Sexual Problems

Q. What is impotence or erectile dysfunction [ED]?

Inadequate penile erection to complete sexual activity satisfactorily either masturbation, oral sex or vaginal.

Q. What are the causes for ED?

Physical and psychological causes are the two main reasons for ED. Main physical causes include diabetes, atherosclerosis, alcoholism, side effect of certain medications, spinal cord injury, prostate gland surgery, etc while psychological causes includes interpersonal relationship conflicts, stress and anxiety, depression, sexual boredom etc.

Q. How one can prevent ED?

Lifestyle modifications like quitting smoking and alcohol consumption, regular exercise, and low fat diet can prevent ED.

Q. When to see a doctor for ED?

Sooner the better. Knowing the underlying cause for ED is very important and helps the clinician plan further management.

Q. What are the treatments for ED?

The treatment include oral medications like sildenafil / injectables, mechanical aids like vibrator, hormonal replacements &/or psychological therapy with counseling.

Q. What is premature [rapid] ejaculation?

Premature ejaculation (PE) is a condition where a man ejaculates earlier than he or his partner would like him to. Premature ejaculation is also known as rapid ejaculation, rapid climax, premature climax, or early ejaculation.

Q. What are the treatments for premature ejaculation?

Sex – therapy
Stop start [Do-Redo method]
In this method the male partner is asked to stimulate his penis and then stop for 30-60 sec and then re-simulate. This has to be repeated for 5-6 times.


After stimulation of penis the penis needs to be squeezed below the head, this prevents early ejaculation.


Medications which reduce penile sensation like local anesthetic gel or spray might help.
Some tips to reduce premature ejaculation :

  • Use a Condom, &/or anesthetic spray to reduce the sensitivity of penis
  • Don’t attempt intercourse until your partner had an orgasm
  • Masturbation before intercourse might delay ejaculation.
  • Be relaxed and involve in fore play, do not be in a hurry for penetrative act

Q. What is retrograde ejaculation?

Retrograde ejaculation is a condition in men, wherein the semen flows back into the urinary bladder instead of flowing out through the urethra. Men with retrograde ejaculation achieve orgasm, but the ejaculate is either nil or low in volume.

Q. What are the causes for retrograde ejaculation?

Anatomic causes, drug-induced and unexplained (idiopathic) causes are the main factors causing retrograde ejaculation.

Q. What are the treatments for retrograde ejaculation?

Conversion of retrograde into antegrade ejaculation by drug therapy · Harvesting of sperm from postejaculatory urine · Surgical treatment

Q. What is Viagra and how does it work?

  • Viagra [Sildenafil Citrate] is a medicine to treat erectile dysfunction. Viagra will work by increasing the smooth muscle relaxation in the penis, and with this efficiency of the erection will increase.
  • The only contraindication to Viagra is the use of nitrates [sublingual nitroglycerin, long acting nitrates, and nitrate paste]. Both cannot be used at a time. The severe side effect will be drop in blood pressure.
  • Viagra is taken half an hour before desired sexual activity. The dosage 25-50mg once a day. Viagra will work if the man is aroused. 60-70% men with erectile dysfunction can achieve erection with Viagra. Viagra has no effect on libido; it will not increase the sex drive.

Q. I do not have erectile problem when I masturbate but it does not work when I am with my partner, why?

Penile erection is a complex mechanism which involves lot of chemical messengers from brain and local penile tissue. Along with these chemicals visual stimulation, mood has a significant role to play in penile erection. Some worries, anxiety, work pressure, stress or performance anxiety might hinder the normal mechanism of erection. Counseling session from a sex therapist usually helps. On rare occasions, medication is indicated.

Q. I have pain during intercourse which is causing disturbance in sexual pleasure, please guide me otherwise I am a healthy man?

Pain during erection might be because of:

  • Peyronie’s disease- due to this you might have also observed curve or Bend in the penis when it is erect
  • Irritation of the skin along the shaft of the penis [balanitis]
  • Infection of the prostate gland or urethra either case you should contact the doctor

Pain during ejaculation / and pain in pelvis is because of

  • Infection of the urethra
  • Sexually Transmitted Disease (STD)