Brief Answer:
medicines,ayurvedic products and behavioral modifications are there

Detailed Answer:
Hello XXXX,

Thanks for writing to us.

To increase sexual desire and pleasure healthy lifestyle is the most important aspect. With healthy body one can enjoy sex the best.

You can use medicine cum vitamin supplement containing pyridoxal-5-phosphate, mecobalamin and l-methylfolate (trade name tetrafol plus) is very helpful in my patients. It has shown improvement in 50-60% patients of mine with Erectile dysfunction(ED).You may get this medicine over the counter as it is vitamin product.

There are some natural lifestyle measures which help to improve blood flow to penis and overall sexual performance.

- The most important factor is healthy heart. Blood is pumped in to body by heart. So regular exercise and avoidance of fatty fast food are important measures to prevent heart disease. Regular walking, swimming or running overall improves blood flow to whole body circulation including penis and keep the mind fresh.

- Good healthy food is also an important aspect. Bananas, Garlic, dry fruits(they contains vitamins), eggs, cow milk, cow butter are good food which may help in erectile dysfunction.

- Avoid smoking and alcohol. Low amount of alcohol can help in increasing blood flow but more amount can cause opposite effects. So better to avoid the same.

As you are form XXXXXXX I would like to also mention ayurvedic medicine option. Tentax forte is the medicine which is used for ED. No side effects has been reported.

Tetrafol and tentex both will be useful for sex drive. You can take once a day tetrafol plus after meal and one tentex forte at night with a cup of milk for 2 months.

There are medicines when problem of erectile dysfunction is there. This medicine can help to increase sex drive. I recommend using it only when there is erectile dysfunction. I am describing it for your information.

5- PDE inhibitor group of medicines like sildenafil or tadalafil are used for ED. One of them should be used 2 hours prior to sex. They cause headache, stuffy nose nausea and gastric discomfort like common side effects. Proper physical check-up of cardiac system should be done by a doctor before starting the same. These are prescription medicines and you need to consult doctor/psychiatrist/sexologist for the prescription.


Now discussion about early ejaculation.

First of all Premature Ejaculation (PME) defined when male partner ejaculates early before the female partner reaches to orgasm. There is no absolute time by which we can diagnose PME. It is relative term and female partner is the best judge.

From your history I guess you do not have PME but still you want to enjoy longer.
For your information I am mentioning treatment aspect 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. Master and XXXXXXX technique can also be learnt from qualified sexologist/Psychiatrist which includes sessions in couple as it is couple sex therapy. It can help in prolongation of time.

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 anesthetic gel/spray. For this you have to consult doctor.

In ayurvedic products confido or tentax royale can be used for premature ejaculation. They are likely available over the counter without prescription.

In my opinion confido will be good option for you among these. You can take it daily one tablet.
Clomipramine or depoxetine just before sex is also good option. This will not cause any significant side effect. But you need to consult doctor to get the prescription.


Hope I have answered your query, I will be happy to help further.

Regards,

Dr.Chintan Solanki.

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Brief Answer:
couple counselling will help

Detailed Answer:
Hello,

Thanks for follow up.

I have answered supplements name and how you should take the same in previous answer.

Ans 1.
Tetrafol and tentex both will be useful for sex drive. You can take once a day tetrafol plus after meal and one tentex forte at night with a cup of milk for 2 months.

When frequency of sex once a week, there is accumulation of semen in seminal vesicles.Due to full seminal vesicles semen comes out fast when you go for sex. If you can do masturbation before 2 hours of sex or you can do sex second time after first attempt of sex successively after two hours seminal vesicles will be somewhat empty and in second attempt your ejaculation will take long time.

Confido can be used for longer ejaculation.You should take it daily one tablet at night for 2 months.
Above medicines you can get without prescriptions.
If you will not be benefited with confido, clomipramine or depoxetine can be taken just before 2 hours of sex for lengthening the ejaculation time.
Other behavioral medications I have already suggested in previous answer.

Ans 2:
Yes you can both lick each others genitalia if you both are comfortable and enjoy the same.Keep good hygiene.Wash genitals thoroughly before proceeding for such foreplay.If you both are free of infection no need to worry.

Use sex position in which both partners are comfortable. There is no specific position which is ideal for all.

Ans 3:

Your wife mostly does not need any medicines if she is overall healthy.Female can have multiple orgasm one after another.If she feels that she needs any supplements she can be given tetrafol plus.

The best way is you both go to psychiatrist/sexologist for couple sex counseling. Master and XXXXXXX Technique will help you.


Hope this answers your concern. Feel free to discuss further.

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Brief Answer:
move forward as we discussed on phone

Detailed Answer:
Hi,

You can move forward as we discussed on phone before an hour.

If still any query there, I will be happy to answer. If not, you can close the discussion and if feasible give your feedback and rating so I can improve my service. In future you can contact me directly on this site if you wish with this link:
http://bit.ly/drchintansolanki
by clicking on 'Ask me a question' on same page.

All the best and wish you good health.

Dr.Chintan Solanki.

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