Most common sexual difficulty faced by men is either Inability to achieve erection Or Difficulty in sustaining erection once it is gained

This situation may occur once in a while for any person. But, in some men it may happen so often that he may need a doctor’s help.

This can happen to any man, although some men may never experience this problem.

Most commonly erection problems have a psychological reason. Men suffering from this problem should check if he is experiencing one or more of the following issues,

1.   Do I feel guilty about sex, because of any past or present experience?

2.   Do I really love my partner? Does she really love me?

3.   Am I bored with this relationship?

4.   Am I no longer attracted to my partner?

5.   Is she really attracted towards me?

6.   Is sex becoming monotonous and boring ritual?

7.   Do I feel anxious when I think about sex?

8.   Do I feel guilty about any aspect of my relationship?

9.   Am I worried about my sexual performance?

10. Is my partner expecting me to be a great performer? (expecting too much from me)

11. Why do I always need to fantasize for getting and maintaining erection?

Problems of erection which is misleadingly called impotence can also be caused by excessive alcohol consumption or when person is too tired and experiencing extreme fatigue.

Sometimes person may experience a soft penis ejaculation, in the absence of proper erection.

Similar to the fact that some reasons lead to disinterest in sex and cause failure in getting erection or loss of erection, one can create reasons to develop want for the sex.

Some of these measures are,

1.   Develop own sexuality and learn to get pleasure out of sexual relation

2.   Have sex only when you really want to

3. Understand your partner through developing sexual language and communication to express each other’s expectations, limitations and wants.

4.  Prepare yourself for the occasion and avoid casual approach to sex till you develop confidence of performance.

5.  Do not get disheartened if she does not express pleasures as you expect (some women do not express although they may be getting extreme pleasure from the sex)

6. Have frequent non-sexual touching to develop familiarity and reduce performance related anxiety.

7.  You are not a machine to get same output every time. Upsets are quite common even in most loving couples. These should be taken lightly by both the partners. (Any kind of criticism may worsen the condition and permanently disturb marital relations.

In some cases an understanding partner can help in solving the problem, especially in cases of premature ejaculation.

If the problem of lack of erection persists even after making sincere efforts, or if the man has never had an erection, then doctor’s help is indicated.

Doctors may also suggest tests to rule out for medical causes such as diabetes, hormone problems and diseases affecting nerves or blood vessels. Certain medicines, like those given for treating high blood pressure, can sometimes cause loss of erection.

With the help of Sonography, it is now possible to identify medical reason for men who never experienced erection.

For these men who never had erection due to medical problems, treatment can be given by Andrologists (Uro-Surgeons) with the help of injection therapy or by inserting implant in the penis surgically.

Pre-marriage guidance may be of great help in avoiding or identifying problem of erection by understanding own sexuality as well as understanding realities and expectations from sexual relations in married life.  

Self-help for erection problem is more relevant for those who wish to make sure they will have good erection for their special occasion and when the problem is primarily psychological.

The best way to reassure yourself that you can get erection is by masturbation. And even if it subsides quickly, you can get back the erection by stimulating the penis again.

Following exercise done step by step will ensure result and confidence within few days or weeks.

Do this exercise when you are completely relaxed.

1.  Stimulate your penis head by moving the finger over sensitive tip of the penis or by holding the penis lightly in the palm grip and moving the skin forward and backward gently.

2.  Use the fantasy of your choice like photograph or a video clip. But focus on being and thinking sexual.

3.  Keep doing it until you get erection. Few times you may experience a mild soft erection.

4.  Do not get disheartened if it takes time or you fail couple of time.

5.  Erection has more to do with your thinking than physical stimulation.

6.  Try any method right from being completely dressed to completely nude. You may even try rubbing the penis against the bed or a pillow.

7.  Use the technique which stimulates you most. If you feel need for lubrication
to facilitate stimulation, you may use lubricant like Key-Jelly which is water soluble.

