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Erectile dysfunction during sexual activity, depression, premature ejaculation,fortnightly erection, sleep disorder, kegel exercises - Online Doctor Chats

Date : 21-Feb-2012
User rating for this question
Excellent Posted in: Erectile Dysfunction
Answered by

General & Family Physician
Practicing since : 2005
Answered : 2408 Questions
Doctor :   Hi
Doctor :   How can I help you?
User :   hi doctor
User :   did you get my request
User :   I am 29 years old , height 5 feet 7 inches , weight 77
Doctor :   I am sorry, what request are you referring to- you meant your query?
User :   yes
User :   no issues i am happy to ask again
Doctor :   Please proceed.
User :   i am suffering from erectile dysfunction which is hindering my family life
User :   i am married for 3 years
User :   its not that i do not get erection at all . i get erection on sexual stimulus but not hard enouh for pentration
Doctor :   Proceed.
User :   if i havent had any sexual activity for about a week i get some erection , but it deteriorates immediately after ejaculation
Doctor :   Since when have you noticed these symptoms?
User :   its been for over 2 years
User :   i used to get hard erections before
Doctor :   Ok
User :   and also have noctornal erections
User :   but nowadays i have problems
Doctor :   Now a days problems refers to nocturnal erections or erection during sexual activity?
User :   erection during sexual activity
Doctor :   Ok
User :   my wife is pestering me a lot and she thinks i have problems
Doctor :   Do you feel that the hairs on the pubic region/axillary are getting sparce recently?
Doctor :   Do you involve in masturbation?
User :   well not any noticable change
User :   yes i do mastrubate sometimes
Doctor :   Are you able to masturbate normally or do you find the erection is not sufficient while masturbation also?
Doctor :   Since how long have you been married?
Doctor :   Do you have children?
User :   erection is not suffcient while mastrubation
User :   married for 3 years and no children
User :   my wife had a abortion last sep during her first month of pregnancy
Doctor :   Ok
Doctor :   Do you smoke or consume alcohol?
User :   we are planning for a family now again
User :   i was smoking and drinking occasionally for 3 years before marriage
User :   but after marriage i have quit smoking and drinking completely
Doctor :   That is good. Do you have history of diabetes, high blood pressure, thyroid problems, heart problems, psychological problems in the past?
User :   no none
User :   but psycological depression
Doctor :   Are you on any pills or illicit drugs?
User :   no none as of now
Doctor :   Ok
Doctor :   Let me explain to you.
User :   i suffered from depression at the age of 17-18
User :   sure
Doctor :   Since you report that you are able to have good erections once in fortnight and since you do not have any other associated symptoms
Doctor :   I do not find any medical condition that could be causing the erection problems.
Doctor :   Having said that
User :   i get sexually aroused when looking at sexual content but erection is not occuring
User :   i do not find my wife attractive enough
Doctor :   Erectile functions are also affected due to psychological problems such as stress, anxiety, depression, energy levels, partners sexual intent and so many other psychological factors.
User :   but if find other women attractive
User :   ejaculation if fast as well
Doctor :   Now let us discuss about the problems that you have seperately.
Doctor :   1. Ejaculation happening fast.
User :   i feel my penis head heavy and its large
Doctor :   Ejaculation normally happens in 2-5 minutes in an average man.
User :   ok
Doctor :   If the ejaculation occurs earlier than 2 minutes it is referred to as premature ejaculation.
Doctor :   It is most often easily correctable.
User :   definetly not within 2 minutes
Doctor :   Ok
User :   so i think its good
Doctor :   If it is not within 2 minutes, then definitely you don't have a problem.
Doctor :   But still you could use some measures to delay this ejaculation
Doctor :   as you wish to.
User :   we havent had any sexual intercourse for past 9 months
Doctor :   The following measure will help in delaying ejaculation.
User :   i have mostly been involving in mastrubation
User :   sure
User :   but the major problem that i have now is that if i have had sex in a week i will not get enough erection for 7-10 days
User :   is that normal ?
