I’ve been facing difficulty in getting or maintaining an erection during sexual activity. I’d like to know the possible causes and treatment options.

Question #14234

160 days ago

268

I’ve been facing difficulty in getting or maintaining an erection during sexual activity. I’d like to know the possible causes and treatment options. - #14234

Humayun Khan

Hello Doctor, I have been facing some difficulty in maintaining a proper erection. I have diabetes, but it is well controlled. I would like to know if I can take Sildenafil, and if yes, what dosage would be safe to start with. Kindly advise.

Age: 39

Chronic illnesses: Hello Doctor, I have been facing some difficulty in maintaining a proper erection. I have diabetes, but it is well controlled. I would like to know if I can take Sildenafil, and if yes, what dosage would be safe to start with. Kindly advise.

300 INR (~3.53 USD)

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Doctors' responses

Dr. Shayeque Reza

I completed my medical degree in 2023, but honestly, my journey in healthcare started way before that. Since 2018, I’ve been actively involved in clinical practice—getting hands-on exposure across multiple departments like ENT, pediatrics, dermatology, ophthalmology, medicine, and emergency care. One of the most intense and defining phases of my training was working at a District Government Hospital for a full year during the COVID pandemic. It was chaotic, unpredictable, and exhausting—but it also grounded me in real-world medicine like no textbook ever could. Over time, I’ve worked in both OPD and IPD setups, handling everything from mild viral fevers to more stubborn, long-term conditions. These day-to-day experiences really built my base and taught me how to stay calm when things get hectic—and how to adjust fast when plans don’t go as expected. What I’ve learned most is that care isn't only about writing the right medicine. It’s about being fully there, listening properly, and making sure the person feels seen—not just treated. Alongside clinical work, I’ve also been exposed to preventive health, health education, and community outreach. These areas really matter to me because I believe real impact begins outside the hospital, with awareness and early intervention. My approach is always centered around clarity, empathy, and clinical logic—I like to make sure every patient knows exactly what’s going on and why we’re doing what we’re doing. I’ve always felt a pull towards general medicine and internal care, and honestly, I’m still learning every single day—each patient brings a new lesson. Medicine never really sits still, it keeps shifting, and I try to shift with it. Not just in terms of what I know, but also in how I listen and respond. For me, it’s always been about giving real care. Genuine, respectful, and the kind that actually helps a person heal—inside and out.

160 days ago

This requires personal consultation.
Counselling is needed before treatment initiation.

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Dr. Bharat Joshi

I’m a periodontist and academician with a strong clinical and teaching background. Over the last 4 years and 8 months, I’ve been actively involved in dental education, guiding students at multiple levels including dental hygienist, BDS, and MDS programs. Currently, I serve as a Reader at MMCDSR in Ambala, Haryana—a role that allows me to merge my academic passion with hands-on experience. Clinically, I’ve been practicing dentistry for the past 12 years. From routine procedures like scaling and root planing to more advanced cases involving grafts, biopsies, and implant surgeries. Honestly, I still find joy in doing a simple RCT when it’s needed. It’s not just about the procedure but making sure the patient feels comfortable and safe. Academically, I have 26 research publications to my credit. I’m on the editorial boards of the Archives of Dental Research and Journal of Dental Research and Oral Health, and I’ve spent a lot of time reviewing manuscripts—from case reports to meta-analyses and even book reviews. I was honored to receive the “Best Editor” award by Innovative Publications, and Athena Publications recognized me as an “excellent reviewer,” which honestly came as a bit of a surprise! In 2025, I had the opportunity to present a guest lecture in Italy on traumatic oral lesions. Sharing my work and learning from peers globally has been incredibly fulfilling. Outside academics and clinics, I’ve also worked in the pharmaceutical sector as a Drug Safety Associate for about 3 years, focusing on pharmacovigilance. That role really sharpened my attention to detail and deepened my understanding of drug interactions and adverse effects. My goal is to keep learning, and give every patient and student my absolute best.

