Brief Answer:
Kindly provide details of your problems.

Detailed Answer:
Hello,

Welcome to the forum and thanks for posting your query to the forum.

I completely understand your deep concern related to penile erection and the sustaining time during intercourse. For young man of of your age all the problems you described makes a big issue.

After reading your query I can make out that you have liver problem and are on liver medications too. The type of problem you have described can be related to various causes including medical illness or medications or due to simple psychological factors or stress also.

In view to help and guide you best I request you to kindly elaborate your query in terms of:

- Since how long you have erection problem and sustaining time during intercourse.

- Do you feel morning erections. How often you have intercourse in a week with your wife/girlfriend.

- What is the size of your penis in flaccid (normal) state and after erection.

- Since how long you have liver problem. Is it been confirmed as cirrhosis of liver or what is the diagnosis given by the doctor.

- What are the medications given by the doctor for the liver problem and since how long you are taking the same.

- Have you gone for any investigations if yes then any abnormalities in the same.

-Your job profile, daily routine and marital status.

Hope to hear soon form your side.

With regards,

Dr Sanjay Kumar Kanodia
MD- Dermatology & Sexually transmitted diseases

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Brief Answer:
Penis issues: kegels exercise; lose undergarment

Detailed Answer:
Hello young fellow,

Welcome again to the forum and thanks a lot for your swift follow up with important details.

I have gone through your complete query with diligence and after analyzing the complete situation let me guide you regarding your various problems:

- Let us first deal with your erection problem: As I said earlier that the erection problem can be due to various reason including medical illness or medications or due to simple psychological factors or stress also.

In your case, it appears to be basically related to psychological issue and superadded by medical problem of liver illness. During the erection of penis it is the mind which plays the most important role in excitement and vigor to release certain chemical which causes gush of blood into the penile tissues. This makes the penis firmer and harder than normal state. If at all there is any anxiety or any apprehension is present at the time of intercourse then it causes less release of those chemicals and resultant bit flaccid sate.

Additionally in males there is always a tension of "Performance anxiety". It means that males are the active partner and has to sustain the erection as well as accomplish the sexual act actively. This anxiety itself causes bit looseness.

In case if there is any fear of time, place and person then also becomes a big issue. I very often counsel young men like you who are not even able to get erection to fear to wrong place and time with girl friend giving undue pressure in the back of the mind.

Liver problems can also cause indirect impact as a medical illness can have impact in proper release and metabolism of male hormones in the body. SO your liver issue can also be one of the important cause of the same.

Fro the part of sustaining the erections all the above mentioned causes are also contributory. An additional issue is when the intercourse is done after long period of time then there is always a chance of early ejaculation which is totally normal process.

As I can get form your history that you do feel morning erections off and on, so by this time you do not have any major hormonal issue or internal issue causing the condition and therefore there is no need to go for any tests.

For the part of treatment for both I suggest you to first and foremost reduce your anxiety level of anything serious or related issue of previous mistakes. Masturbation which we often commit as main cause of all these causes is not at all related to any of your problems. Masturbation is normal physiological process and never causes looseness or erection or weakness. So stop correlating to any of issue with the same.

I suggest my patients to do simple meditation to calm down your nerves. Additionally the most important part of therapy is "Kegel exercises". These are pelvic floor exercise where we do repeated contraction and relaxation of the muscles of lower abdomen and pelvic floor.

TO guide you simply these are exercises related to muscles which helps in urination and defecations. As all the blood vessels pass through these muscles so strengthening these muscles helps in sustaining erections and prolonging the time of intercourse.

You can go on Google by the key words "kegel exercises for erectile dysfunction" and can find videos and maneuver of the same.

Secondly at the time of meeting with your partner keep yourself relaxed and calm. Chose a place of most safety where you should not have any tensions regarding surroundings and chose the right time also. Don't be hasty in jumping over the act and try to do best foreplay you can have.

Take out your penis as soon as you feel sort of ejaculation and drift your mind in to other direction. So it is a break - act - break routine to follow the complete thing. It will prolong the act and slowly you will feel confidence in the same.

Don't feel shy to talk to your girlfriend regarding the issue so that she can also cooperate you by not becoming hasty and exciting you more to have early ejaculation.

If at all you feel that these things are not working in three months then there are certain medications for sustaining the erection to be taken under medical guidance only. But in my experience 90% of my patients get results with these simple measures.

As you have liver issue also so I would not prefer to go for any medications and the above measure of exercise are safe in your liver problem also.

Now next is your penile size issue: It is one of the most common phobias I have seen in young men like to think that the penile size is small. Young buddy to give and get ultimate pleasure even 2 inch of erect penis is sufficient......yes you got it right just 2 inches. Yours is more than 4 inches so is totally normal or above. What we see is the size in various movies where we start comparing with ourselves which is totally wrong.

So stop thinking for the same...you are perfectly alright with your size!!!!

For the part underwear problem: It is always better to wear a lose underwear. Wearing a tight undergarment causes less blood supply to the testicles and therefore harm to testicular tissues.

Take a proper and full course of your medications for liver problem so that you could regain best health. Be under proper and timely follow up of your liver doctor to get early and best relief.

I hope these information will relax your mind. I will be glad to guide you any further.

With regards,

Dr Sanjay Kumar Kanodia
MD- Dermatology & Sexually transmitted diseases

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Brief Answer:
Big NO to pills and pumps. your size is too good!!

Detailed Answer:
Hello young fellow,

Welcome again to the forum and thanks a lot for your further follow up and queries.

Now for the part of pumps and pills: As I already guided you for the same in previous mail, I am against the use of pills as well as pumps for you because of your liver condition.

Pills on one side always go through a metabolism in liver so can harm not only your already weak liver but also your rest of systems too. As I got from information provided by you in first mail that your liver condition can go towards cirrhosis so I personally guide you to be very much careful towards taking any sort of medications. To each and every doctor you visit and any of the medications you take (even for simple headache) - you must tell your treating doctor regarding your liver condition. SO big NO to pills please !!!

Now for pumps- these are double edged swords. I have seen more more harms and long term side effects rather benefits of the pumps too. there is no scientific proof of exact benefit of the pumps and have observed rather more side effects in my clinical practice. Penile tissues are one of the most soft tissues of our body and if any damage is produced then can cause irreparable loss to it.

I already guided you that your penile size is much more than what is required for normal sexual act. Your penile size is very much good enough!!!

So just relax for the issue of length of penis as your erect penile size is quite enough to satisfy any sort of female desires.

Just follow the instructions provided in the previous mail and relax for any of the issues of size.

I hope these information will help you. I will be glad to guide you any further.

With regards,

Dr Sanjay Kumar Kanodia
MD- Dermatology & Sexually transmitted diseases

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