Brief Answer:
hi

Detailed Answer:
Hello,
Thanks for your query.
I appreciate your efforts for medical consultation in so much distress.

Important aspects of your query are:
•     40 year old male
•     Known case of hypertension and occasional alcohol use.
•     Complaints of: Erectile dysfunction and premature ejaculation.

In treatment sexual problems first step is to identify cause of the problem. Erectile dysfunction can be a result of a psychological or physical problem.

Psychological causes: Most common cause in young patients. These include performance anxiety, emotional weakness, inferiority complex, stress, marital or relationship problems, low mood, feelings of guilt, and the effects of a past sexual and emotional trauma.

Physical causes: Include neurological disorders, alcoholism, smoking, hormonal imbalances, diabetes, hypertension, blood vessel disease and chronic diseases.

Structural problem: Deform penis and tight foreskin problem.

So, there is need to rule out certain medical conditions which can affect erection. These include diabetes, high blood pressure, heart or thyroid conditions, poor circulation, penile venous incompetency of penis and neurological causes. For that comprehensive evaluation and laboratory tests are needed.

Following steps will help you in ED:
-Monitor your BP and keep it in normal range with treatment.
-quit smoking and alcohol (if you are taking any)
-Eat a healthy diet rich in vitamins, minerals and antioxidants: fruits, milk and eggs
-Exercise, particularly aerobic exercise (like: Jogging, skipping and cycling) daily. It will increase blood flow all over body and will reduce stress.
-The commonly prescribed drug by the doctors is sildenafil (Viagra) or Tadalafil (Megalis), which causes erections to be stronger and long lasting, but should be taken after prescription. It is important to rule out medical conditions specially related to cardiovascular system before starting such treatment. Both of these medicines have excellent result in physical causes of erectile dysfunction.




Premature ejaculation is also 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 (PME) 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 of PME:

-Treatment of above conditions (if present) after examination.

-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.

-In many persons woman on top position increases ejaculation time, so try this position and experiment with other positions also.

-Condoms with desensitizing creams (marketed as Kohinoor extra time) help in increasing ejaculation time. Just wear this as normal condom and start sex after 30 seconds of penile massage, as medicine take some time to act.

-Prescription Medicines like Tab Dapoxetine 2 hours before sex also helpful.

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,

---

Brief Answer:
Hi

Detailed Answer:
Hello again,
Thanks for follow up,

You can meet me to narrow down list of required laboratory tests.

A person can take viagra if there is no cardiac problem history and normal BP currently. Viagra is usually in 50mg doses 1-2 hour before sex, after prescription. Maximum it can be given on alternate day.

TC and happy journey.

---

Brief Answer:
Hi

Detailed Answer:
Hello Mr XXXXXXX

In presence of normal BP with treatment, viagra can be taken.

TC

---

Brief Answer:
Hi.

Detailed Answer:
Hello Mr XXXXXXX

Yes, it is one of its side effect in case of excessive rise in BP. That is why it is taken in physician supervision.

You can take it on alternative day after prescription from nearby physician till you meet me.

TC

---