Brief Answer:
it is premature ejaculation

Detailed Answer:
Hello XXXXX,

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

You have problem of premature ejaculation.

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. 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:
it is erectile dysfunction

Detailed Answer:
Hi,

Thanks for clarification. You are losing erection before ejaculation. It means it is erectile dysfunction. I need more information.

- What is duration of marriage life and was there any such problem before?

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

- Do you pay more attention to erection while trying for intercourse?

- Do you have any physical illness?

- How is relationship with your partner? Any emotional or social problem is there?

- Is morning erection present?

- Is there any history of smoking or alcohol?

- Is there any difficulty in urinating?

- When did you do successful intercourse last?

- Is there any history of masturbation? If yes, how was pleasure/orgasm during masturbation?

I will be happy to help further after your response.

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Brief Answer:
avoid performance anxiety, go for serum testosterone level

Detailed Answer:
Hi,

Thanks for answers and sorry for delayed response.

Form history it seems that there is no major physical problem. Performance anxiety is also playing role up to some extent.

I want to clarify about performance anxiety.

Sometime due to fatigue, lack of mood, situational problem or environmental changes man can fail in sex. It is normal phenomenon. However when this failure makes person apprehensive about erection, sex life is affected. This is called performance anxiety. After such failure when person actively thinks about erection or success of intercourse during sex/masturbation his mind is likely diverted to such thoughts. For constant erection continuous exciting/romantic/erotic feelings should be there in mind. If mind diverted to concern about erection, erection would not be possible.

While doing masturbation keep yourself relax.

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.

In any case in future you will fail after multiple attempts; medicines are there to get confidence.

5-PDE inhibitor group of drug like sildenafil or tadalfil is useful. Person can take it before hours of sex for good erection. After 3-4 successful attempts he will have confidence and person can do without help of medicines later on. These are prescription medicines and you need to consult doctor for the same.

At this point I also would like to suggest going for serum testosterone level (free and total testosterone at fasting). If it is low supplement can be given.

I recommend one supplement called tetrafol plus 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 as well as patients with low or absent libido. You should take it after meal twice a day. If you feel some improvement in 15 days you should continue for at least 2 months. You may get this medicine over the counter as it is vitamin product.

Feel free to discuss further.

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