Brief Answer: Need evaluation Detailed Answer: Hello, Thanks for your query. I appreciate your efforts for medical consultation in so much distress. Important aspects of your query are: • 30 year old male • Known case of concentration and cognition problems • Complaints erectile dysfunction and premature ejaculation In your case erectile dysfunction should be treated first. Premature ejaculation sometime improve experience in sexual activities. Erectile dysfunction can be a result of a psychological or physical problem. Psychological causes: Most common cause in young patients. These include performance anxiety, emotional weakness, inferiority complex, stress, marital or relationship problems, low mood, feelings of guilt, and the effects of a past sexual and emotional trauma. Physical causes: Include neurological disorders, alcoholism, drug abuse, hormonal imbalances, diabetes, hypertension, blood vessel disease, chronic diseases and medicines side effects (like anti depressants/steroids). Concentration and cognition problems are common in anxiety and depression. Both condition can cause erectile dysfunction and premature ejaculation. You have already received Dothiepin, which is an antidepressant. Dothiepin has side effect in form of decrease sexual desire, prolong ejaculation and erectile dysfunction. It is better that you have stopped it. Following steps are needed in your case: 1. Talk to a therapist/Psychiatrist: Make an appointment to rule out anxiety, stress and depression in your case. 2. Be open with your partner. Talking with your partner about your anxiety can help ease some of your worries. Trying to reach a solution together might actually bring you closer as a couple and improve your sexual relationship. 3. Get intimate in other ways. There are many ways to be intimate without actually having sex. Give your partner a sensual massage or take a warm bath together. Take turns pleasing each other with masturbation so you don't always have to feel pressured to perform sexually. 4. Exercise. Not only will working out make you feel better about your body, but it will also improve your stamina in bed. Start aerobic exercise (like: Jogging, skipping and cycling) daily for 30 Minutes. It will increase blood flow all over body and will reduce stress. 5. Distract yourself. Try putting on some romantic music or a sexy movie while you make love. Think about something that turns you on. Taking your mind off of your sexual performance can remove the worries that are stopping you from getting excited. 6. Quit smoking and alcohol (if you are taking any) 7. Condom like Kohinoor extra time help in delaying ejaculation. There is also need to rule out certain medical conditions which can affect erection. These include diabetes, high blood pressure, heart or thyroid conditions, poor circulation, penile venous incompetency and neurological causes. For that comprehensive evaluation and tests, help of other specialist may also needed. As you are in Delhi NCR, you can visit me personally also after taking my address from XXXXXXX I hope this information has been both informative and helpful for you. In case of any doubt, I will be available for follow ups. Wish you good health. Regards, http://bit.ly/Dr-Ashish-Mittal

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Brief Answer: Visit psychiatrist near your place of residence. Detailed Answer: Hello again, Thanks for follow up. It is better visit psychiatrist near to your place so that you can follow up easily, after searching on net. With medical treatment some lifestyle modifications are necessary in treatment. So, follow above mentioned all steps, which will help you. Please accept my answer in case there are no further queries and recommend our services to your friends too if you have found it helpful. Wish you good health. Regards

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