8.   Once you have an erection, stop stimulating further and allow it to subside.

9.   Once the penis becomes soft, start stimulating it again, using the method you find most comfortable as well as pleasurable.

10.  Allow the erection to subside second time.

11. Now stimulate the penis for the third time and continue until ejaculation takes place.

12. Repeat this exercise on several occasions until you feel quite confident that you are in charge of your erections and can control them at your will.

13. When you have done these exercises several times a week for couple of weeks, you are ready to go ahead with sexual intercourse.

Follow the exercise couple of times before going ahead with actual sexual intercourse.

Initially it is recommended to start with ‘woman-on-top’ positions. Once you gain confidence and control, you can try ‘man-on-top’ positions.

Following treatments are available for erection problems

Medical Treatments

The problem of erection can also be due to medical reasons. Although this is more common in elderly men, some younger men may also have this problem.

This problem can be overcome successfully by medical treatments like,

·      Vacuum Device

A device may be placed over the penis to produce vacuum which will pull blood into the penis and cause erection of penis.

The erection thus produced can be retained by putting a ring around the base of the penis which will stop back flow of blood from the penis.

Although person can get sufficient erection to enjoy intercourse, many do not like this device as the erection is not very hard.

·      Injection System

Man is trained to inject a special drug directly into the spongy part of his penis, which increases the blood flow into the penis and produces a firm erection.

This erection can last for about an hour; and gives extreme satisfaction to most men using it.

Extreme care is required for using this injection and must be used only with doctor’s advice and only in indicated cases.

The risk with this injection involves a serious condition called ‘Priapism’, where the penis does not return to normal after its normal duration.

If urgent medical treatment is not given, this condition could lead to permanent damage to blood vessels inside the penis.

This injection is strictly not indicated for those who get normal erection. Person trying it for having the sustained erection may cause irreversible damage of the penis. 

 Surgical Treatment 

·      Penile Implants

The implant which is a hydraulic device comprising two hollow cylinders is inserted surgically inside the penis. These cylinders are connected to a fluid reservoir placed in the abdomen and a pump often placed in the scrotal pouch.

Man can pump the fluid inside the cylinder to get the erection as and when he requires and can open the valve to drain the fluid back in to the reservoir causing erection to subside.

Penile implants have enhanced the sex lives of many men, but are not suitable for those having reduced penile sensation or have little or no sex drive.

Premature ejaculation is the condition when a man ejaculates sooner than he wanted to.

This problem experienced by most men in some part of their sex life, but most common in younger men who are beginning their sex life and are still learning how to control their ejaculation.

This is a sensitive and personal issue for men which must be solved easily with the help of the partner. If not resolved in early stages of married life, it could lead to marital conflicts.

There is no hard and fast rule as to when exactly premature ejaculation may occur.

A man may ejaculate before the penis becomes erect, or while he begins penetration, or sometimes be as soon as the penis is inserted.

The situation becomes embarrassing when premature ejaculation occurs on the ‘First Night’ or during first few sexual encounters. This could be either due to uncontrolled sexual excitement or due to lack of control over sexual sensation.

Rarely, premature ejaculation may be due to medical reasons involving nervous system of genitals.

Most cases of premature ejaculation can be treated successfully by the couple themselves with the help of squeeze technique, without needing doctor’s help.

Learning Sexual Communication may help in explaining this situation to the partner and get her support without affecting loving relationship.

In few cases, where person does not respond to the ‘squeeze technique’, option of medical treatment is considered.

Premature ejaculation can be handled by individual himself. But because such lack of control over ejaculation is experienced during marital sexual relations, help taken from the understanding wife is more effective

As wife, you can follow following steps

1.  Stimulate the penis simply by touching over the tip of the penis or by holding the penis in the palm and use up and down movements until he is about to ejaculate

2.  Then hold the penis between the thumb and first finger, by keeping the thumb on the frenulum, where head and the shaft of the penis meet. Press the penis firmly between these two fingers for 10 to 15 seconds till his feeling of ejaculation stops.

