Hi,
Thank you for writing in.

The problem faced by you is commonly seen in men who are newly married and are unable to achieve total penile erection. The result is inability to enjoy penetrative sex, leaving both partners frustrated and unsatisfied.

You have written that before marriage you could get full erection through masturbation. However post marriage, there is little hardness during foreplay and that also disappears by the time both of you are ready for penetrative sex.

With these features, it seems like you have performance anxiety for not getting proper erection. This is because you have achieved erection during masturbation earlier in your life. If in doubt, erection is tested by injecting medicine into the penis and doing ultrasound to study the blood flow in the penis. This is known as penile Doppler and done by a radiologist.

However if you feel that you have any of the underlying medical conditions, please get evaluated by a physician as well.

Some of the medical causes causing erectile dysfunction are:
Problems with blood supply to your penis.
Diseases like diabetes, kidney problems, stroke and trauma.
Hormonal problems.
People who take certain medications for hypertension, stroke, heart diseases, thyroid diseases.

I will discuss in detail the psychogenic causes of performance anxiety and how to deal with it.
The solution lies in trying to control the anticipation of the need to perform well during sexual activity, that which is causing an amount of stress in you.

There are different sex therapies available to help you achieve it. If you were my patient, I will do your complete psychological evaluation and also would like to bring your partner and talk on the matter openly with both of you. This is known as couple therapy.

Evaluation will be in detail to find out the exact psychological cause and if any situations occurring prior to or after sexual intercourse is related to the problem.
This is followed by counselling both you and your wife on mutually co operating and getting educated on normal human sexual behavior.

You must be mentally relaxed and your partner will be taught how to co operate and help you out. Fore play can be extended till such time that full erection is achieved. You will also be taught about the benefits of mutual sexual satisfaction and benefits attached to it.

I would suggest both you and your partner to consult a qualified psychiatrist who could help you out by a scientific approach to your problem.

Talking about medicines, you must not start medication for your performance anxiety until you have tried sex therapy and couple therapy. Reason being you dont have any underlying physical disease and psychological motivation will surely benefit you.

Hope this helps,

Dr A. Rao Kavoor

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Hi,

Thank you for writing back to us,

The new information you gave points more towards the presence of a psychological basis for the difficulty in erection.

As i already have mentioned about sex therapy, it is likely to be very beneficial in your case. I cannot replace a therapist on this forum, but i can brief you up on what to expect when you visit a therapist.

Firstly, a detailed evaluation is done of all the causes responsible for the problem specifically in your case. Every patient has a varied list of causes and the treatment varies accordingly. In the evaluation, factors that caused this problem and all the factors that are maintaining this problem are identified. For eg. there are many causes that can precipitate sexual dysfunction in a person like- discord in the general couple relationship, a random failure, dysfunction in partner, depression or anxiety disorders, traumatic sexual experience etc. Example of factors that can be maintaining a problem in a person may be - performance anxiety, fear of failure of erection, partner demands, poor communication, inadequate sexual information, restricted foreplay, drug or alcohol intake etc.
There are usually more than one factors that are responsible for the problem. Until they are all identified the problem cannot be solved.

Once that is done, next is the intervention per se, you will be asked to follow instructions, in a graded fashion. Beginning from small steps to longer sequence of events. Like starting from a non-genital focus moving on to a genital focus and finally intercourse, step by step. Trying to jump to the last step is what patients tend to do and this causes more anxiety and anticipation of failure which in turn leads to worse performance the next time.

So i hope you now understand the importance of seeing a therapist in person. Sessions are taken in a structured way.

I could give you a general tip, try and focus your attention on pleasurable sensations (with co-operation from the partner), try and recognize in your partner the acts or parts that you find arousing and focus on that. That will help take your mind off anxious thoughts.

I hope this answers your question,
Dr A Rao Kavoor

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