My Doctor Tells

Mumbai’s #1 Sex Health Clinic

Samadhan Health Studio

Dr. Ashok Koparday
Dr. Hetal Gosalia

Dr. Ashok Koparday | Dr. Hetal Gosalia

Erectile Dysfunction, the condition experienced by a few, but misinterpreted by the majority. ED is more of the mind and less of the penis in the youth, so it is curable to the core. Whereas medicines may be needed for 40+.

  • Are you a man losing erection when you try to insert the penis in the vagina or while wearing a condom?
  • Or do you lose erection during foreplay?
  • Are you the one losing erection during change of position?
  • Do you feel yourself as one who is just not getting the perfect hard-on?
  • Have you lost your morning hood?
  • Or are you the one who feels that your penis doesn’t get hard when you attempt to masturbate?

If you find yourself as one of these persons, then you have arrived at the right place because a sexologist is whom you need; to help you through this. Here we have provided an all-encompassing rundown of erectile dysfunction.

What is Erectile Dysfunction?

Erectile Dysfunction is a sexual dysfunction. In Erectile Dysfunction (ED) a man cannot develop or maintain an erection of the penis during sexual intercourse. We have categorized erectile dysfunction as ‘ED in Youth’ and ‘ED for 40+’.



Excessive Masturbation

Men feel guilty of masturbating excessively and presume that they are unable to have an erection due to the overuse of his organ. But, for the fact of the matter, masturbation is a normal physiological process. Do consider reading our blog post on, ‘Masturbation in Men’.


Men feel that frequent nightfalls cause weakness in the penis. They assume that this results in ED, which is not true. But, for the fact of the matter, nightfall also is a normal biological process. We have addressed this in detail in one of our blog posts ‘Nightfall’.

Tight Foreskin

Men feel that the foreskin which covers the front part i.e. the head of the penis causes ED. Truly to say, the foreskin is not responsible for erection issues. The most common foreskin issues are phimosis and paraphimosis, which we have addressed in detail here.


With age, the erection does not come and sexual life ends, is what men feel. But, it is not true at all. With proper stimulation and the adequate help of medicines prescribed by an experienced sexologist, whatever be the age, men can live a healthy sexual life.


There is no list of symptoms for this. It is clear that erectile dysfunction is the persistent or recurrent inability to perform penovaginal sex. It occurs due to inadequate tightness in the penis.


We at Samadhan Health Studio categorize ED as:
1. Situational ED
2. Organic ED

Differential Diagnosis

Differentiating Erectile Dysfunction between situational or organic is necessary. A detailed history of men suffering from ED by the doctor is taken. In situational ED, emotional factors are figured out by the expert. In contrast to situational ED is purely organic ED, which is because of actual damage caused by diseases such as diabetes or hypertension. Thus, the pathological process is implicated in the causation of Organic Erectile Dysfunction. We now put light on each of these types, its causes, effects, treatment, diagnosis, and prognosis.

Situational   Erectile   Dysfunction

Situational ED can also be termed as Psychological ED,  Temporary ED, or even Psychogenic ED. Here, the man presents himself with TEMPORARY INABILITY in obtaining and/or maintaining an erection. And presumes it is not good enough for satisfactory sexual intercourse. Men when not able to rise to some occasions or with some partners get shaken up and feel that there is a problem with their ‘ORGAN’. These begin as occasional or temporary erection problems which men label as ED for themselves, by themselves. If not managed correctly, the problem worsens leading to weaker erections even during masturbation. We doctors here, call this as ‘TDE’ i.e. ‘Temporary Difficulty in Erection’. A man may not have ED, but the doubt, the apprehension, the belief, just the imagination, and the worry of ED can lead to ‘IMPOTENCE’.

There is no structural abnormality or damage to nerves, blood vessels, or penile tissue in this type of ED. This type of ED has a high rate of complete cure even without medicines. 

Erection in the penis depends upon the most important sex organ the ‘BRAIN’. 

Doubts and Fear about sex decrease the percentage of erection. Shamelessness and Carefree Mind gives maximum erection. When a man labels himself as having erectile dysfunction part of his mind keeps watching his performance which is called spectatoring. Spectatoring further decreases erection because he is not carefree and focused on sexual pleasure. Each failure of getting erection pulls the man 10 steps behind. Not getting an erection once upon a time is itself the cause of not getting an erection every other time.


1. Fear and Performance Anxiety

When there is performance anxiety even a normal man with a normal penis can have difficulty in erection. Wrong ideas about sex and the pressure resulting from, excess desire to impress the partner are the commonest cause of situational ED. Men have unrealistic expectations about sexual functions that the erection of the penis and duration of sex is inadequate to satisfy his partner. They have wrong ideas/beliefs about what satisfies a woman and think they are inadequate. If you feel that you are not able to satisfy your partner, check out our blog post on ‘How to Maximize Female Satisfaction’.

2. Self Doubts

The germ of ‘self-doubt’ creates erectile problems in healthy adult men. Men feel that they won’t be able to satisfy their partner. He assumes that he has side effects of masturbation, nightfall, and an inadequate penis size. This is also one of the causes of situational Erectile Dysfunction.

