Brief Answer:
need to evalaute for physical factors, provide more information

Detailed Answer:
Hello,

Thanks for writing to us.

At age of 54 we need to check for physical causes of erectile dysfunction.

To help you more describe more about your problem and provide more information.

- When did you do your last successful intercourse without medicine and with medicine?

- Is morning erection present when you wake up?

- Do you have any physical illness, specifically diabetes or high blood pressure? If yes describe details with medicines.

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

- Is there any difficulty in urinating?(to check for prostate problem)

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

- How is your overall physical general health?

- Have you undergone testosterone level? If it is reduced we need to provide replacement.


You have already taken sildenafil which is likely useful. When you take this medicine your problem is early ejaculation. For that you have also taken depoxetine (sustimax contains both sildenafil and depoxetine).

-What was the effect of sustimax?Was it helpful for lengthening duration?

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.

- Let me know if you have PME or ED or both?

Treatment of ED:

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 have already tried sildenafil.
-Let me know that have you take after doctor's opinion or your own?


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 1 month. 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.

As you are form XXXXXXX I would like to also mention ayurvedic medicine option. Tentex forte is the medicine which is used for ED. No side effects have been reported. I use it infrequently and no specific studies are there of its efficacy. Two tablets daily at night with a cup of milk should be taken.

I will be happy to help you further after your response.

Regards,
Dr.Chintan Solanki

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Brief Answer:
Other medicines for PME are there,testosterone evalaution is needed

Detailed Answer:
Hello Mr. XXXX,

Good morning and thanks for information.

Healthy lifestyle, no medical problem, presence of morning erection and some erection with medicines suggest possibility of further improvement.
Serum testosterone evaluation is needed. If it is low, supplementation can be provided.
As mentioned in previous answer you can start tetrafol plus and tentex forte for ED.
Other options are trazodone and yohimbine. But for these medicines you need to consult psychiatrist/sexologist.

I am in XXXXXXX otherwise I would like to treat you for sure. I am providing a link through which you can search psychiatrist/sexologist near to you in XXXXXXX After finding the name with this link you can search contact on internet easily. You can ask your family doctor also to refer you to someone.

http://doctor.healthcaremagic.com/doctors/Doctors-in-Mumbai/L18863S0

Treatment for PME:

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.

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 as well as in ED.

3. 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.

You can discuss and start appropriate treatment after consulting doctor.

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Brief Answer:
drinking of plenty of water does not matter for sexual dysfunction

Detailed Answer:
Hello,

Thanks for follow up.

Drinking water and passing urine frequently do not matter with sexual dysfunction. If you have any difficulty in urinating we need to check for prostate problem.

Take care.

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