Hello and Welcome to ‘Ask A Doctor’ service. I have reviewed your query and here is my advice. Male sexual arousal is a complex process that involves the brain, hormones, emotions, nerves, muscles and blood vessels. Erectile dysfunction can result from a problem with any of these. Likewise, stress and mental health concerns can cause or worsen erectile dysfunction. Sometimes a combination of physical and psychological issues causes erectile dysfunction. For instance, a minor physical condition that slows your sexual response might cause anxiety about maintaining an erection. The resulting anxiety can lead to or worsen erectile dysfunction. Most common cause: 1. Depression, anxiety or other mental health conditions, 2. Stress, 3. Relationship problems due to stress, poor communication or other concerns. Sometimes it may be due to some organic cause 1. Heart disease, 2. Diabetes, 3. Obesity, 4. Smoking. The best way to prevent erectile dysfunction is to make healthy lifestyle choices and to manage any existing health conditions. For example: 1. Work with your doctor to manage diabetes, heart disease or other chronic health conditions if you have. 2. See your doctor for regular checkups and medical screening tests. 3. Stop smoking, limit or avoid alcohol, and don t use illegal drugs. 4. Exercise regularly, 30 mins per day at least. 5. Take steps to reduce stress. 6. Get help for anxiety, depression or other mental health concerns. The first thing your doctor will do is to make sure you re getting the right treatment for any health conditions that could be causing or worsening your erectile dysfunction. Depending on the cause and severity of your erectile dysfunction and any underlying health conditions, you might have various treatment options. Your doctor can explain the risks and benefits of each treatment and will consider your preferences. Your partner s preferences also might play a role in your treatment choices. Oral medications are a successful erectile dysfunction treatment for many men. They include: i. Sildenafil (Viagra), ii. Tadalafil (Adcirca, Cialis), iii. Vardenafil (Levitra, Staxyn), iv. Avanafil (Stendra). The doctor will explain to you the benefits and side effects of each and help you to make a decision. If your erectile dysfunction is caused by stress, anxiety or depression — or the condition is creating stress and relationship tension — your doctor might suggest that you, or you and your partner, visit a psychologist or counselor. Same is the case with premature ejaculation. Common treatment options for premature ejaculation include behavioral techniques, topical anesthetics, medications and counseling. Keep in mind that it might take time to find the treatment or combination of treatments that will work for you. Behavioral treatment plus drug therapy might be the most effective course. Behavioral techniques: In some cases, therapy for premature ejaculation might involve taking simple steps, such as masturbating an hour or two before intercourse so that you re able to delay ejaculation during sex. Your doctor also might recommend avoiding intercourse for a period of time and focusing on other types of sexual play so that pressure is removed from your sexual encounters. The pause-squeeze technique: Your doctor might instruct you and your partner in the use of a method called the pause-squeeze technique. This method works as follows: i. Begin sexual activity as usual, including stimulation of the penis, until you feel almost ready to ejaculate. ii. Have your partner squeeze the end of your penis, at the point where the head (glans) joins the shaft, and maintain the squeeze for several seconds, until the urge to ejaculate passes. iii. Have your partner repeat the squeeze process as necessary. By repeating as many times as necessary, you can reach the point of entering your partner without ejaculating. After some practice sessions, the feeling of knowing how to delay ejaculation might become a habit that no longer requires the pause-squeeze technique. If the pause-squeeze technique causes pain or discomfort, another technique is to stop sexual stimulation just prior to ejaculation, wait until the level of arousal has diminished and then start again. This approach is known as the stop-start technique. Condoms: Condoms might decrease penis sensitivity, which can help delay ejaculation. Climax control condoms are available over the counter. These condoms contain numbing agents such as Benzocaine or Lidocaine or are made of thicker latex to delay ejaculation. Examples include Trojan Extended, Durex Performax Intense and Lifestyles Everlast Intense. Medications: Topical anesthetics: Anesthetic creams and sprays that contain a numbing agent, such as Benzocaine, Lidocaine or Prilocaine, are sometimes used to treat premature ejaculation. These products are applied to the penis 10 to 15 minutes before sex to reduce sensation and help delay ejaculation. Hope I have answered your query. Let me know if I can assist you further. Regards, Dr. Sanjay Kini