Doctor :   1. Practice Master and Johnsons exercises during masturbation as well as sexual intercourse. The exercises named as Start and Stop exercises, where you stop sexual intercourse before you get the urge to ejaculate, wait for few minutes and then restart.
Doctor :   Let us discuss the issues one by one.
User :   sure
User :   ok
User :   sometimes its hard to stop ejaculation , but i will try
Doctor :   The exercises meant can be practiced for few weeks. This will help you to control the ejaculation better and helps in better satisfaction.
Doctor :   You need to stop just before you get the urge to ejaculate.
User :   ok
Doctor :   If you feel that you are about to ejaculate, you may also squeeze the base of the penis.
Doctor :   This will help in preventing the ejaculation better.
User :   ok
Doctor :   You will not loose the erection, since there is no ejaculation
Doctor :   and you may continue sexual intercourse for more period of time.
User :   i hear it
Doctor :   2. You can use certain local anesthetic creams such as delay cream.
Doctor :   Applying it over the penis before sexual intercourse.
User :   is it to be applied on the penis
User :   ok
Doctor :   The disadvantage of this cream is that it may reduce the sensations during sexual intercourse too.
User :   i see
Doctor :   So some people do not enjoy sexual intercourse while using the cream.
User :   ok
Doctor :   But this is also an option to delay intercourse.
User :   ok
Doctor :   3. You can increase the time of foreplay.
Doctor :   Women take a lot time to achieve climax when compared to men, so by increasing foreplay
Doctor :   you can help your partner achieve climax.
Doctor :   You could then involve in sexual intercourse leading to ejaculation.
User :   what product would you recommend
Doctor :   Thus both your partner are satisfied.
Doctor :   These 3 options are available for delaying ejaculation. You could use any of the above options.
Doctor :   My recommendation though is the first one.
User :   stop before ejaculation right
Doctor :   Right.
User :   ok
Doctor :   Now coming to the next problem.
User :   yes
Doctor :   Erection dysfunction.
User :   yes after one ejaculation it takes 7-10 days for further erection
User :   that too is not sufficient enough
Doctor :   Erection function are affected by medical problems such as diabetes, cardiovascular problems, neurological problems and endocrine problems.
Doctor :   They are also affected by psychological factors such as those explained above.
Doctor :   Now since you are able to have erections once in a fortnight, I do not feel you have any medical problems as the cause.
Doctor :   On analysing your symptoms the probable causes
Doctor :   why you are suffering from the problems are the following.
Doctor :   1. Fear of a medical problem.
User :   the fortnightly erection that i informed u about is only during mastrubation that to when i stimulate the penis b touch
User :   ok
Doctor :   Presence of erections successfully until completion of ejaculation either during any sexual activity rules out medical problems.
Doctor :   Hence it is more likely that the causes is psychological.
User :   ok i see
Doctor :   Apart from the no.1 cause that I mentioned
Doctor :   other factors that could be contributing are
Doctor :   2. Depressive symptoms
Doctor :   3. Lack of sexual interest towards your partner.
Doctor :   4. Probably stress at work
Doctor :   5. Nutrition and sleep may be contributing to the symptoms also.
Doctor :   These factors needs to be addressed first and the erection functions is expected to improve.
Doctor :   So the measures that you can follow are
Doctor :   1. Talk to your partner and discuss your problems.
User :   lack of sexual interest towards my wife is certainly a problem that i know i have , but i am not finding any was to get around that
User :   i do not find her sexually very attractive
Doctor :   Talking and discussion will solve any misunderstanding you have.
Doctor :   Beauty and attraction is in the mind.
User :   she is also very assertive and commanding in nature which turns me off
Doctor :   i do not think your partner has changed physical appearance, it is most likely
User :   she doesn't find me attractive as well
Doctor :   that what change has happened is in your mind.
Doctor :   The same applies with your partner.
Doctor :   There are no medical drugs available that can change the thoughts.
