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Dr. Andrew Rynne

Family Physician

Exp 50 years

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Noticed erectile dysfunction. What cure should be done?

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Dr. Jonas Sundarakumar

Psychiatrist

Practicing since :2003

Answered : 2190 Questions

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Posted on Wed, 19 Dec 2012 in Erectile Dysfunction
Question: While we have intercourse, penis suddenly shrinks in a minute. Earlier it was hard when we about to start
doctor
Answered by Dr. Jonas Sundarakumar 5 hours later
Hello and welcome to Healthcare Magic. Thanks for your query.

I will certainly help and advise you regarding your problem. In order to guide you better, can you please provide the following clarifications...

- How long have you been having this problem?

- How frequently does this problem happen? Does it happen only in certain situations or everytime you are sexually aroused?
- How long are you able to perform sexual intercourse?

- Do you have a problem of pre-mature ejaculation?
- Are you married? Do you have any problems or stress in your relationship?

- Do you suffer from anxiety, negative thoughts or low mood?

- Do you smoke or consume alcohol or any other drugs?

- Do you have any other medical problems or are you on any medication currently?

Please get back to me with these details, so that I can advise you in a better way.

Regards,
- Dr. Jonas Sundarakumar
Consultant Psychiatrist & Sexologist

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Jonas Sundarakumar 2 hours later
- How long have you been having this problem? I am recently married, from the last 1 month I am having this problem

- How frequently does this problem happen? Does it happen only in certain situations or everytime you are sexually aroused? Everytime

- How long are you able to perform sexual intercourse? When I tried to get inserted, my penis suddenly shrink, so i can say only 2 minutes

- Do you have a problem of pre-mature ejaculation? No

- Are you married? Do you have any problems or stress in your relationship?
Yes I am married & there is no stress

- Do you suffer from anxiety, negative thoughts or low mood? No

- Do you smoke or consume alcohol or any other drugs? I used to smoke

- Do you have any other medical problems or are you on any medication currently? No
doctor
Answered by Dr. Jonas Sundarakumar 6 hours later
Hello again and thanks for your clarifications.

You seem to be having a problem of Erectile Dysfunction. This is 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, etc.) need to be ruled out. For this, you may need to undergo a few blood tests since cetain medical conditions like diabetes, high cholesterol, etc. can lead to sexual dysfunction. Sometimes, hormonal imbalances can also lead to low sexual drive and poor sexual functioning. So, certain additional tests like testosterone level, FSH, LH levels, etc. may be required. Similarly, in order to rule out any blood flow problem to the penis, which could be causing poor erections, a doppler study is sometimes advised to check for the blood flow to the penis. Rarely, a tumescence testing done as this test helps to differentiate between medical and psychological causes.

Having said 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. Especially, in young men, physchological causes are more likely than medical diseases. 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 he 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 as the last resort and 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.

- Dr. Jonas Sundarakumar
Consultant Psychiatrist & Sexologist

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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I have attched the conversation i had with a doctor below...can you please go through it and give your opinion.


senthil.psgct: Hi, I'm 27 and not able to ejaculate whenever i masturbate, but i'm having wet sleep
Doctor: Hi
Doctor: I am Dr. Jagdish
senthil.psgct: Hi Doctor
Doctor: Are yo married?
senthil.psgct: no
Doctor: Do you used to ejaculate normally before?
senthil.psgct: i never tried to masturbate
Doctor: Are you masturbating now/
senthil.psgct: yeah, when i try now im not able to ejaculate
Doctor: How many times you masturabated ?
senthil.psgct: probably 9 or 10 different times over last 2 years
Doctor: so any time did u have ejaculation
senthil.psgct: never
senthil.psgct: i was having a very small drop sometimes
Doctor: usually the normal quantity of ejaculated fluid ismax 1 teas sponn 5ml
senthil.psgct: no not that much
Doctor: but u r wetting the cloths in sleep
senthil.psgct: i might be getting that quantity in sleep
Doctor: is that right?
senthil.psgct: yeah
Doctor: plz hold
senthil.psgct: ok
Doctor: The first thing you should due if you are concerned is to have a semen analysis performed.
Doctor: f at that time the volume is determined to be low, than you must first determined that the specimen was obtained properly(48-72hrs abstinence) and retrograde ejaculation has been ruled out.
Doctor: *if
senthil.psgct: what is that...how and where to do that?
Doctor: I will tell u
Doctor: Low volume may represent a rare decreased in androgen levels.
Doctor: If you go to lab ask for semen analysis
Doctor: they will give a kit and ask you to collect semen in th bottle ok
Doctor: Do u follow me?
senthil.psgct: oh...k...how do i get the semen?
Doctor: Any amount is ok
Doctor: one drop is also fine
senthil.psgct: see im not able to ejaculate when i masturbate and thats my problem
Doctor: ok
Doctor: Low volume may represent a rare decreased in androgen levels.
Doctor: So please get the serum testosterone levels
senthil.psgct: through semen analysis?
Doctor: No
Doctor: it is a blood test
senthil.psgct: ok
Doctor: If the harmone is low , the semen is not prodcueed
senthil.psgct: if thats the case, then it shud not be produced in sleep also rite?
Doctor: There are other causes no ejaculation
Doctor: ok
senthil.psgct: u there?
Doctor: obstruction of the ejaculatory ducts, Vas Deferens, or epididymus cause no ejaculate
Doctor: For that u need ultrasound of prostate,Vasography
senthil.psgct: but doctor im ejaculating in sleep so obstuction of duct is ruled ou
senthil.psgct: u there?
Doctor: Plz be patient
Doctor: if the chat is not complete Iwill call u
senthil.psgct: ok..hope u have my number
Doctor: 0000&
senthil.psgct: no...its 0000..last digit has typo err
Doctor: the point is u r ejaculating in sleep and not ejaculating in masturbation
Doctor: ok
senthil.psgct: yes
Doctor: So but the investigations are same
Doctor: Why are you not ejaculating
Doctor: Defintely u r prodicuing semen
senthil.psgct: yes
Doctor: The semen is produced in prostate and mixed with sperms from testicles
Doctor: It comes from deep in prostate thru urethra
senthil.psgct: i see
Doctor: in between uyerthra and testiclea there are tubes which carry semen'
senthil.psgct: oh..
Doctor: When there is an obstruction of the ducts it will go back to bladder
Doctor: or it may n ot come forward]
senthil.psgct: i see
senthil.psgct: why is this obstruction not happening in sleep
Doctor: So u need Ultrasound of the proistate to see whether there is obstrctuion of the ducts going thru the prostate and to see if there is swelling of the prostate which might be blocking'
Doctor: I dont know
Doctor: There is no explanation for all
Doctor: Vasography is they inject dye thru the penis and look whether the floe is normal or obstructed
senthil.psgct: i see...
senthil.psgct: may i know whats ur qualification?
Doctor: MBBS with 2 yr family medicine in USA
Doctor: I recommend you consult the urologist . He will do the ultrasound of the Prostate and assist in vasography
senthil.psgct: ok..
Doctor: May I ask u few Q
Doctor: Do you have any medical problems ?
senthil.psgct: yes
senthil.psgct: no
Doctor: Do you take any medicines ?
senthil.psgct: im perfectly fit...don take any medicines
Doctor: ok
Doctor: DO you have any stress ?
senthil.psgct: no
Doctor: Ok
Doctor: So I do not see any other causes of no ejaculation from history
Doctor: Do you have any diifuclty urination
senthil.psgct: nope
Doctor: So probably there is back flow of semen or might be obstruction

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