Hi XXXXXXX

Thanks for the query.

It seems that you have difficulty achieving an erection hard enough to enable you to have a satisfactory sexual intercourse. It is important to examine this situation for possible causes of the weak erections. This condition is also referred to as Erectile Dysfunction.

First of all, it is important to rule out any medical conditions that might lead to weakening of the erections. Some of the commonest medical conditions that lead to weak erections are Diabetes Mellitus, addictions (alcohol, drugs, smoking) and some medicines. There could also be some heart related conditions involved. You may have to check into these and rule them out. For this purpose, you will have to consult a Physician.

You may also have to look into the male hormone, Testosterone. A deficiency of this hormone can contribute to erectile dysfunction.

Probably one of the most important causes for erectile dysfunction other than the medical ones, is anxiety. Performance anxiety can be detrimental to achieving and maintaining a strong enough erection. If you do not have a problem achieving and maintaining a harder erection while masturbating alone, you can consider anxiety as a highly probable cause for the weak erections. Another way to assess the role of anxiety is to observe early morning erections. Early morning erections are more likely to be normal if no medical condition is involved.

From the description you have provided, it seems that you may have to consider anxiety as a possible cause, get yourself assessed for any hormonal imbalances and try a few techniques that might help improve the performance.

After consulting with a physician, you can try medicines that enhance erections. Some of the well known medicines are Tadalafil, Vardenafil and Sildenafil. Please consult with you doctor for the dosage prescription. It is important to rule out any medical condition, especially any heart condition, before you can try one of these. Long term use of these medicines is not recommended, though.

You may need to find out if you do in fact have anxiety about the intercourse. A mental health professional (psychiatrist/psychologist) can help you figure out anxiety producing thoughts and how to deal with them.

A few reports mention position during intercourse as a significant factor. With more movements of lower back, erection may be lost quicker than needed. You can try the more passive position, lying on your back.

These following measures might be helpful to you:
1. Lifestyle changes might help you. If you smoke, are overweight, under stress, etc. you may have to deal with those situations.
2. Regular physical exercise helps maintain a good erection, as it helps the blood circulation better.
3. I would like to mention that you should not allow excessive guilt or shame to affect your confidence and future efforts.

I hope this was helpful to you. You may write to me again if you have any more questions regarding your current problem.

Take care.

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Dear XXXXXXX

You can consult an Physician or an Endocrinilogist for Testosterone assay. Lower than normal levels of Testosterone can contribute to erectile dysfunction.

A tight foreskin which does not retract on erection, or is too tight, can actually affect the quality of the erection. You can consult a surgeon regarding this problem. This condition also makes penetration difficult.

You may also have your partner get herself examined for any problems with the vaginal opening. She may need to make sure she doesn't have an intact or a thick hymen. This can prevent successful penetration.

If you haven't already used it, generous use of lubricants do solve the problem often.

There are studies that report a benefit with Arginine and there are studies which report it is no more beneficial than placebo. For the lack of a conclusive evidece, I cannot suggest you the use of arginine, but you can certainly give it a try.

I hope this helps a bit. Let me know if you have more queries to discuss.

Take care.

Abhijeet Deshmukh, MD

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