3.  During this time, care should be taken not to move fingers. Any such movement may stimulate him further and ejaculation may take place.

4.  Initially sometimes you may experience ejaculation before you get control over it by pressure. This should not be taken as failure. But, next attempt can be done only when he is able to get another erection same day or some time later.

5.   Repeat the stimulation and squeeze procedure till he expresses control over ejaculation even in stimulated condition

6.   Initially you may have to use the process several times before proceeding
for intercourse.

7.   Repeat the same process each time you have sex until he is confident of
performing without it.

8.   You may even start having intercourse without using the squeeze technique,
but get him to withdraw when he is about to ejaculate, and repeat the squeezing process.

9.   Finally move on to sex without squeezing.  With his new-found confidence,
he should gain greater control over his ejaculation.

10.  Helping him to enjoy sex will help in building better and stronger
relationship.

Alternatively, man can signal to his wife during intercourse that he is about to ejaculate. They both become still and stop further movements. Wife can then grip the penis with her vaginal muscles which will stop sensation of ejaculation without losing the erection.

Some men become aroused and maintain an erection but, are not able to ejaculate inside the vagina.

This condition is known as ‘Retarded Ejaculation’ which can be caused by either physical or psychological factors.

Physical causes may include hormonal imbalances, effect of certain drugs (like anti-depressants, anti-hypertension) or too much of alcohol consumption. This situation may also happen in case of spinal injuries.

In most of these situations medical help is indicated.

Psychological causes may include aversion (dislike/hatred) to sex, or a belief that sex is ‘dirty’. Ejaculation may also get delayed when there is fear of losing control over it, or fear of partner becoming pregnant, or when there is anxiety about sexual performance or when woman is more aggressive and expects even more.

Psychological reasons for retarded ejaculation can be handled by therapy with the help of the female partner.

Couple should avoid intercourse for few days and focus on solving this issue.

In a relaxed situation female partner should encourage or help him to masturbate until he experiences orgasm and ejaculates.

Once he is comfortable with getting orgasm, couple can go ahead with sexual intercourse using combination method. That is, masturbation followed by intercourse to ensure he ejaculated inside her.

In this condition the process of arousal and erection is normal. The man also experiences orgasm and ejaculation.

But in some cases, mostly in men with diabetes, the bladder neck does not close properly during process of ejaculation. Thereby spurts of semen get pushed into the bladder. And, the person experiences different sensation during ejaculation

Although there are no physically harmful effects of retrograde ejaculation, it may become cause of infertility.

Timely advice from the doctor can help in solving this condition surgically.

Desire for sex may vary in men to men. It may also be different in the same person at different age or in different situations or with different person.

The sexual desire in men may vary from totally absent or low desire; or may be so strong that it may disturb his personal or married life.

The causes could be psychological, hormonal, or a combination of both.

A woman who faces situation wherein man has absence of or low sexual desire, feels low esteem due to feeling of rejection or not being attractive.

Woman may also be dissatisfied in relationship if man has sexual desire lower than her desire.

A man with relatively lower desire may express higher sexual desire and his sexual energy is raised when he has fallen in love and while courting. But, this desire and urge will drop back to its original level within few months of marriage.

This creates a deep sense of dissatisfaction in wife, especially when his increased desire was due to her higher level of sexual interest in him.

This also suggests that if wife continues her interest by understanding her partner and maintains the loving relationship the lower desire may not disturb their married life.

In this condition opening of urethra is on the side of the head of penis instead of at the tip of the penis. Hence, the person passes urine from the side of the head of penis.

This is a developmental problem which is detected at birth.

Since the semen also uses the same path for ejaculation, the person may find difficulties in sexual relationship.

Usually doctors recommend surgical correction at younger age itself so that person is comfortable during adulthood.