Brief Answer: Below steps will help you. Detailed Answer: Hello, Thanks for your query. I appreciate your efforts for medical consultation in so much distress. Important aspects of your query are: • 48 year old male • Known case of Erectile dysfunction (ED) and Premature ejaculation (PME) • Currently on Tfil10 mg for erection and sustinex 30 mg for ejaculation • Complaints of: Poor response to PME Premature ejaculation is a very common and treatable problem. Premature ejaculation is diagnosed when ejaculation time is less than 3 Min, or both partners are not satisfied with sex. Premature ejaculation (PE) is common problem and depends on multiple factors like: *Psychological factors: most common. The psychological factors may include stress, performance anxiety and depression *Medical causes: Reflex activity of ejaculatory system, thyroid problems, diabetes, hypertension, excessive alcohol use and neurological causes. Following steps will be helpful for treatment: -Treatment of above conditions (if present) after examination. -In many persons woman on top position increases ejaculation time, so try this position and experiment with other positions also. -Start jogging in morning for 20-30 minutes daily, as it reduces performance anxiety and improve blood circulation. - Try distracting yourself when you feel you are about to ejaculate. Take a deep breath and stay relaxed during intercourse. - Do not worry about performance and talk to your partner openly about any apprehensions if you have. Conversation with partner during sex also delay ejaculation. - Stop-start technique- In stop start technique, near ejaculation stop all movements, relax and think about something else. Then wait for 1 minute before starting movements. According to number of stops, ejaculation time will come under your control. -Squeeze- pause technique: squeeze the end or the tip of the penis for 10 to 20 seconds when you are close to ejaculation and then resume stimulation after withholding for half a minute. -Sustinex contain dapoxetine. It is used 1-2 hour before sex. Check if you are taking it at-least 1 hour before sex. Try to check response by taking it 2 hour before sex. It is a SSRI group of medicine and used on demand basis. If response is poor then you can also try other SSRI medicine which is taken daily like escitalopram 5mg. -Condoms with desensitizing creams (marketed as Kohinoor extra time) help in increasing ejaculation time. I hope this information has been both informative and helpful for you. In case of any doubt, I will be available for follow ups. Wish you good health. Regards,

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