Q: I am 25 years old. I am experiencing a slight difference in my erection from the past three months. Previously I used to get erection whenever I used to think of sex. But now I need to press for some time to get it. I don't get full erection also, its only partial. I consulted 2 doctors as well. The first one said that this is due to suppressed sex and told me to get married soon. The second doctor asked me to take certain tests. My blood sugar, fasting was 81 and post prandial was 106. Blood pressure was normal. I am 165 cm tall and I weigh 63 kg. The ultrasound of lower abdomen was normal too. Even prostate glands and seminal vesicles are normal. Free testosterone - 11.5 normal range. PSR - 0.25 normal. I also underwent the Doppler Test. After seeing all the reports, the doctor asked me to get married. He said this could be due to blood circulation but asked not to worry. He prescribed Sumenta - 2 months 1-0-1; Heyforte - 2 months 0-0-1. He asked me to meet him 2 weeks before the marriage for a powerful medication to remove anxiety and do well. Why has it happened so suddenly? Should I masturbate? Is it treatable? Should I get married? It is disturbing my daily activities.

A:Anxiety about impotence ranks first in order of prevalence, in all the sexual fears that men have. Ironically, the fear itself is the greatest cause of impotence. In 90% cases of impotencies, the cause is stemming from the mind (psychogenic). It is only in 10% cases that the cause is biological. Just as it is not possible to make saliva, tears and digestive juices flow, similarly there is no possible way a man can ‘will’ himself to have an erection. These things happen on their own in response to situations and circumstances. If one involves oneself in ‘relaxed’ foreplay, without ‘spectatoring’ at the organ (waiting for the erection to happen), the erection happens on its own accord. Behind the fear of failure to get an erection is a fundamental anxiety – the fear of being rejected. It is important to understand that most men will experience this phenomenon at least a few times, that they want an erection, but are unable to get one. This is entirely normal, and is nothing to worry about. Often, an occasional failure to get an erection can be related to stress, fatigue, insufficient stimulation, or intoxication. Some men have situational erection problems. For instance, they can get an erection when they are masturbating, but are unable to get one when they are with their partner. This usually means that the problem is primarily ‘psychogenic’. Erectile dysfunction can become a problem when it is persistent or frequent. “Performance anxiety” is a common problem. If a man is more focused on how well he is performing with a partner, rather than on enjoying the sensations in the sexual act, it may be difficult to achieve or maintain an erection. This can become a vicious cycle, where the anxiety about whether or not one will have an erection becomes so intense that he is unable to become to have an erection, which leads to more anxiety, and so forth. The way to fix this problem is to relax. The more you relax and enjoy the experience of sex (whether you have an erection or not), the more likely you are to be able to get an erection. Other men are unable to become erect in any situation, whether alone or with a partner. This usually suggests that the problem is primarily organic (physical). Organic causes of erection problems may include diabetes, kidney disease, multiple sclerosis, Parkinsons disease, injuries to the spinal cord or brain, reactions to certain medications especially hypertension medications, antipsychotic and antidepressant drugs, chronic alcoholism, atherosclerosis or other vascular problems. If the cause is organic or constitutional, then appropriate medical or surgical measures will have to be undertaken. If it is due to psychogenic or situational causes, the treatment will be “sex counselling” and “supportive therapy”. It is necessary to find out the cause (diagnosis) of this problem first, through history taking, examination and investigations. Once the cause is found, only then can treatment be advised. It is possible to help you professionally. If you are Mumbai based, you can visit Heart To Heart Counselling Centre.