160 days ago

Hello sir
See before taking any medication
I would like to suggest some curative and preventive measures for better clarity
Avoid heavy meals and alcohol
Take ashwagandha or triphala once a day for 2 months
Do meditation
Do physical exercises atleast for half an hour
Especially kegel exercises atleast half an hour daily
Take shilajeet once a dayfor 1 month once a day .
Also take triphala/ ashwagandha onca a day for 1 month
In case of no improvement in 1 month,
kindly consult gynaecologist for further
clarification
Regards
Hopefully you recover soon
Regards

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Dr. Prasannajeet Singh Shekhawat

I am a 2023 batch passout and working as a general physician right now, based in Hanumangarh, Rajasthan. Still kinda new in the bigger picture maybe, but honestly—every single day in this line teaches you more than textbooks ever could. I’ve had the chance to work under some pretty respected doctors during and after my graduation, not just for the clinical part but also to see how they handle people, real people, in pain, in panic, and sometimes just confused about their own health. General medicine covers a lot, right? Like from the smallest complaints to those random, vague symptoms that no one really understands at first—those are kinda my zone now. I don’t really rush to label things, I try to spend time actually listening. Feels weird to say it but ya, I do take that part seriously. Some patients just need someone to hear the whole story instead of jumping to prescription pads after 30 seconds. Right now, my practice includes everything from managing common infections, blood pressure issues, sugar problems to more layered cases where symptoms overlap and you gotta just... piece things together. It's not glamorous all the time, but it's real. I’ve handled a bunch of seasonal disease waves too, like dengue surges and viral fevers that hit rural belts hard—Hanumangarh doesn’t get much spotlight but there’s plenty happening out here. Also, I do rely on basics—thorough history, solid clinical exam and yeah when needed, investigations. But not over-prescribing things just cz they’re there. One thing I picked up from the senior consultants I worked with—they used to say “don’t chase labs, chase the patient’s story”... stuck with me till now. Anyway, still learning every single day tbh. But I like that. Keeps me grounded and kind of obsessed with trying to get better.

158 days ago

Hello Humayun
By going through your history and evaluation of your health status i am recommending you following medicine -
Rx - 1) Tab Autrin
1 tab daily after food for 2 months
2) Tab ashwagandha 500
1 tab twice daily after food for 2 months
3) Tab tadalafil 10mg
2 times a week
Investigation:
CBC, ESR
Thyroid Profile (TSH, T3, T4)
Fasting Blood Sugar & HbA1c
Vitamin B12 & D3
Testosterone (Total & Free) – for stamina/libido concerns
Thank you

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Dr. Arsha K Isac

I am a general dentist with 3+ years of working in real-world setups, and lemme say—every single patient teaches me something diff. It’s not just teeth honestly, it’s people… and how they feel walking into the chair. I try really hard to not make it just a “procedure thing.” I explain stuff in plain words—no confusing dental jargon, just straight talk—coz I feel like when ppl *get* what's going on, they feel safer n that makes all the difference. Worked with all ages—like, little kids who need that gentle nudge about brushing, to older folks who come in with long histories and sometimes just need someone to really sit n listen. It’s weirdly rewarding to see someone walk out lighter, not just 'coz their toothache's gone but coz they felt seen during the whole thing. A lot of ppl come in scared or just unsure, and I honestly take that seriously. I keep the vibe calm. Try to read their mood, don’t rush. I always tell myself—every smile’s got a story, even the broken ones. My thing is: comfort first, then precision. I want the outcome to last, not just look good for a week. Not tryna claim perfection or magic solutions—just consistent, clear, hands-on care where patients feel heard. I think dentistry should *fit* the person, not push them into a box. That's kinda been my philosophy from day one. And yeah, maybe sometimes I overexplain or spend a bit too long checking alignment again but hey, if it means someone eats pain-free or finally smiles wide in pics again? Worth it. Every time.

160 days ago

Hello,
Please consult your urologist or diabetologist before starting Sildenafil to confirm it’s safe with your current health and medicines.
They can also screen for hormonal or vascular causes and suggest long-term management.
You can likely use Sildenafil safely at 50 mg as a starting dose, if you’re not on nitrates and your heart health is stable.
Maintain good diabetic control, exercise, and follow up with your doctor for tailored advice.
You can check hormonal profile
Due to diabetes,blood flow to the penis also get affected.
Anyway my advice is please consult your physician first ,then start taking medicine
I trust this helps
Thank you

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Dr. Aarav Deshmukh

I am a general physician with 8 years of practice, mostly in urban clinics and semi-rural setups. I began working right after MBBS in a govt hospital in Kerala, and wow — first few months were chaotic, not gonna lie. Since then, I’ve seen 1000s of patients with all kinds of cases — fevers, uncontrolled diabetes, asthma, infections, you name it. I usually work with working-class patients, and that changed how I treat — people don’t always have time or money for fancy tests, so I focus on smart clinical diagnosis and practical treatment. Over time, I’ve developed an interest in preventive care — like helping young adults with early metabolic issues. I also counsel a lot on diet, sleep, and stress — more than half the problems start there anyway. I did a certification in evidence-based practice last year, and I keep learning stuff online. I’m not perfect (nobody is), but I care. I show up, I listen, I adjust when I’m wrong. Every patient needs something slightly different. That’s what keeps this work alive for me.

