Hi XXXXXXX

Welcome to Healthcare Magic and thanks for your question.

You have mentioned that you are suffering from multiple sexual problems like premature ejaculation, erectile dysfunction, decrease in libido (sexual desire / excitement) and ?infertility. In such cases, the first important step is a comprehensive evaluation. This is because the causes of sexual problems are varied and often multiple factors may be involved. A proper evaluation will include a detailed medical, sexual and psycho-social history, a thorough physical examination and certain investigations, as per the necessity.

In order to help you better, I would like to have more details / clarifications about your sexual problems:

1) How long are you having such problems?
2) Was the onset of your problems sudden or gradual?
3) Are you married? If so, how is your personal relationship with your wife?
4) Does your sexual partner complain of any sexual dissatisfaction due to your sexual problems? What are your partner's expectations?
5) Are you having any problems in having children (infertility)? If so, for how many years?
6) Does your sexual problem persist at all times or only at certain times or specific situations?
6) What is your ejaculation time? How long are you able to maintain an erection?
7) Do you practise masturbation? If so, how often? Do you have any guilt because of that?
8) Do you have symptoms like feeling low, decreased energy, easy fatiguability, negative thoughts, anxious thoughts, etc.

Please get back to me with these details and I will be able to guide you further.

Wish you all the best.

- Dr. Jonas Sundarakumar
Consultant Psychiatrist

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Hi again XXXXXXX

Thanks for the details. I am able to have a fair picture about your problem. Now, it is very common for unmarried men to have a lot of doubts and inadequate feelings about their sexual performance. I understand that you are all the more anxious because you are going to get married in the next six months. You have mentioned that you have been feeling low, fatigued, run down and anxious. It also looks like you are having a low self esteem, guilty feelings (maybe related to your masturbation) and a lot of negativism. Now, please remember that the body's sexual performance is greatly dependent on the mind. Only if the mind is relaxed, confident and free of inadequacies, the body will be able to perform its sexual functions to it's complete potential.

Now, these kind of feelings of sexual inadequacy and anxiety regarding sexual performance is very common among young, unmarried males. These problems usually become more prominent prior to marriage. The truth is that in most of such cases, there is no medical abnormality detected and once the person overcomes his anxiety and feelings of inadequacies, the sexual functioning and performance automatically becomes normal.

Here's what I would suggest for you;
1) First get a detailed assessment (including a thorough physical examination) done by a psychiatrist or sexologist in your place.
2) If you are suffering from a prominent lack of sexual desire, then you may need some blood investigations to see if there is a medical cause for it (hormonal imbalances, diabetes, etc.)
3) Once any potential medical cause is ruled out, then you will have to start working on your self esteem and confidence levels (there are certain good counselling techniques which can eradicate your negative, self-defeating thoughts and improve your self-esteem)
4) If your anxiety or low mood is prominent and causing you distress, you may need some medication for a short term.
5) Eat a health, nutritious and balanced diet and exercise regularly.
6) Avoid smoking, alcohol or any other substances of abuse as they can have an adverse effect on your sexual functioning.

I'm sure that if you follow these suggestions, you will be able to come out of your problems very soon.

Wish you all the best.

- Dr. Jonas Sundarakumar
Consultant Psychiatrist

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