3. Unconsummated Sex

In about nearly 50% of newlywed couples going for honeymoon, the men have difficulty in erection and are unable to consummate the marriage. They label themselves having ED and suffer in silence and their self-esteem takes a lower ride. This is nothing but the wrong diagnosis of ED, which we have addressed in our blog post ‘Wrong Diagnosis of ED’.

4. Forced Sex for Pregnancy

When the couple is planning for pregnancy, dates for sexual intercourse are given by the gynecologist. The man is conscious and nervous which leads to a lack of erection due to which he labels himself as one having ED.

5. Emotional Disturbance

When a man is not emotionally sound, is under stress due to relationship issues or workplace issues, he may not be in a mood to have sex. Due to this, he may not get his best erection. Since the mind is the greatest sex organ, a happy mood is necessary for an erection.

6. Other Common Reasons

Sometimes, common issues like fatigue, distraction, ignorance, inadequate sexual arousal, or no mood to have sex, may lead to TDE.


  1. It causes marked dissatisfaction and can lead to severe distress amounting to depression. Not getting it up is utterly shameful for a man’s psyche. It can happen in young hunk or elderly people. The man is so crestfallen that he feels he cannot show his face or walk with pride. This is not uncommon in young men having an affair with a pretty woman whom he coveted for long. Some young men feel so low that their embarrassment cannot be described herein words. Then he tries desperately to get an erection, even then he does not get the erection, feels depressed.
  2. It does affect self-esteem and it reflects in work, relationship, and other areas of life. The mind becomes unquiet 24/7.
  3. Marriage comes at a risk, especially among the newlyweds.
  4. Misunderstanding between the couple develops as the partner feels dejected when the man avoids going in bed with her.
  5. Men sometimes do not seek treatment due to feelings of embarrassment which eventually leads to disharmony in life.
  6. Men having TDE, generally avoid their marriage with the thought that ‘How can I get married if, ‘I am not getting a proper erection?’ or ‘How will I satisfy my to-be wife?’ and other similar doubts.


Following are the examples of how the man approaches us, and we doctors at Samadhan Health Studio categorize his Erectile Dysfunction as Situational ED:

  1. Before marriage, the man had a good erection. But, after marriage, he finds it difficult to get an erection.
  2. The man has a good erection when alone, but when with a sexual partner, he doesn’t get that hard-on he used to have.
  3. The man had no problem in achieving and maintaining his erection. Then, once he failed to get an erection after which his erections began to wane just at the time of insertion. Later, he did not get an adequate erection even on watching pornography.
  4. The man is meeting his girlfriend or his ex after a long time. At the time of sexual intercourse, the erection wanes.
  5. He is tired/exhausted/drunk/irritated and finds that the tool, which worked well to date fails to rise to the occasion.
  6. With a prostitute. She usually tells him to drink beer before visiting. Some others scare you.
  7. The man postpones or avoids his marriage giving excuses to family members.
  8. The man gets an erection during foreplay with the partner but loses erection at his attempt of insertion in the vagina.


Nine out of ten people do not get erection at least once by the age of forty.


We at Samadhan Health Studio, prefer to treat situational ED without medicines which include:

1. Cognitive Therapy Counselling
Here the false beliefs about penis size, masturbation side effects, and female satisfaction are corrected by the right knowledge.
The man has to know that it is unpleasant not to get an erection when desired, but it is not a crime. This will facilitate sexual arousal in his limbic system after which the man will get an erection, as he used to.
Erection can come and go. WAXING and WANING or erection is common. After the erection is lost (waned) again erection comes (waxed).
Erection cannot be willed, just like you wish the hand to rise and it happens. Because the arms have voluntary muscles. Thus, raising the hands is under voluntary control, whereas erection is not.

You cannot WILL an erection, but you can GET an erection.

2. Methods of Regaining Erection Naturally
Once the erection is lost during foreplay you need not panic. Don’t get nervous. That’s the key.
Restart foreplay. With your self-confidence intact you are bound to get an erection again.
During sex play sometimes erection decreases, which is ‘waning’ and erection comes back. which is ‘waxing’. Waning and waxing is the way the penis behaves.
So remember to be BINDAS.
A healthy lifestyle and food habits will help you to maintain good erections.
Learn and practice Kegel Exercises.
Sex Joy Therapy distills sensuous pleasure and removes the inhibitory brain signals thus bringing about full erection using your power, without medicine. Sex Joy Therapy eliminates the need of taking medicine to bring about an erection.Do consider checking out our post on ‘Tips to better erection Naturally without Medicines

3. Treatment of ED with Medicines
The use of proper medicine in the right dose prescribed by an experienced sexologist is needed. We request you to not analyze and prescribe drugs for yourself or rely on the local chemist for suggestions. And, don’t ever plan on visiting the BABAs or BAPPUs sitting in TAMBUS selling tablets, powders, ointments, and what not under the name of medicines.
With this treatment procedure that we at Samadhan Health Studio have adopted for treating Situational Erectile Dysfunction, the man gradually regains his confidence. This increase in self-confidence helps him get the erection he desired. Also, in couple therapy, an understanding and cooperative female partner is of huge help.

