Brief Answer:
medicines and some behavioral approch can increase duration

Detailed Answer:
Hello XXXXXXX

Thanks for writing to us.

Probably you are talking about early ejaculation.

You have not given much detail about your problem. I will try my best to give appropriate answer.

Premature Ejaculation (PME) or early discharge 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.

There are medicinal and non medicinal approaches to treat 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.
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:

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 behaviour 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 using 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.

Hope I have answered your query.Feel free to discuss further about doubts.

Regards,
Dr.Chintan Solanki.

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Brief Answer:
hardness gone before or after ejaculation?

Detailed Answer:
Hello Mr. XXXX,

Thanks for follow up and clarification.

If your hardness gone before ejaculation it is erectile dysfunction(ED).

If your hardness goes after ejaculation it is premature ejaculation(PME).

For ED treatment approach is different.

5- PDE inhibitor group of medicines like sildenafil or tadalafil are used. One of them should be used 2 hours prior to sex. They causes 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.

Another medicine cum vitamin supplement containing pyridoxal-5-phosphate, mecobalamin and l-methylfolate (trade name tetrafol plus in India)is very helpful in my patients. It has shown improvement in 50-60% patients of mine with ED.You should take it after meal twice a day. If you feel some improvement in 20 days you should continue for at least 2 months. You may get this medicine over the counter as it is vitamin product.

If both PME and ED are there treatment of both should be done.

Please revert back to me what exactly happens during sex (ED or PME)and since when problem is there?

take care.

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Brief Answer:
No clomipramine

Detailed Answer:
Hello Mr. XXXXXXX

Thanks for information.

No clomipramine is not indicated. PDE inhibitor group of drugs should be used(like sildenafil,tadalafil).
As I mentioned it needs some examination and doctor's prescription . You need to consult the doctor for the same.

However you can go for tetrafol plus without any side effects. It can be taken twice daily after meal. Continue for 20 days and see the response.

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.

Hope this answers your query.

If still any query there, I will be happy to answer.
If not, you can close the discussion and give your feedback which can help me to improve service.

In future you can contact me directly if you wish with this link:
http://bit.ly/drchintansolanki


All the best.

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