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

I have reviewed both your semen analysis reports. The results are normal and it is sufficient for pregnancy.

Regarding your penis size, it is normal and well sufficient for normal sexual intercourse. Only an erect penis size of less than 3 inches is considered abnormal and your size of 4.4 inches is an average size.

Variation in penis size actually does not make a major difference in sexual performance or fertilty. However, having erection problems and premature ejaculation may affect fertility. This is because the vagina has to be well lubricated and the semen has to be deposited in the deeper part of the vagina for the sperms to travel upwards into the cervix. When there is poor lubrication due to inadequate sexual intercourse or if the semen is not deposited in the deeper part of the vagina because of a poor erection, then the semen can leak out of the vagina, instead of remaining inside and sperms travelling upwards.

So, if you are having an erection problem, I would suggest that you try medication like Tadalafil for a short period of time. This can improve the quality of erection. The starting dose is 10mg and can be increased to 20mg if needed. It has to be taken 1 hour before sexual activity and can be taken as and when required.

Also, it would be a better idea not to withdraw the penis out immediately after ejaculation, so that the semen stays inside for longer. You can ask your wife to also keep her hips and legs elevated (on pillows) to help the semen stay in the deeper part of the vagina and prevent it from leaking out.

Have sex as fequently as possible. It is important to keep track of the fertile period but it does not mean that you should have sex only during that period.

Regarding your wife's periods, they are slightly irregular. So, regarding her next ovulation period, the calculation can be done approximately only, since her cycles are not regular. Her ovulation period will approximately be between 19th to 24th May, 2013.

Sometimes hormonal imbalance can cause irregular periods and this can be one of the causes of infertility. So it would be a good idea to see a gynecologist also for an evaluation.

Wish you all the best.

Regards,
Dr. Jonas Sundarakumar
Consultant Psychiatrist & Sexologist

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Hello again XXXXXXX

There can be a variety of causes for erectile dysfunction - 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 and sexual history, a thorough physical examination and certain investigations.

Firstly, any medical causes (like diabetes, hormonal problems, blood flow problems, vitamin deficiencies, etc.) need to be ruled out. For this, you may need to undergo a few blood tests like:
1) Basic blood tests - including lipid profile (cholesterol), blood sugar, urea, creatinine, etc.
2) Testosterone levels - total and free testosterone
3) FSH / LH levels
4) Thyroid function tests
5) Ultrasound doppler of the penis (to check for any blood flow problems)

These tests will give you a clear picture what your sexual problem is due to - any hormonal problems or any other systemic problems or local problems in the penis. According to the diagnosis, further treatment can be planned.

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. 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. Often, persons can develop what is known as a "performance anxiety". Basically, the subconscious fears and doubts whether or not he will be able to perform well itself results in anxiety, and this performance anxiety itself then causes erectile dysfunction.

So, I would suggest that you see a sexologist in person to have a check-up and the tests which I have mentioned, so that further treatment can be planned accordingly.

Regards,
Dr. Jonas Sundarakumar
Consultant Psychiatrist & Sexologist

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Dear XXXXXXX

The hormone test reports are normal and the levels of hormones are sufficient for fertility and pregnancy.

FSH (Follicle Stimulating Hormone) and LH (Leutenizing Hormone) are the hormones produced by the brain, which control the production and release of sex hormone (Testosterone) levels.

Testosterone is the male sex hormone responsible for sexual development and sexual functions. Your testosterone level of 309 ng/dl is normal.

However, the free Testosterone level is a more reliable way of estimating the body's testosterone level. So, you can send me the free Testosterone level result once it is ready.

Regards,
Dr. Jonas Sundarakumar
Consultant Psychiatrist & Sexologist

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Sure. You're welcome...

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Hello again XXXXXXX

Your free testosterone levels are LOW. In fact, in young males the levels are supposed to be in the upper two-thirds of the normal range. The low testosterone could be a possible cause for your erection problem.

Low testosterone level is treated with testosterone replacement therapy. So, I would advise you to see an endocrinologist for further treatment. You will need a physical examination and if necessary, other evaluations before making a decision to start testosterone replacement.

Regards,
Dr. Jonas Sundarakumar
Consultant Psychiatrist & Sexologist

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Low testosterone may affect sexual desire and sexual functioning, but is unlikely to have a major impact on fertility / pregnancy. For fertility / pregnancy, a normal motility of sperms, your fertility appears to be unaffected.

Regards,
Dr. Jonas Sundarakumar
Consultant Psychiatrist & Sexologist

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If you have a normal semen analysis and you are able to have sexual intercourse, then the testosterone level is unlikely to affect the chances for pregnancy. Fertility or ability to have a baby mainly depends on the normal production of adequate and good quality sperms. Like I had mentioned before, if this criteria is fulfilled, then having a low testosterone level may not affect the chances for pregnancy. So, it is not a must for you to take hormone replacement treatment in order to be able to have a baby.

However, low testosterone may affect sexual functioning. So, if you feel that your problem with sexual functioning (like erection problem) is very troublesome or if your sexual desire is low, then you can consider going in for testosterone replacement treatment. Having testosterone replacement therapy is unlikely to affect the chances of pregnancy.

Regarding your second question about side effects, in general hormone replacement treatment, when done under proper adivise and guidance by a specialist is safe. But there can some side efects associated with this treatment like increased acne, hairfall, fluid retention, gynecomastia, testicular atrophy, etc. But these side effects are rare if the treatment is given appropriately under regular monitoring.


Regards,
Dr. Jonas Sundarakumar
Consultant Psychiatrist & Sexologist

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You're welcome. Take care.

Best wishes,
Dr. Jonas Sundarakumar
Consultant Psychiatrist & Sexologist

(Kindly close the query and leave a review if you are satisfied with my answers.)

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