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Suggest treatment for erectile dysfunction

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Practicing since : 2004
Answered : 1853 Questions
Hi doctor,
I am a 29 year old male and an anaesthetist by profession and got married just 6 monnths back, before my marriage I used to masturbate quite frequently, sometimes even three to four times a day.during these masturbations I was able ejaculate even without full erections, although I was able to get full erections when thinking about some new stuff.I never got physical with anyone before my marriage
After my marriage which is arranged one, I discovered that I suffered from erectile dysfunction at various stages, sometimes I was not not able to achieve adequate erection despite foreplay on other times I was able to achieve erection but lose it just prior to penetration.many times it feels like although erection has been achieved but it's hardness is not adequate for penetration.quite often I feel a decrease in desire despite having a beautiful and attractive wife.
I surfed the net regarding this problem, any came to conclusion that this erectile dysfunction is perhaps psychogenic I tried to give up masturbation, in hope to cure myself but that didn't work, although I still masturbate but occasionally. I also read about tadalafil it works and can be taken for short duration till you get your confidence back, I took it twice once 5 mg and once 10 mg, but that too didn't work.despite this I am able to get early morning erections, not everyday but quite often
I am a smoker and smoke 2 to 5 cigarettes per day and also obese my height is 176 cm and weigh almost 100 kg, and hit the gym 3-5 days a week

Posted Sun, 31 Aug 2014 in Urinary and Bladder Problems
Answered by Dr. Ashish Mittal 32 hours later
Brief Answer:
Hi Doctor....

Detailed Answer:
Hello Doctor,
Thanks for your query.
I appreciate your efforts for medical consultation in so much distress.

In treatment Erectile dysfunction (ED) first step is to identify cause of the problem. Erectile dysfunction can be a result of a psychological or physical problem.

Psychological causes: Most common cause in young patients. These include performance anxiety, emotional weakness, inferiority complex, stress, marital or relationship problems, low mood, feelings of guilt, and the effects of a past sexual and emotional trauma. Men with psychological problem usually have normal nocturnal/early morning erections, whereas men with physical problem often do not.

Physical causes: Include neurological disorders, alcoholism, smoking, hormonal imbalances, diabetes, hypertension, blood vessel disease and chronic diseases.

What I can understand from your query is that you are not able to sustain hard erection which is required for intercourse. You are 29 years of age and at this age, any difficulty in getting or maintain an erection is due to psychological reasons in most of the cases. Same time you have other risk factors for poor erection in form of:

Following measures will help you:
-First of all, quit smoking and alcohol (if you are taking any)
-Reduce your weight, at-least 2 kg every month, and bring your BMI <25.
-Eat a healthy diet rich in vitamins, minerals and antioxidants: fruits, milk and eggs
-Erection do not get affected by masturbation in long term. If you have normal erection sometime during masturbation and poor erection during sex it indicate conditioning of body for masturbation, which will solve after few weeks of stoppage of masturbation.
-Have faith in yourself and do not take any stress. You can talk to your partner openly and indulge in plenty of foreplay before sex. As you will worry, your problem will increase further. You can also plan to some short vacation for honeymoon, which will relieve your stress.
-Exercise, particularly aerobic exercise (like: Jogging, skipping and cycling) daily. It will increase blood flow all over body and will reduce stress.

There is also need to rule out certain medical conditions which can affect erection. These include diabetes, high blood pressure, cardiac or thyroid conditions. For that get yourself evaluated.

Apart from that in person evaluation and examination by psychiatrist may be necessary in your case to identify and treat psychological cause of ED, specially sexual anxiety. Same time if you are not responding to tadalafil 10mg, you can increase its dose to upto 20mg (after ruling out hypertension and cardiac problem).

As you are in XXXXXXX you can visit me personally also after taking my address from healthcaremagic in XXXXXXX Asia Hospital.

I hope this information has been both informative and helpful for you. In case of any doubt, I will be available for follow ups.

Wish you good health.
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