Brief Answer:
Your problem can be treated

Detailed Answer:
Hello,

Thanks for writing to us.

Your penis is not standing properly means you probably have erectile dysfunction(ED). And early discharge may be premature ejaculation.

I want to clarify and inform you about both situations.

According to criteria diagnosis of erectile dysfunction is made when erection problem is there for most of the time during at least 6 months period.

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.
Tadalafil is preferred in patients with blood pressure.

You can use another 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 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.

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.

Let me know:

- Since when problem is there?

- Do you have any physical illness?, if yes describe details with medicines.

- Is there any history of history of smoking or alcohol?

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

Now about early ejaculation:

There is no specific ejaculation time we can say normal for a man during sex.

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. 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. 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 counseling 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 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.

- Kegel exercise may help.

Hope this answers your query.I would like to help you further.

Regards,
Dr.Chintan Solanki.

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Brief Answer:
I have mentioned medicines already,clomipramine and tadafil are good

Detailed Answer:
Hello,

Thanks for follow up.

If I were your treating doctor I would suggest clomipramine daily at night and tadalafil just before 2 hours of sex for 1 month. With this Tetrafol plus twice a day after meal. And after one month only terafol plus for one more month.

All the best.

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