Hello and welcome to Healthcare Magic. Thanks for your query.

Your seem to be having a mild erectile dysfunction problem. This is the most common sexual problem in men. Now, erectile dysfunction can be due to medical causes as well as psychological causes. So, regarding management of this problem, firstly, any medical causes (like diabetes, hormonal disorders, blood flow problems, etc.) need to be ruled out. But in your case, you mention that you don't have any known medical problems and that your sugars are normal. Moreover, this problem has been there only for a few days and so, this is very likely to be only a temporary problem.

You have said that you keep kaving some abdominal pain during intercourse. You have also had some recent episodes of loose stools. So, it could be possible that you may be having some gastric problem which is causing these symptoms. Now, whenever there is physical pain or discomfort, this can interfere with sexual activity and can sometimes result in erectile dysfunction. Since you say that you are able to get a good erection and engage in sexual intercourse, but you tend to lose it inbetween. So, it is unlikely that you have a major problem like a vascular or hormonal problem causing this.

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. Performance anxiety, feelings of sexual inadequacy, self-doubts, relationship problems and poor communication / understanding with the partner, etc. can all affect sexual functioning and performance.

Often there is an interaction between physical and psychological causes. For example, if there has been a problem with erection once due to some mild physical problem, the person gets very anxious about and starts doubting his future sexual performance. Subsequently, during the next few sexual performances, this anxiety and self-doubt itself will lead on to further erectile dysfunction. Soon, this becomes a viscious cycle and the problem becomes worse. So, removing the person's doubts and fears, and improving his self-confidence levels will also definitely help in improving sexual performance.

Since your problem has been there only for a few days, I would advise you not to worry much about it. If your abdominal pain is recurrent, then it's advisable to get it checked out and treated. Importantly, don't become too anxious or worried about this. I feel that your erectile dysfunction problem is only mild and temporary. If necessary, you can try medication like Tadalafil (Megalis), for a few days, which will improve erection. As your gastric problem settles down completely and as your anxiety decreases, your sexual problem should also become alright soon.

Wish you all the best.

- Dr. Jonas Sundarakumar
Consultant Psychiatrist & Sexologist

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Hello again,

Regarding your testicular problem, there can be wide variations in testicular size between persons. But if you feel that it is disproportionalely large, then the possibilities to be considered are a congenital varicocele (enlargement of the veins surrounding the testes) or congenital hydrocele (fluid collection around the testicular sac), since you have had this problem from childhood. This diagnosis can be confirmed by having a physical examination done by a doctor, and sometimes, an ultrasound is required. Even, if this is the diagnosis, treatment is not absolutely necessary. Usually treatment is considered only if the person has any pain or discomfort or any other symptoms. Definitive treatment for both these conditions is surgical.

Regarding your stomach sounds, they may be due to an acidity problem where there may be excess gas formation and during the process of stomach movements, this could be resulting in the gurgling sounds. You can tackle this problem by following strict timings for your meals, avoiding oily and spicy foods and taking more of fibre-rich foods like XXXXXXX vegetables.

Regarding getting a better erection, I would give you the following suggestions:

1) Firstly get rid of any thoughts that you may be sexually inadequate or any doubts that you may not be able to perform properly. Like I mentioned before, performance anxiety, feelings of sexual indequacy and self-doubts can all affect sexual functioning and performance. Remember that sex is not just a physical act but also a psychological process involving an expression of emotions, intimacy and love. So, just involve yourself in those feelings and stop focussing on your "performance" alone. Once you do that, then I assure you that your sexual performance will automatically improve.

2) Another common problem responsible for erections getting weak and early ejaculation is inadequate sexual arousal. When the person is not properly aroused, the blood flow to the penis is not maximal, and so, after a few strokes, the erection weakens. The way to tackle this is not to rush into intercourse quickly, but wait till you get fully aroused. So, increase and spice-up your foreplay. Make sure that you initiate penetration only after both of you are fully turned on. Good foreplay not only arouses you but also sparks off the mood in your partner. So, when she is also aroused and involved, then things keep flowing smoothly and effortlessly, and you don't have to be constantly anxious if you are satisfying your partner or not.

3) Improve your communication with your partner - this means both verbal as well as non-verbal communication. Each person has his or her own ways of getting sexually aroused or feeling sexual pleasure. So, this verbal and non-verbal communication will let each of the partners understand each other's needs and thereby make sex both relaxing and enjoyable.

4) Distract yourself stop "monitoring" your sexual performance. Try putting on some romantic music or mild lighting while you make love. Think about the things that turn you on. Taking your mind off of your sexual performance can remove the worries that are stopping you from getting excited.

5) You can try medication which can improve the blood flow to the penis and promote better erection, such as Sildenafil or Tadalafil.

It is also important to eat a healthy & balanced diet, exercise regularly and try to stay positive and stress-free.

Wish you all the best.

- Dr. Jonas Sundarakumar
Consultant Psychiatrist & Sexologist

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Hi XXXXXXX,

I'm glad that my advise is useful to you. With this self-confidence, and by following the suggestions, I'm sure your problems are going to subside very soon.

Now, regarding these medicines, they do not have any major or worrying side effects. Some people may experience temporary heaviness of the head or nasal stuffiness for a few hours after taking these medication, but this is harmless and will settle down on its own after some time. Between the two medicines, Tadalafil is a better choice, since it has a longer duration of action of about 2 to 3 days. So, one tablet's effect will be there upto 3 days. Usually the dosing is as per a need basis (i.e. to be taken during days of intended sexual intercourse) and it doesn't have to be take everyday. It is best taken after food (to avoid any gastic irritation) and about 1 hour prior to intended sexual activity.

Best wishes,
Dr. Jonas Sundarakumar
Consultant Psychiatrist & Sexologist

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