Brief Answer:
medicine and behavioral approach would help

Detailed Answer:
Hello,

Thanks for writing to us.

First of all I want to clarify about masturbation.

Masturbation is safe. Masturbation is natural and normal thing. It is done by 70-95% of the males and 30-45% females in the world. It is not at all harmful. Frequency of masturbation done by an individual varies from once a day to once a week. It depends upon individual libido, wish and timing. It neither causes any weakness nor any problem in sexual activity. In your case doing masturbation will rather help in premature ejaculation.

Many couples take time to adjust in sex life after marriage. You will be able to perform for longer soon.

For early discharge I am recommending following treatment.

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. 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. Sometime use of condom while sex helps in delaying ejaculation by reducing sensitivity of glans penis.

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

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.

In your case I recommend clomipramine to get confidence with behavioral approaches.

Back pain and muscle pain are not related with early ejaculation. You can take pain killer medicine like brefen or diclofenac for the same.

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

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