Brief Answer:
it is not erectile dysfunction

Detailed Answer:
Hello Mr Adarsh,

Thanks for writing to us. I can understand your concern.

First of all I want to clarify about erectile dysfunction diagnosis.

According to DSM 5 definition, Erectile dysfunction (ED) can be diagnosed when person fails most of the time (say more than 50%) in last 6 months during intercourse. You are facing problem just after marriage and not during masturbation as well as morning erection is complete. This means you do not have physical problem likely. It is likely psychological problem.

I get this type of question frequently from newly married couple. After marriage many couples like you suffer from difficulty in sex life. Sometime it will take 3-5 months to reach to normal sex life. Most of them do not have any physical problem. This happens due to fear or anxiety of either of the partner. Treatment is mostly couple counselling about sex.

Let me know more so I can guide you further.

- Do you pay more attention to penis/erection while trying for intercourse?

- How much time do you spend in foreplay?

- How is relationship with wife going on apart from sex life?

- Was she aware that you have taken medicine for sex?

I will be happy to help further after your response.
Regards,
Dr.Chintan Solanki.

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Brief Answer:
it is performance anxiety

Detailed Answer:
Hi,

Thanks for information and sorry for delayed response.

Performance anxiety is likely playing role in your case as you are giving attention to penis.
Sometime due to fatigue, lack of mood, situational problem or environmental changes man can fail in sex. It is normal phenomenon. However when this failure makes person apprehensive about erection, sex life is affected. This is called performance anxiety. After such failure when person actively thinks about erection or success of intercourse during sex/masturbation his mind is likely diverted to such thoughts. For constant erection continuous exciting/romantic/erotic feelings should be there in mind. If mind diverted to concern about erection, erection would not be possible.

While doing sex keep yourself relax.

Whenever you go for sex, spare enough time in foreplay. You should not think actively about erection, your mind must be occupied with sexual/romantic feelings. During foreplay your partner should try to arouse you and note that your penis gets erection or not. When she feels that penis is sufficiently erect she herself should try to put erect penis in vagina gradually and you should continue your foreplay feelings without being conscious about erection. You must try to enjoy and only enjoy.

If your partner is not aware about this situation you can do on your own. You just should try to do sex without being conscious about erection. Enjoy without thinking of your ability of maintaining erection and you will succeed or not.

Do not take viagra. I recommend following supplements.

You can use medicine cum vitamin supplement containing pyridoxal-5-phosphate, mecobalamin and l-methylfolate (trade name tetrafol plus) is very helpful in my patients. It has shown improvement in 50-60 patients of mine with ED. You may get this medicine over the counter as it is vitamin product.

I would like to also mention ayurvedic medicine option. Tentex forte is the medicine which is used for sex related problem. No side effects have been reported.

If I were your treating doctor I suggest one tablet of tetrafol plus after meal twice daily for two months and one tablet tentex forte daily at night with a cup of milk for 4 weeks.

Feel free to discuss further.

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Brief Answer:
these are normal events

Detailed Answer:
Hi,

Thanks for follow up. It is good to hear that you are doing well.

Occasional failure in sex is normal. Like in every cricket match star batsman (like XXXXXXX tendulkar) cannot make century. No need to worry for that.

I will describe treatment of premature ejaculation later in this answer.

Dull penis after sex is normal. It is due to refractory period.In males there is called refractory period after ejaculation and orgasm. This is the period during which it is physiologically impossible for a man to have additional orgasms. The penis may be hypersensitive and further sexual stimulation may feel painful during this time frame. While the refractory period varies widely among individuals, ranging from minutes to days, most men cannot achieve or maintain an erection during this time. Many perceive a psychological feeling of satisfaction and are temporarily uninterested in further sexual activity.There are suggested hormonal, neurotransmitter and muscle fatigue theories to specify refractory period. Average period duration varies from 5 to 45 minutes. But it can be less like 15 minute and more like 1 day also.

During foreplay it is also normal that erection goes up and down. What you have told also suggests that still you are trying to check the erection and that is causing some performance anxiety, try to avoid it.

And last but not the least sex and orgasm are not the only way to stay together happily. Sometime foreplay gives the more pleasure than orgasm. Orgasm lasts for few seconds while foreplay can last for minutes to hours. Outing, candle light dinner and other romantic things also give happy time.

Treatment for PME:

Medicines:
Clomipramine and paroxetine are choice of medicines which are used as antidepressants (For depression dose is higher).
I prefer clomipramine for PME. No significant side effects with these medicines. Initially say for 0-30 days daily after dinner and later on just on the day when you do the sex.
Paroxetine is more potent but it may cause side effects like headache, gastric discomfort, giddiness and sedation. In patients with blood pressure it should be used in consultation with physician/cardiologist.

One molecule called depoxetine has been used specifically for PME and should be taken before 2 hours of sex when required.
These medicines are prescription medicines and you need to consult doctor/psychiatrist/sexologist for prescription.


Behavioral approaches are as follows for your information:

1. Stop and Squeeze technique can be applied which you can learn from internet and ask me if any query in that.(In brief, method suggests that you should try to divert your mind for a moment when you feel ejaculation arousal and penis should be tightly squeezed with hand inwards by your partner preferably).

2. Kegel exercise also helps in some cases. You can learn the same from internet.

3. Sex counselling of your sexual behavior and methods. Like if you are down and female partner on top, gravity is going to help you for lengthening the time.

4. You should do masturbation before sex (at least 2 hours before ). It will make seminal vesicles somewhat empty and at time of sex semen will take more time to come out.

Another approach:
-Use of condoms. Sometime use of condom, while sex, helps in delaying ejaculation by reducing sensitivity of glans penis.

--Topical application of lignocaine anesthetic gel/spray. For this you have to consult doctor.

In general clomipramine is the first choice.


I recommend behavioral approaches whichever applicable in your case.

Clomipramine will be less likely needed.

If still any query there, I will be happy to answer if not, you can close the discussion and if feasible give your feedback and rating so I can improve my service.

In future if you wish you can contact me directly on this site with following link:
http://bit.ly/drchintansolanki

by clicking on 'Ask me a question' on same page with three follow up questions.

All the best.

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