your erection problem. Also, if you are able to have good erections during sleep, then again, this indicates that there is no major medical cause. 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. Treatment is 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 removing the person's doubts and fears, and improving his self-confidence levels will also definitely help in improving sexual performance. Also, there are certain medication which improve the blood flow to the penis and promote better erection, such as Sildenafil, Vardenafil and Tadalafil. But medication is usually advised only in severe cases. So, I would advise you to consult a psychiatrist or a sexologist in person to have a detailed assessment and evaluation done. Also, avoid alcohol, smoking or any unnecessary medication and try to stay stress-free and positive. Wish you all the best. Regards, Dr. Jonas Sundarakumar Consultant Psychiatrist & Sexologist

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