Brief Answer:
performance anxiety is likely, clomipramine improves early ejaculation

Detailed Answer:
Hello XXXXXXX

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

Sex and masturbation are the same function of body and mind to get pleasure just mechanism differs. Problem in one method only suggests there is likely psychological problem.

I want to clarify about performance anxiety and treatment for early ejaculation.

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/ejaculation or success of intercourse during sex/masturbation his mind is likely diverted to such thoughts. For constant erection without ejaculation continuous exciting/romantic/erotic feelings should be there in mind. If mind diverted to concern about ejaculation, early ejaculation occurs.

While doing masturbation keep yourself relax.

Whenever you go for sex, spare enough time in foreplay. You should not think actively about erection/ejaculation, 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 ejaculation. You must try to enjoy and only enjoy.

You seem to be suffering from early ejaculation. In medical language it is called premature ejaculation.

According to the latest diagnostic criteria by DSM 5, premature ejaculation should be defined when there is ejaculation within one minute after entering tin to vagina or even before penetration.

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 20-30 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.

I recommend clomipramine in your case.

Hope I have answered your query, I will be happy to help further.
Regards,
Dr.Chintan Solanki.

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