Brief Answer: Need further clarifications... Detailed Answer: 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 feel guilty about your masturbation? Do you fear that this may be causing you sexual weakness? - 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

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Brief Answer: Advised further evaluation and counselling... Detailed Answer: Hello again and thanks for your clarifications. I can understand that you are going through a lot of distress due to your sexual problem. Now, there can be a variety of causes for your sexual problem - both medical causes as well as psychological causes. So, the first and most important step in management is a proper evaluation. This will include a detailed medical, sexual, personal and social history, a thorough physical examination and certain investigations, as per the necessity. 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 so that in case any problems are detected, then treatment can be targeted specifically. I would advise you to have the following tests: 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) 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, depression, 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, young people who have not yet had sexual intercourse develop a type of fear or anxiety called "performance anxiety". They have fear and doubt whether or not they will be able to perform intercourse well or not. This fear or anxiety itself results in erection problems. In such cases, counselling will help in removing the person's doubts and fears, and improving his self-confidence levels. So, I would advise you to have all the tests done and consult a psychiatrist or a sexologist in person to have a systematic evaluation and sexual counselling. If you are very depressed, then you may need anti-depressant medication also. Masturbation is a part of normal human sexual behaviour and it does not cause any sexual weakness or sexual problems. So, you needn't worry or feel guilty about that. A healthy and nutritious diet, regular physical exercise and relaxation techniques like yoga can also help improve your overall sexual health. Wish you all the best. Regards, Dr. Jonas Sundarakumar Consultant Psychiatrist & Sexologist

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