Brief Answer:
Detailed advise and suggestions given...

Detailed Answer:
Hello again and thanks for your clarifications.

You have mentioned that you are suffering from two sexual problems, namely Premature ejaculation and Erectile dysfunction.

Firstly, regarding your problem of pre-mature ejaculation, this very common problem in young males. Now, the good news is that in more than 90% of persons with this sexual problem, there is no medical abnormality causing this. Most of the times, the underlying causes are the following:

1) A hypersensitive response of the penis

2) Anxiety / fears / doubts about inadequate sexual performance (called as "performance anxiety")

So, keeping this in mind, I would like to give you the following advise to overcome this problem:

1) Firstly get rid of thoughts that you may be sexually inadequate or your doubts that you may not be able to perform properly. Like I mentioned before, performance anxiety, feelings of sexual indequacy, self-doubts, etc. can all affect sexual functioning and performance. So, removing the person's doubts and fears, and improving his self-confidence levels will definitely help in improving sexual performance. Remember that sex is not just a physical act but also a psychological process involving an expression of emotions, intimacy and love. So, just involve yourself in those feelings and stop focussing on your "performance" alone. Once you do that, then I assure you that your sexual performance will automatically improve.

Most importantly, performance anxiety soon becomes a "viscious cycle" That is, anxiety leads to poor performance and poor performance then leads to further anxiety and this keeps on increasing. So, the key is to break this cycle at some point of time and take control of yourself.

2) The other main cause for pre-mature ejaculation is hypersensitivity of the penis to touch sensations. Now, there are certain specific sexual techniques which can reduce this hypersensitivity. The "stop-start technique" or "squeeze technique" have been proven to be successful in reducing this hypersensitivity and increasing the ejaculatory time.

In the stop-start technique, the penis is stimulated (by sexual intercourse or by masturbation) till a point when you feel close to orgasm. At that point, the stimulation is stopped for some time and after a small gap, it is continued. This process is repeated repeated a few times.

In the squeeze technique, the penis can be stimulated by hand (by masturbation or by your partner) till a point when you feel close to orgasm. At that point, the lower part of the head of the penis is squeezed tightly with the index finger and thumb around for a few seconds till the erection decreases. Then the stimulation is restarted and the process is repeated a few times.

Both these techniques, if practised regularly can increase your time taken for orgasm.

3) One more problem responsible for early ejaculation is inadequate sexual arousal. When the person is not properly aroused, the blood flow to the penis is not maximal, and so, after a few strokes, the erection weakens and ejaculation occurs. The way to tackle this is not to rush into intercourse quickly, but wait till you get fully aroused. So, increase and spice-up your foreplay. Make sure that you initiate penetration only after both of you are fully turned on. Good foreplay not only arouses you but also sparks off the mood in your partner. So, when she is also aroused and involved, then things keep flowing smoothly and effortlessly, and you don't have to be constantly anxious if you are satisfying your partner or not.

4) Improve your communication with your partner - this means both verbal as well as non-verbal communication. Each person has his or her own ways of getting sexually aroused or feeling sexual pleasure. So, this verbal and non-verbal communication will let each of the partners understand each other's needs and thereby make sex both relaxing and enjoyable.

5) Distract yourself stop "monitoring" your sexual performance. Try putting on some romantic music or mild lighting while you make love. Think about the things that turn you on. Taking your mind off of your sexual performance can remove the worries that are stopping you from getting excited.

6) There are also certain medication like Dapoxetine (Prilyxet), which can help you with this specific problem of premature ejaculation. But like I mentioned before, medication should be kept only as a last resort after trying the behavioural methods and sexual techniques.

Now, coming to your other problem of erectile dysfunction, the first and most important step in management is a proper evaluation. This will include a detailed medical, sexual, personal and social history, a thorough physical examination and certain tests, as per the necessity.

Firstly, any medical causes (like diabetes, hormonal problems, blood flow problems, vitamin deficiencies, etc.) need to be ruled out. For this, you may need to undergo a few blood tests. Often, a Penile Doppler test is advised to check if the blood flow to the penis is normal or not.

You have mentioned that you have used the tablet Tazzle but did not have any benefit. In this case, I would advise you to try the tablet Caverta 50mg. This has to be taken 1 hour before sexual intercourse.

It is also important to eat a healthy & balanced diet, exercise regularly and try to stay positive and stress-free.

If you follow all these suggestions and advise properly, I'm sure you will be able to overcome your sexual problems very soon.

Wish you all the best.

Regards,
Dr. Jonas Sundarakumar MBBS., DPM., MRCPsych.(U.K.)
Consultant Psychiatrist & Sexologist

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