instruction: hello doctor I am a 31 year old male I am married for the last six years before getting married there was an incident where I had a sexual encounter with a girl however during this I had erectile dysfunction so after about one year I got married to my long term friend in the initial three to four months I had issues of not being able to maintain an erection however over time we adjusted to a pattern and we got over it after about six months we have been having frequent sex over the last four to five years however throughout this time maintaining the erection for more than say 10 mins has always been impossible recently I had a sexual encounter with another girl but had a lot of problems in getting the erection and maintaining it I have a well built physique and do regular exercise and play games my weight is 89 keg and height is around 10 I am a heavy nonvegetarian and eat lots of fish chicken and beef after the above incident I have started doing a bit of diet control along with my regular exercise I also have an inguinal hernia over the last few years and I am planning to get it operated soon I have been thinking of buying tented royal but wanted to take advice from you before going ahead with any medication
output: hello from your query I could infer that you had difficulty in getting and maintaining an erection with the new girl only you were able to have frequent and normal sex with your wife before the encounter with the above said girl it means that the cause for erectile dysfunction at the incident was due to performance anxiety which is purely situational and psychological hence nothing to worry much about physical causes and be relaxed and enjoy your sexual life with your wife and masturbation once in a while I will not recommend any such enhancers like tented royal as it makes you feel that you lost your vigor and you have regain which is not real what you lost is your confidence which you need to regain exercise yoga etc can make you fit which in turn improves your sexual life if you are so much worried about physical causes then you need to do routine blood and urine test serum testosterone fasting state fbi fasting blood sugar and pubs post prandial blood sugar ash thyearoid stimulating hormone prolactin these are basic tests for male dysfunction do mention about the frequency of masturbation erection status during masturbation early morning erections etc