User :   i agree
Doctor :   It is possible only talks and discussion.
Doctor :   You need to spend time with each other.
Doctor :   Clear of any misunderstandings you may have.
User :   o
User :   ok
Doctor :   If you don't feel that the symptoms are solved, then there are family counselling sessions available.
Doctor :   they are both doctors and other religious agencies who provide counselling.
Doctor :   You and your partner needs to attend those sessions.
Doctor :   You will find it beneficial.
Doctor :   Are you following?
User :   yes
Doctor :   Other measures available to treat the erectile dysfunctions now are
User :   do you know of any that you could recommend so that we can consider if we need
Doctor :   Family counselling is done both by psychiatrist, psychologist, religious communities.
User :   ok
Doctor :   My suggestion is that you first spend time with your partner, talk and discuss with her.
User :   sure will follow that
Doctor :   Some of the misunderstandings and problems that you have can be resolved by self discussions.
Doctor :   If it is still not happening, then both of you can attend the counselling sessions.
User :   i have one last question
Doctor :   I do not recommend these sessions straight away because active participation from both partners
Doctor :   is essential.
User :   sure
User :   i understand
Doctor :   Hence you first need to talk to your partner and convey your intensions.
User :   got it
Doctor :   Before commenting further, another exercise therapy i recommend to treat erection dysfunctions is
Doctor :   Keegels exercises.
Doctor :   This is an exercise that helps strengthening pelvic floor muscles.
Doctor :   Strengthening these muscles helps both in erection dysfunction as well as early ejaculation.
Doctor :   The exercise is as follows.
Doctor :   While passing urine, try stopping the flow and holding the urine back.
Doctor :   The muscles that you use while trying to hold the urine are the pelvic floor muscles.
Doctor :   Repeated contractions of these musculature during urination as well as during your free time
Doctor :   lastly if all these are not improving the erections,
Doctor :   will strengthen the pelvic floor and thus stronger erections.
Doctor :   then you can opt for oral medical drugs, intrapenile testosterone injections.
Doctor :   You can also try penile vacuum pumps or penis rings.
Doctor :   They are all useful in treating erection problems.
Doctor :   Have you followed what I have suggested?
User :   yes i got that
Doctor :   Do you have any other query?
User :   my last question
Doctor :   Proceed
User :   you know that males get erections only when there is enough semen secretion in the testes
Doctor :   Erection occurs independent of testosterone hormone.
User :   or otherwise the sexual urge is created only when there is enough secretion
User :   i mean secretion of semen
Doctor :   Testosterone hormone deficiencies can affect semen production, reduced libido as well as affect erections.
User :   is that why after a ejaculation it takes 7-10 days for further erection an ejaculation ?
Doctor :   After an ejaculation, rarely men get erections immediately.
Doctor :   Average men take a 15 to 20 minutes to achieve a second erection.
Doctor :   I mean a second strong erection.
User :   this never happens for me
Doctor :   This period of is referred to as refractory period.
User :   i my case it very long 7-10 days
User :   what could i do for this ?
User :   may be not exactly 7 -10 days but atleast 2-3 days
Doctor :   Let me explain to you in simple words.
Doctor :   The refractile period normally occurs due to the time taken for the blood to fill up in the blood vessels of the penis.
Doctor :   This takes a few minutes in most men.
Doctor :   Such delayed refractile period can occur if there is diabetes, neurological problems, liver and other metabolic problems too.
Doctor :   Since you do not report of any of these medical conditions, it is unlikely that they could be impairing/increasing the refractile period.
Doctor :   You may get your blood sugar, blood pressure and urological examinations done,
Doctor :   if the suggested measures do not help in treating the erectile dysfunction.
Doctor :   Do you follow?
User :   its been years since i have done an tests for any medical conditions
User :   yes
Doctor :   Do you have any other query?
User :   any hormone tests needed ?
Doctor :   Serum testosterone levels and DHEA levels are done to look if testicular hormones are normal or not.
