Brief Answer:
clomipramine with confido can be tried with behavioral approach

Detailed Answer:
Hello XXXXXXX

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

You have already tried paroxetine but no improvement. I would like to brief you about early ejaculation and its treatment.

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 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.

Confido is an ayurvedic product and recommended for premature ejaculation.
You can take it with milk every day for 2 months.

If I were your treating doctor I would recommend clomipramine and confido at present with behavioral approach whichever applicable.

Let me know more information.

- Since when problem is there?

- How did problem start? Any specific incidence was there?

- Do you have any physical illness, specifically diabetes or high blood pressure? If yes describe details with medicines.

- Do you have any habit of tobacco use, smoking and alcohol? If yes, provide details.

- When did you do your last successful sex?

- What is frequency of sex/ masturbation?

- What is duration of early discharge (let me know past and current duration)?

- What is your wife's opinion about this problem?

- Do you pay more attention towards erection/ejaculation while you do sex?

I will be happy to help further after your response.

Regards,
Dr.Chintan Solanki.

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Brief Answer:
increase frequency of intercourse/masturbation

Detailed Answer:
Hi,

Thanks for follow up and information. I am sorry for delayed response.

You told that,' I pay more attention on ejacuation while sex. due to ejacuation i am not doing frequent intercourse.' This means increasing frequency of intercourse or masturbation will help to last long. As mentioned before doing masturbation just before 2 hours of sex will also help.
Also avoid giving attention to penis/erection.ejaculation during sex. it creates performance anxiety which can also contribute to ejaculation.

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 ejaculation. You must try to enjoy and only enjoy.

I also recommend clomipramine with above approach.You just to ask your doctor for prescription.

Hope you will be benefited by given recommendations.

Feel free to discuss further.

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Brief Answer:
you can ask your family doctor

Detailed Answer:
Hi,

Clomipramine is prescription drug. You can ask your family doctor to prescribe it for you in dose of 10 mg and you can take it daily night for 1 month and then onlt before 2 hours of the intercourse as and when required. I am sorry that online prescription is not available.

Take care.

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