Sex problems or sexual problems refer to any physical or emotional issue that prevents an individual or couple from achieving satisfaction from the intimate relationship and sexual activity. It can happen at any phase of sexual activity. The most common causes can be classified into psychogenic or organic factors.

Organic factors or physical cause include many physical and/or medical conditions such as Diabetes Mellitus, cardiac problems, vascular diseases, neurological disorders, hormonal imbalances, chronic diseases of liver and kidney,  side effects of certain medications, alcoholism, drug addiction etc.

Psychological causes include mental stress, anxiety and concern about sexual performance, marital discord and relationship problems with the partner, past traumatic experiences, guilt feelings, mental diseases etc.

From our experience of treating thousands of patients with sexual problems from Kerala and outside, it is found that 99% of men complaints of small penis merely got an apprehension and doubt about the size of their sexual organ. It is only a concern, and not a fact. The size of flaccid penis is immaterial and it will keep on changing based on the atmospheric and body temperature. Most men worry about the size of the flaccid penis. The only published research study conducted in India on penile size is from Dr. Promodu’s Institute of Sexual & Marital Health which is published in the International Journal of Impotence Research (2007, 19,558-563). The mean erected length is found to be 13.01 cm with a SD of 1.62 cm.  The summary of this study is available at the Institute’s website (www.drpromodusinstitute.in) and the full paper is available in the internet at the journal’s site.

One need not worry about the penile size. You may consult a doctor practicing modern medicine and can examine your body to alleviate your apprehensions.

A lot of cheating and exploitation with false claim / advertisements of medicines / instruments to increase the size of the penis is happening. Hence public should guard themselves against such unscrupulous elements.

No, it is not a disease. The size of the flaccid penis is immaterial and it will keep on changing based on the atmospheric and body temperature. Most men worry about the size of the flaccid penis

From our experience of treating thousands of patients with sexual problems from Kerala and outside, it is found that 99% of men complaints of small penis have merely got an apprehension and doubt about the size of their sexual organ. It is only a concern, and not a fact. The only published research study conducted in India on penile size is from Dr. Promodu’s Institute of Sexual & Marital Health which is published in the International Journal of Impotence Research (2007, 19,558-563). The summary of this study is available at the Institute’s website site and full paper at the journal's website.

You need not worry about the penile size, consult a doctor practicing modern medicine who can examine your body and alleviate the apprehensions. A lot of cheating and exploitation with false claim / advertisements of medicines / instruments to increase the size of the penis is happening. Hence public should guard themselves against such unscrupulous elements.

Erectile dysfunction is an inability to achieve or maintain an erection sufficient enough to have a successful, satisfactory sexual intercourse. Erectile dysfunction is one of the most common sexual problems of men reported world over. In Kerala, South India erectile dysfunction is the most common sexual problem observed. Out of the 4003 patients with sexual problems seen at Dr Promodu’s Institute from February 01, 2006 to January 31, 2011 erectile dysfunction accounts for 42 percent. The number of people seeking treatment for sexual problem in general and erectile problem in particular is increasing day by day.  Erectile dysfunction is also known as impotence, male erectile disorder, erectile disorder, erection problem etc. Both organic and psychogenic impotence are included here.

There are multiple causes for erectile dysfunction. It can be broadly classified into organic and psychogenic causes. Organic causes include the presence of any systemic illness, side effects of medicines, hormone imbalances, problems with the blood circulation to the penis, neurological problems etc. Psychogenic causes include performance anxiety, unhealthy mental state, depression, anxiety, past traumatic experiences, relationship problems with the partner etc. What ever may be the cause there is effective treatment for erectile problems.

Pain on the penis during sexual intercourse can be due to many reasons such as infections, trauma, or other diseases. Excessive manipulation can sometimes lead to temporary pain. At the same time, painful lesions or sores on the penis like genital herpes or another infection can cause pain. Inflammation of the prostate gland, infection in the urinary bladder or urethra, fungal infections such as balanitis, sickle cell anaemia, lack of lubrication inside the vagina, etc can also cause penile pain. A condition known as peyronie's disease results in an abnormal curvature of the penis that makes intercourse painful for a man. In rare instances, pain may be a sign of cancer of penis.

If the erection persists for more than 4 hours, experience pain and not due to continuous sexual stimulation or desire this condition is called priapism. In the normal condition sexual stimulation leads to increase in blood to flow into the penis which results in an erection.  After ejaculation or the stimulation is discontinued, the blood drains and the erection recedes. When priapism occurs, blood that is sent to fill the penis becomes trapped, causing the erection to remain without relief. This condition is painful if left untreated for a long time it can result in scarring inside the penis, and sometimes, permanent erectile dysfunction. Priapism can occur in any male, even newborns, but most commonly develops between the ages of 5 and 10 years and 20 and 50 years. Treatment includes applying ice packs, intracavernosal injections, cavernosal wash, aspirating blood from the penis etc. Occasionally surgery is necessary to restore proper blood flow and drainage.

There are different causes for premature ejaculation. This may be due to some kind of infection in urinary bladder, urethra, prostate gland or seminal vesicles. Inflammation of the prostate gland is a cause of PE. Hypersensitivity, habituation, performance anxiety, stress etc also can lead to PE.

