Brief Answer:
medicine can help better

Detailed Answer:
Hello,

Thanks for writing to us.

There are no scientific evidences with studies suggesting efficacy of musli or herbal supplements in premature ejaculation. However if you have taken and getting benefit you can continue the same.

I want to mention better treatment for the same.

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 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. 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. It reduces sensitivity of glans penis and delays the ejaculation.

--Topical application of lignocaine anesthetic gel/spray. For this you have to consult doctor.

In ayurvedic products confido can be used for premature ejaculation. It is likely available over the counter without prescription.

If I were your treating doctor I would recommend clomipramine and confido.


Hope I have answered your query, I will be happy to help further.
Regards,
Dr.Chintan Solanki.

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Brief Answer:
second arousal delay is due to refractory period

Detailed Answer:
Hi,

Thanks for follow up.

Second arousal delay is due to refractory period and it is natural.

In males there is called refractory period after ejaculation and orgasm. This is the period during which it is physiologically impossible for a man to have additional orgasms. The penis may be hypersensitive and further sexual stimulation may feel painful during this time frame. While the refractory period varies widely among individuals, ranging from minutes to days, most men cannot achieve or maintain an erection during this time. Many perceive a psychological feeling of satisfaction and are temporarily uninterested in further sexual activity.

There are suggested hormonal, neurotransmitter and muscle fatigue theories to specify refractory period. Average period duration varies from 15 to 45 minutes. But it can be less like 1 minute and more like 1 day. In your case this period is likely around of 1 day. As age increases its duration increases. And in young age many males do not have refractory period at all.

This is natural phenomenon, not dysfunction we can say (though it is affecting your sexual activity) and no specific treatment for the same.

Explain this to your wife. You can again involve in sexual activity after few minutes. However if you can last longer in first attempt with treatment of PE, I think your wife will be much satisfied as females generally can have multiple orgasm without any refractory period and even she will not demand for second time.

For full and harder erection medicines as well as supplements are there.

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.

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 ED. You may get this medicine over the counter as it is vitamin product.

I would like to also mention ayurvedic medicine option. Tentex forte is the medicine which is used for sex related problem. No side effects have been reported.

If I were your treating doctor I suggest one tablet of tetrafol plus after meal twice daily for two months and one tablet tentex forte daily at night with a cup of milk for 4 weeks.

All the best.

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