158 days ago

Erectile dysfunction can indeed be related to diabetes, even if it is well controlled. Diabetes can affect blood flow and nerve function, which are crucial in maintaining an erection. You’re right to consider Sildenafil, as it’s a common oral medication used for treating erectile dysfunction by increasing blood flow to the penis. However, before starting Sildenafil, an evaluation of your cardiovascular health is necessary, since the medication can have implications on the heart and blood pressure. Assuming no contraindications such as severe heart disease or concurrent use of nitrates (which can lead to a dangerous drop in blood pressure), Sildenafil can generally be started at a low dose. The initial recommended dose is often 50 mg taken approximately one hour before sexual activity, though doses can range from 25 mg to 100 mg depending on effectiveness and tolerance. This should not be used more than once per day. You should be aware of potential side effects like headaches, flushing, or dizziness. It’s always a good idea to discuss the use of Sildenafil with your healthcare provider first, to ensure it’s safe given your overall health profile and any other medications you may be taking. They might also investigate other potential causes of erectile dysfunction, such as changes in lifestyle, stress levels, or psychological factors, which might be contributing or could be targeted alongside medication to improve outcomes. Make sure to seek professional medical advice if you experience any unusual symptoms or if erections become painful or prolonged, as these can require immediate attention.

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Dr. Nirav Jain

I am a qualified medical doctor with MBBS and DNB Diploma in Family Medicine from NBEMS, and my work has always been centered on treating patients in a complete, not just symptom based way. During my DNB training I rotated through almost every core department—Internal medicine, Pediatrics, Obstetrics & Gynecology, Surgery, Orthopedics, ENT, Dermatology, Psychiatry, Emergency medicine. That mix gave me the skill to manage acute illness, long term disease and preventive care together, something I find very important in family practice. In psychiatry I worked closely with patients who struggled with depression, anxiety, stress related problems, insomnia or substance use. I learned not just about medication but also about simple psychotherapy tools, psycho education and how to talk openly without judgement. I still use that exp in family medicine, specially when chronic disease patients also face mental health issues. My time in General surgery included assisting in minor and major procedures, managing wounds, abscess, sutures and emergencies. While I am not a surgeon, this gave me confidence to recognize surgical cases early, provide first line care and refer fast when needed, which makes a big difference in online or OPD settings. Now I work as a consultant in General medicine and Family practice, with focus on both in-person and online consultation. I treat conditions like fever, infections, gastrointestinal complaints, respiratory illness, and also manage diabetes, hypertension, thyroid disorders, and lifestyle related chronic diseases. I see women for PCOS, contraception counseling, menstrual health, and children for common pediatric issues. I also dedicate time to preventive health, lifestyle counseling and diet-sleep-exercise advice, since these small changes affect long term wellness more than we often realize. My key skills include holistic diagnosis, evidence based treatment, chronic disease management, mental health support, preventive medicine and telemedicine communiation. At the center of all this is one thing—patients should feel heard, safe, and guided with care that is both professional and personal.

158 days ago

Thank you for opening up about this, Humayun. Erectile issues are quite common, especially among men with diabetes, and the good news is they’re usually treatable once we identify the cause and manage it properly.
Erectile dysfunction in diabetic men often happens because long-term diabetes can affect blood flow and nerve function in the penis. Even with good sugar control, mild changes can persist.
Kindly get done these tests before starting any medications - HbA1c, Lipid profile, Sr. testosterone, RFT and a BP check (as sildenafil can lower BP).
And about starting medications, it’ll be best for you to consult a certified psychiatrist or a Family Physician first, as he/she needs to get a proper history and stress evaluation. You can take an online consult from me as well, as I’m a Family Physician.
Sildenafil can cause interactions/reactons with other medicines, so need to get all medicine details from you.
Till then, you can start with these lifestyle changes - Exercise daily, it improves blood flow and testosterone levels. Sleep 7–8 hours nightly. Limit stress.
Feel free to reach out again.
Regards,
Dr. Nirav Jain
MBBS, DNB D.Fam.Med

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