What a sexologist does?

Patients before approaching us, have a lot of questions like  ‘Why choose a sexologist?’, ‘What will a sexologist do?’ and ‘How will a sexologist help?’ So, here we have listed down the points on why opt for a sexologist and not a urologist or a GP doctor.

Sexologists at Samadhan Health Studio:

  1. Identify anxiety by detail, in-depth case history, which demands time.
  2. Address the underlying issues. Patients may suffer marital distress and can go into a deep depression. We address each of the peripheral concerns.
  3. Give time and 100% privacy to listen to the circumstances of his erection problem.
  4. Address the cause of erectile dysfunction and help uproot it.


For doctors, especially urologists

Telling the guy, “Don’t worry!” is the worst way of managing Erectile Dysfunction. I assure you he won’t worry if it was happening with you.
Please don’t prescribe Viagra (or similar medicine) and send him off in 5 minutes. He will be happy with the magic pill. But now without the Viagra, he won’t be able to do sex. And sex is a natural activity. Another unfortunate thing is that he will fail to respond to Viagra (or similar PDE 5 inhibitor). This will force him to believe that he has a serious problem ‘An INCURABLE Erectile Dysfunction’.

For patients

When you have difficulty getting erection it is important to know the cause of not getting a good erection. Avoid self-medication. Taking medicines like Viagra without consulting a sexologist has risks. One of the risks being, becoming dependent on medicines lifelong.


The problem of erection is cured without medicines under the expert’s advice and you will rise with self-esteem in all fields of life.

If there is progressive and constant failure of achieving erection noticed by the Man along with clinical illness is grouped under organic ED. The man’s personal bedroom life is affected. Sexual intimacy is missing. But the desire for sex to perform is always present whatever be the illness or the age.


  1. Vascular
  2. Neurological & Nerve Disorders
    Spinal Cord injury
    Multiple sclerosis
    Alzheimer’s Disease
    Parkinson’s Disease
    Prostate Surgery
  3. Endocrine Diseases
  4. Side Effects of Drugs

Men not getting an erection start to feel depressed and their self-esteem gets affected. This may lead to relationship discords.


The expert takes a detailed history of the patient. All the medicines which the man is consuming are checked by the doctor here. Needful medicine is then prescribed taking into consideration his health and ongoing medicines. The prescribed medicine must not have any unwanted effects on his clinical state.

Just as you would not take medicines for diabetes or tuberculosis without meeting doctors so too with sex medicines. Sex Medicines are NOT to be taken without meeting and consulting doctors. Ayurvedic medicine also SHOULD NOT be purchased from shops or websites. Meet Ayurveda Doctor. Get examined by a good Ayurveda doctor. The best place to find an Ayurvedic doctor is Ayurveda Medical College and Ayurveda Hospital. Do not purchase BABA’s or BAPPU’s medicines which are sold in TAMBUS. We have covered all methods of treating ED in the WORLD in MEDICAL SCIENCE here.

    1. Oral Medicines
    The oral medicines used for the treatment of Erectile Dysfunction are:
    A. Ayurvedic Medicines
    B. Allopathy Medicines
    These medicines are a boon to people with ED. They are miracle medicines. However, they have to be used with caution. Testosterone patches are seldom required. Testosterone is useful in selective conditions only.
    Principal generic medicines that are taken by mouth are:
    1.Sildenafil which is well-known as Viagra

    2. Vitaros Cream
    The use of DDAIP’s chemical technology enables Alprostadil in the Vitaros Cream to penetrate through the skin into the penis to cause an erection. Sold as Vitaros this cream has been approved as a first line treatment of Erectile Dysfunction in Canada.

    3. MUSE (Medicated Urethral System for Erections)
    It is the treatment for ED by insertion of pellets in the urethra. MUSE contains the medicine Alprostadil which enables erection by inserting a pellet, small tablet, in the urinary opening (urethra). We have addressed this treatment in detail in our blog post ‘MUSE’

    4. Injections given in penis
    Injection of Alprostadil, Caverject Injection of alprostadil, same as Prostaglandin E1 in corpora cavernosa, that is the tissue of the penis, similar to an injection of insulin that people with diabetes take. In penis low doses of a three-drug combination of papaverine, phentolamine, and alprostadil as an injection may be used to treat erectile dysfunction.

    5. Vacuum Device
    This acts by the mechanical action of pulling and pooling blood in the penis tissue to cause an erection. This vacuum device does not require any medicines, hence it is good for those who cannot or do not want to take medicines. Vacuum Device is a hollow tube that is placed over the penis and an apparatus to create negative pressure. To maintain the erection, a constriction ring is placed over the base of the penis.

    6. Shockwave Therapy (ESWT)
    Extracorporeal Shock Wave Therapy ESWT is also available and we have written in detail about this here.

    7. Surgical Penile Implants