### instruction:
If you are a doctor, please answer the medical questions based on the patient's description.

### input:
I am an india, from kerala my problem is since 3 years now,,I am engaged and,,but since 3 years now,, i cannot have intercours with my wife. while we are near and start to have sex, my penis will get erect, and when i trying to insert my penis in her vagina suddenly my penis is becoming down and not erecting at all. iam really shame with my wife, what to do I dont know, please you people can help me,,please show me the good suggetion. if any good doctors near by Mangalore Karnataka, please advise me thanks and regards jai

### output:

Hello misunderstand your concerned have erectile dysfunction problem. Treatment depends on the cause of problem first you have to find the cause of the problem. Two main causes: psychiatric problem (severe depression, anxiety, relationship issue), medical cause (obesity, diabetes, enlarged prostate, spinal problem/damage to back nerve, low testosterone, smoking and alcohol consumption, Chronic orchids/epididymitis)Consult the urologist and psychiatric to find the problem after doing following investigation: nocturnal penile tumescence test, intravenous injection test, color Doppler of penile area, hormonal test: FSH, LH, thyroid, Testosterone, lipid profile, blood sugar, CBC, ESR. Doctor may give treatment and advice according to cause like, Engage more in foreplay before sex, avoid stress and get relax while having sex, cognitive behavioral therapy to find defect in the thought process, use double condoms during sex, avoid smoking and alcohol, regular exercise like walking, relaxation exercise and medication 45-60 minutes in the morning, pelvic exercise, try women on top position, take healthy diet and fruits, more antioxidant (almond and COQ tablet)If you did not get better from above advise:take testosterone injection if low testosteroneSildenafil and paroxetine 30 minutes before sex after proper evolution. Hope this may help you Best regards