Hello and thanks for trusting me to help you. I am a board certified consultant with over 30 years of experience.
Well as you describe,inability to maintain an erection can be a sign of erectile dysfunction(ED).
Psychological factors such as stress,anxiety,guilt,depression,low self-esteem, and fear of sexual failure,poor performance anxiety cause 10 to 20 percent of ED cases.
In most of the cases,it will improve if they simply stop having sexual intercourse for a while and instead focus on enjoying the physical sensations of pleasure rather than sexual arousal.
Fore play can be very important and help improve erection.
Also regular exercise helps to have a good sexual life.
Monitoring erections that occur during sleep can help rule out certain psychological causes of ED.
Healthy men have involuntary erections during sleep.
If nocturnal erections do not occur, then ED is likely to have a physical rather than psychological cause.
As you are suffering from last few years so you should get your detailed physical examination including blood sugar levels,CBC, urinalysis, lipid profile, serum creatinine and LFT, free testosterone to rule out any systemic physical cause of ED as well.
Further utrasonography of testes, penile nerve test,snap and strain guage test,penile biothesiometry can be done.
Don't put yourself under the scrutiny and just start enjoying it. Things should come back to normal.
You may need psycho sexual therapy which helps to reduce performance anxiety, develop the new sexual skills and knowledge, modify negative sexual attitudes, and improve communication between both of you.
Involving the partners in the counseling process and psycho sexual therapy helps.
Now line of treatment may include
1)Sildenafil (Viagra), vardenafil (Levitra) and tadalafil (Cialis).You didn't get any improvement.
2) Use of intraurethral suppositories,the vacuum device, and intracavernous injection.
3)Placement of a penile prosthesis. This is a surgical option.
4) Combination therapies like
Sildenafil Plus Intraurethral Prostaglandin E1
Oral PDE-5 Inhibitors Plus Intracavernous Injection of Prostaglandin E1
Sildenafil Combined with an Oral Alpha-Antagonist
Intracavernous Prostaglandin E1 Combined with Oral Alpha-Antagonist
Vacuum device and intracavernous injection therapy
Testosterone Plus Sildenafil
For treatment you need to see a Urologist for further evaluation and management.
I hope this helps.
Let me know if you have any further query so we can discuss it thoroughly in every aspect.
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