Hello doctor, I am a 47-years-male. I am still unmarried and virgin. I am struggling with a humiliating problem and unable to contact any andrologist directly. Hence, I am humbly requesting your kind help with your valuable advice. When I was 27, I was unable to get sexual erection though impulse was there. I contacted a local urologist, he gave me Papaverine injection to my penis and advised to use Libidol tablets at that time. I did not find any improvement. Later, I approached a famous sexologist in our city. He said nothing is wrong in me and wrote Mustang, Alprazolam and Fluoxetine tablets. Accordingly, I used, but no result I observed. My sister is a gynecologist and I gone through her old medical books for sexual impotence and gathered some information on various tests. Later, when I was 29 years, again I met the same urologist and expressed my willingness to go for a Doppler ultrasound test and attended, which revealed that there was arterial insufficiency. Basing on the report, the urologist suggested me to go to a particular place to approach famous andrologist there. I went and met the andrologist. He conducted the Rigiscan test for two days and gave Prostaglandin E1 to my penis and injected some distilled water into my penis through the machine for maximum enlargement of the penis and suggested me to use simply Nuzak capsules (Fluoxetine content) without saying any further. Again I approached our local famous sexologist and showed the reports. He said nothing wrong with me. I asked him whether to go for hormonal tests also. Based on my interest, he suggested me to go for FSH, LH, serum prolactin and testosterone tests. In that hormone test, he identified that the serum prolactin level is more than the specified range (around 1%) and hence suggested me to use Proctinal tablets half tablet a day for 30 days. I followed his instructions accordingly and after some time, I observed good and long-lasting erections and maximum enlargement of the penis when attained erections. Sometimes, due to foreskin, a little bit of discomfort also caused when penis maximum enlarged due to erection. I used to get excellent erections both day time and night time. As I said, still I am a virgin and whenever I failed to control myself, I used to do masturbation. But within 30 minutes, I used to get excellent erections further. This was happened until I attained 43 years. Later, there is a gradual change and now not getting day time erections and during night sleep. I observed though there is an erection, I am getting around 50% hardness only and not getting good erection and maximum enlargement of penis as earlier. I do not have any sugar or BP issues. I never took alcohol and I am purely vegetarian. Now I am getting pressure for marriage. I am unable to take a decision whether to go for or not keeping in view the sexual erection problem. I do not know whether I can make happy of my lady and give birth to a child. I saw that Aswagandha capsules boost sexual erections and hence using for the past one month. Also read in websites that horny goat weed (750 mg) with maca (150 mg) also gives good results in correction of erectile dysfunction and hence, recently bought one and using for the past one week one tablet per day. Some websites also suggesting to use Pycnogenol with L arginine for good erections. However, I would like to have a specialist consultation. Hence, could you please help me by guiding the way I have to follow to get rid out of this embarrassing problem? Also, suggest to me whether horny goat weed with maca is good or bad. If any medication is suggested, I can follow it. Earlier, I gone for self hormonal tests and found all FSH, LH, serum prolactin and testosterone were within the normal range. If you need any more clarification, I can provide you. Could you please also guide me till what age, a person gets strong erections to perform sexual inter course?
Hi. I have read through your query in detail. Please find my observations below. The normal prolactin levels in males are 2 to 18 ng/mL. If your latest prolactin levels are in normal range then it is acceptable. You have mentioned earlier that there was arterial insufficiency due to which there was no proper erection. It is important to know if there is any persisting arterial insufficiency right now. If it is found then this should be treated first. Surgical treatments are available but non-surgical treatments should be first applied. Following treatment guidelines might be of help to you. Please note that every treatment might not bring about a good results in every patient and one or more treatment options should be used to watch for positive outcomes. The treatment for erectile dysfunction is the following. 1. Life style changes including a healthy diet, free from mental stress and avoiding alcohol and smoking. 2. Physiotherapy and sex therapy (this is only for those who are in a relationship). 3. Any androgen deficiency due to age is to be corrected. For this testosterone levels are to be measured and medicines like L-carnitine or DHEA (dehydroepiandrosterone) are given. 4. Phosphodiesterase type 5 (PDE5) inhibitors like Sildenafil, Vardenafil or Tadalafil might show positive results when given in the recommended dose. 5. If there is hyperprolactinemia then medicines are there to reduce prolactin level. 6. If above does not work then intracavernosal injections might help under medical supervision. 7. The transurethral administration of Alprostadil (Prostoglandin E1) gel also helps many patients. 8. There are special vacuum devices which can be used with intracavernosal injections or PDE 5-inhibitors. 9. Ligation of penile veins and arterial revascularization are the surgical methods used. It is important to know that please try the above methods of treatment under medical supervision one at a time and know which is the most suitable treatment. The sexual performance of a male decreases after 40 years and is more on decline after 60 years. At 47 years, you should get a semen analysis done to know the quality of sperms produced and if it is favorable for pregnancy. The choice of adoption of children is always there if you are not able to have children in the natural method. I hope this helps.