Brief Answer:
it is likely dhobi itch or fungal infection, need more inforamtion

Detailed Answer:
Hello XXXX,

Thanks for writing to us.

Thanks for clear photographs. Your itchy rashes are likely due to typical anatomical structure of male groin around scrotum. Due to excessive sweating it is common occurrence. It is also called dhobi itch or jock itch. This leads to dermatitis, itching and rash. Itching the part worsens the situation more. Sometime these lesions infected with fungus.

In general treatment includes proper hygiene, changing of clothes/underwear if excessive sweating is there, do not wear tight clothes or at least not for longer duration that causes discomfort, anti fungal dusting powder of clotrimazole and if there is no fungal infection and only dermatitis mild steroid like beclomethasone can also be used. Clotrimazole gel can be applied at night. You should consult dermatologist for proper evaluation and treatment.
This problem does not affect sex function at all.

Size of penis:
Normal size of penis in flaccid state is 2 to 4 inches (5 to 10 cm) while in erect position 4 to 6 inches (10 to 15 cm). It varies according to body structure and race. Size of penis does not matter much for satisfying partner.
Anterior 3 inches of female vaginal wall is sensitive to sexual stimuli. Only 3.5 inches of erect penis is sufficient to satisfy female. Hope you are clear about concern of size of penis now.

Please let me know your size of penis.


Masturbation is natural and normal thing. It is done by 95% of the males in the world, mostly before marriage as well as when wife is away, in menses or pregnant after marriage. It is not at all harmful. Frequency of masturbation done by an individual varies from once a day to once a week. It depends upon individual libido, wish and timing. It neither causes any weakness nor any problem in sexual activity.
Your problem of backache during masturbation may be due to position otherwise masturbation does not cause any back pain directly.

Let me know the method and position in which you masturbate.

For erection problem provide some answers

- Since when are you suffering from erection problem?

- How did the problem started? Any specific incidence?

- What is frequency of sex/masturbation?

- When did you do your last successful intercourse/masturbation?

- Do you have any physical illness?

- Is there any disturbance in your relationship with girlfriend or wife?

- Do you have any stress or psychological problem?

- Is morning erection present?

- Do you have any habit of alcohol or smoking? If yes provide more details.

I will be happy to help further after your response.

Regards,

Dr.Chintan Solanki.

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Brief Answer:
it is likely due to anxiety and stress

Detailed Answer:
Hi,

Thanks for reply.

You had break up. You are also going with family issues. As well as you are trying with sex worker and not able to use condom properly. These all suggest you are passing through stress and became anxious about erection.

Sometime due to stress, fatigue, lack of mood, situational problem or environmental changes man can fail in sex. It is normal phenomenon. However when this failure makes person apprehensive about erection, sex life is affected. This is called performance anxiety. After such failure when person actively thinks about erection or success of intercourse during sex his mind is likely diverted to such thoughts. For constant erection continuous exciting/romantic/erotic feelings should be there in mind. If mind diverted to concern about erection, erection would not be possible.

You are passing through same due to condom and trying sex with sex worker. That is why problem is there.
If you can masturbate well, you are completely normal. You can regain sex life as soon as you will be out of stress.
To get confidence back For a while you can take 5- PDE inhibitor group of medicines like sildenafil or tadalafil. One of them should be used 2 hours prior to sex. They cause headache, stuffy nose nausea and gastric discomfort like common side effects. Proper physical check-up of cardiac system should be done by a doctor before starting the same. These are prescription medicines and you need to consult doctor/psychiatrist/sexologist for the prescription.

Skin that covers penis is called foreskin. During sex this skin should be retracted backward behind glans penis (behind ring of penis). If it cannot be retracted backward it is called phimosis and it can be treated.

Feel free to discuss further.

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Brief Answer:
they are Pearly penile papules not acne

Detailed Answer:
Hello,

Thanks for follow up.I am sorry for too delayed response.

The images you have sent which you felt small acne are actually normal anatomical variant called Pearly penile papules. These are small dome-shaped to filiform skin-colored papules that typically are located on the sulcus or corona of the glans penis. Commonly, pearly penile papules are arranged circumferentially in one or several rows and often are assumed wrongly to be transmitted sexually. Pearly penile papules are unrelated to sexual activity. So no need to worry about them. It does not require any treatment.
And yes your foreskin is easily retractable so no chance of phimosis.

For erection I have already described medicines for you if you want to carry on with sex worker.For your information I would like to describe basic treatment of erectile dysfunction.

To get rid of performance anxiety help of partner is also an important aspect.
Whenever you go for sex, spare enough time in foreplay. You should not think actively about erection, your mind must be occupied with sexual/romantic feelings. During foreplay your partner should try to arouse you and note that your penis gets erection or not. When she feels that penis is sufficiently erect she herself should try to put erect penis in vagina gradually and you should continue your foreplay feelings without being conscious about erection. You must try to enjoy and only enjoy. Once penis is able to enter in vagina and strokes starts it is easy to complete successful sex.

If your partner is not aware about this situation you can do on your own. You just should try to do sex without being conscious about erection. Enjoy without thinking of your ability of maintaining erection and you will succeed or not.

However with sex worker above approach would not help much, sildenafil or tadalafil will be more useful.

You can use another medicine cum vitamin supplement containing pyridoxal-5-phosphate, mecobalamin and l-methylfolate (trade name tetrafol plus)is very helpful in my patients. It has shown improvement in 50-60% patients of mine with ED.You should take it after meal twice a day. If you feel some improvement in 15 days you should continue for at least 2 months. You may get this medicine over the counter as it is vitamin product.


There are some natural lifestyle measures which help to improve blood flow to penis and overall sexual performance.

- The most important factor is healthy heart. Blood is pumped in to body by heart.So regular exercise and avoidance of fatty fast food are important measures to prevent heart disease. Regular walking, swimming or running overall improves blood flow to whole body circulation including penis and keep the mind fresh.

- Good healthy food is also an important aspect. Bananas, Garlic, dry fruits(they contains vitamins), eggs, cow milk, cow butter are good food which may help in erectile dysfunction.

If I were your treating doctor I would like to start tadalafil and tetrafol plus.

All the best and take care.

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Brief Answer:
treat constipation if it is there and take vitamin B complex

Detailed Answer:
Hi,

Thanks for follow up.

Cuts at corner of the lips is called angular cheilitis. Common causes are nutritional deficiency, allergy, some digestive problem which leads to constipation, infection and dryness of lips due to environmental condition.

For a while you can use over the counter vitamin B complex tablets containing riboflavin, thiamine, folic acid and niacin two times a day for 5 days. Also try to have more high fiber diet with fruits and vegetables to avoid constipation. Do not take spicy food. Take a glass of warm water when you wake up morning to releave constipation and improve digestion.

Even after above measures you do not feel improvement in a week you should consult doctor for evaluation to check that there is no infection and for specific treatment.

Take care.

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