Yes, there is effective treatment for premature ejaculation. First the cause should be identified. Treatment is planned based upon the cause. Different methods of treatments are available such as medication, sex therapy, anxiety management, or a combination of all this. To decide the type of treatment one needs to undergo a clinical evaluation, physical examination and investigations. With out that it cannot be treated. Definitely there is a cure for this problem. Effective treatment can be provided by a team of doctors including sex therapist, andrologist and marital therapist.

This condition is called as Dyspareunia.  This can be due to various reasons such as lack of lubrication in the vagina (vaginal dryness), a decrease in female hormones leading to vaginal dryness, the presence of yeast or other infections like cystitis, Urethritis (infections of the urinary tract), sexually transmitted diseases etc. A condition known as Vulvar Vestibulitis, any inflammation in a particular area of the vagina, is the most commonly overlooked cause of Dyspareunia. Any pelvic inflammatory disease can lead to pain during sexual intercourse.

A specific condition known as Vaginismus causes involuntary spasms of the muscles within the vagina. They can be so strong, the vagina seals shut making penetration extremely painful or sometimes, impossible. This is due to psychogenic cause.

Recently I had sex with my boy friend on a few occasions. Actually we were planning to marry. Later on I got information that he had sex with some others also and I stopped this relationship. We used condoms every time, but I'm not sure if it was enough protection against HIV. One of my friends told that HIV can get through the small holes in the rubber. Is it correct? I am scared of HIV. Is there any chance for to get the infection?
It is very unlikely for you to get an infection if your partner had used condoms when ever you had sexual intercourse. There are no holes in the condom. If used properly, condoms are some what good protection against HIV and many other sexually transmitted diseases.

Yes! You can get pregnant the first time you have sex if it is during your fertile period that is the ovulation time. If you want to avoid pregnancy, you should use birth control methods right from the first time you have sex.

No, you can’t. Swallowing semen is the same as eating something that passes through your digestive system. It can’t make you pregnant because your mouth or digestive system doesn’t have any connection with your reproductive system. But remember that you can get sexually transmitted diseases through oral sex if your partner is infected. So you should use a condom during oral sex.

Premature ejaculation is a condition in which the male partner ejaculates before he or his partner wishes. WHO defines premature ejaculation as the inability to control ejaculation sufficiently for both partners to enjoy sexual interaction. In severe cases, ejaculation may occur before vaginal entry or in the absence of erection. In short premature ejaculation is the inability of a man to control the ejaculation till the completion of sexual intercourse in such a way that both partners achieve full sexual satisfaction. Premature ejaculation may be classified as lifelong or acquired. Life long PE may begin during teenage. Acquired PE is secondary to other conditions.

Non consummation of marriage or an inability to engage in sexual intercourse could be due to various reasons. Husband's inability to achieve and maintain sufficient erection for penetration (erectile dysfunction), ejaculating prior to the attempt of penetration (premature ejaculation), wife fear to cooperate for sexual intercourse, pain during the attempt, lack of interest of any one partner, dislike towards the partner, wrong positions, wrong methods, lack of knowledge of the couple etc can cause this problem. There is treatment for this problem. Both husband and wife need to undergo a clinical evaluation by a team of doctors consisting of Sexologist, Andrologist and Gynecologist. By proper evaluation the cause can be identified and treated successfully.

No. It depends on each individual's condition. For some women hymen may be intact and may experience a little pain and bleeding when it is ruptured during the first intercourse. This is one of the most common causes of pain during the first intercourse. The hymen can rupture due to several reasons such as exercise, dancing, jumping, running or some other causes. If the hymen is already broken women may not experience bleeding or pain. Many other physical and psychological factors like infections, tightness of vagina, fear of injury or pain, relationship problems etc can lead to pain. Couple needs physical examination and treatment if the pain persists indefinitely. What ever may be the cause it can be identified and treated successfully.

Safe period is the time in a woman's menstrual cycle during which there is no chances for conception. Ovulation period is the known as the fertile period. Safe period can be calculated correctly only if the periods had been regular for the previous 6 months. The normal menstrual cycle is 28 days, usually varies from 26 to 31 days with several days at the beginning that are infertile (safe), a period of fertility (fertile or ovulation period), and several days just before the next menstruation that are infertile (Safe). If it is a 28 days cycle ovulation is expected on the 14^th day. The first day of bleeding is considered as day one of the menstrual cycle. Days 1 to 7 and day 21 to rest of the cycle is calculated as "Safe Period" for individuals with regular 26-30 days cycles. In simple terms one week prior to and one week from the first day of a menstruation can be considered safe. But please remember that the so called safe period need not be safe always. It can go wrong when ever the periods become irregular.

There are different causes for low sperm count.  This condition is known as Oligospermia in medical terms. Causes may vary form an infection to testicular damage. One of the most common causes is variocele. When consider the treatment, the first step to success is identification of  accurate cause. If the cause is identified then the treatment is very easy. Different investigations are available to detect the cause. One has to undergo these tests in a step by step manner under the guidance of a well experienced Andrologist. This condition can be treated and corrected. Earlier the better. If the treatment is taken after developing Azoospermia (absence of spermatozoa) the chance of recovery becomes low.