instruction: hello doctor I am a 30 year old male I have been married for one year my problem is low sexual drive I do have morning erections but not regularly when I have sex one to two times a week I do not masturbate otherwise I masturbate two to three times a week unlike having sex I get enormous pleasure when masturbating when masturbating I withdraw for a few seconds when I am about to ejaculate so that I get a long session of masturbation and also a good climax when having sex I do not get the same pleasure when sliding my penis inside her I guess I have a low sexual drive from the past one and a half years I do not feel any arousal when I see her naked but when I watch a porn movie I get aroused sooner I consume himalayan gokshura capsules for vitality for the past one month apart from that no medications I am a strict non smoker and non alcoholic I do have some stress out of workplace and family issues I do not get enough sleep I did my circumcision when I was years old my penis is dry and I feel less sensitivity when having sex I normally ejaculate within five to ten minutes after insertion no medical conditions like seizure of fits but I feel tired at times I had been watching porn for the past several years could that be a reason for my low sexual desire or is it masturbation I had consulted a doctor in the icliniq she prescribed me bupron al 150 my for 15 days I understand that it is an antidepressant will it help to increase my libido are there any short term or long term side effects can I use this pill on a regular basis please help me to overcome this situation
output: hi at the age of 30 the neurological illness diabetes and hypertension are not common so mostly the cause is anxiety and stress for erectile problems stress and worries can make a person distracted even while masturbation when a person watches a porn movie because of the visual content a person cannot have much distraction but when a person is doing masturbation or sex he may have distraction because of stress in addition to this stress and anxiety can cause low sexual desire financial issues work load at job daily hustles conflict with spouse repeated worry about failure in bed and partner satisfaction are the main reason for psychological erectile problems these are the sources of stress what you have to do is forget about the past failures and make a new beginning for initial four to five encounters in sex you should not go for penetration and just enjoy the foreplay spending more time in foreplay helps in holding erection for longer it also helps in identifying the sensitive areas for arousal in your partner the sensitive areas in female are neck nipple clitoris and anterior wall of vagina during foreplay you have to concentrate on these regions after four to five sexual encounters without penetration you can start intercourse and with prolonged foreplay take help from your partner for holding erection longer like oral sex and masturbation by your partner or whatever she is comfortable with if you are not confirmed about your morning erection then you can perform a bedside test like a paper test in this test you have to apply a strip of paper about am around your penis base while it is in the flaccid state it should be tight enough and use gum to stick both the ends of paper around the penis base when your penis gets an erection during the early morning the paper will be ruptured and this will be the positive finding that it gets normal morning erection if you are depressed then take a visit to a psychiatrist and get treated with antidepressants you can visit a good psychiatrist or sexologist in your city and undergo sexual counseling and therapy bupropion can help in increasing your libido continue it other drugs that can be used for the same are pramipexole cyproheptadine etc pramipexole can be started at a dose of 125 my three times a day dose can be increased to 25 my three times a day after one week I suggest you to continue bupropion and wait for one month if you do not find any improvement then change to pramipexole there is no need to worry about circumcision it can cause this abnormality or decrease sensation in penis glans more you ruminate about having a problem more will be the actual problems for anxiety purpose yoga and meditation will be helpful along with jogging or walking I hope this helps