Doctor :   This test and other tests such as doppler scans and others are necessary if a medical cause is suspected.
Doctor :   The test are done under guidance of an urologist.
Doctor :   You may take up these test if you do not feel the behavioural modification is not helping adequately.
User :   sure
Doctor :   Do you have any other query?
User :   if you dont mind my wife has one question for you
User :   she is typing it now
Doctor :   Yes proceed with the query.
User :   This is Nithya Mrs.Arun. in th month of september 2010 i had an abortion
Doctor :   Ok
User :   since then we never had intercourse with or without protection
Doctor :   Ok
User :   doctor itself told us to have with protrection for 3 months.. so i was frustrated whether he has got any physical problem
Doctor :   Ok
User :   to be frank he is not at all intrested from the begining . for the baby conceiving also i have to request him like anthing.. he has got some unusual fear for having a baby..
Doctor :   Ok
User :   i take care of him always as he knows well.. but am expecting only motherhood from him.. he is unable to fulfill that wat u want me to do in this.. i have lot of pressure from my family abt bab y..
Doctor :   I can understand what is going through with you.
Doctor :   I have discussed these issues with Mr. Arun
Doctor :   As far as physical problems are concerned, I do not feel there are any.
Doctor :   It is probably psychological factors. Fear and anxiety.
Doctor :   It is quite possible that the abortion incident may have affected or have induced these psychological factors.
User :   what is ur advice for me.. if i ask for intercourse he is getting simply angry and says tired... if i dont he himself will never do that
Doctor :   Tiredness and fatiguabilty can be caused by improper sleep, stress factors, medical illness such as diabetes, thyroid problem, nutritional factors and so many.
Doctor :   It is difficult to predict which among these factors may be troubling him.
Doctor :   Having said that, you do not loose hope.
Doctor :   All these issues can be reversed with proper treatment.
Doctor :   After going through his problem, I feel the treatment lies in counselling sessions.
Doctor :   A family counselling session either from a psychiatrist, psychologist or any other religious organizations will benefit each other.
Doctor :   You can also get his blood checked for anemia, blood sugar and cholesterol.
Doctor :   Treatment of these conditions (if necessary) along with proper sleep and good nutrition will be very useful in treating the problem.
User :   lok doctor.ookwise we both are equal ... when he startsss talking about appearance i also have to talk thats what am also doing. am telling him to consult an doctor fror this issue.. is that required now after consulting with u... i need ur opinion
Doctor :   You need to understand that repeated
Doctor :   * repeated force from you
Doctor :   may only result in worsening of the problem.
Doctor :   The best method to handle this situation now are
User :   i understand that
Doctor :   1. Talk and discuss with him.
User :   but atleast once in a while if he has pblm i will understand and leave as i told earlier its been 9 months since last we had intercourse.. if i leave him he will take adv and sleep happily
Doctor :   I mean not talking about pregnancy.
Doctor :   You will need to understand the problem/fear why he is not wishing to have a child.
Doctor :   This is not easily offcourse.
Doctor :   But definitely be tried.
User :   then what should i do .. it is going to be 3 yrs now.. not one or 2 mnths
User :   as a girl my health and age factor also has to support me in this
Doctor :   If your discussions are not helping him, then
Doctor :   you can visit a psychiatrist for counseling sessions.
Doctor :   These counselling sessions will definitely be useful.
User :   sure
Doctor :   If they don't help,
Doctor :   then you could go for treatment such as Artificial insemination.
Doctor :   Offcourse with the consent of your husband.
Doctor :   This is an option available.
Doctor :   It is a technique where your partners semen is collected and then inserted into the uterus, cervix or the fallopian tube.
Doctor :   This is done during the time of ovulation.
Doctor :   You will be able to conceive with this procedure.
Doctor :   Do you follow?
User :   ok thank you doctor
Doctor :   Do you have any other query?
User :   as of now no other queries.. Thank you very much
Doctor :   Thanks for consulting me.
Doctor :   Bye for now.
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