Brief Answer:
further recommendation

Detailed Answer:
Dear
Thanks for contacting Ayurveda with your health concern and going by the consultation given on August 2 I'm of the following opinion:

1. As said earlier that [metoprolol] is a beta blocker while other psychiatric drugs are SSRI's which could be the cause of your sexual dysfunction since all these medicine cause loss of libido and this possibly is the reason that no natural medicine is showing its efficacy on your body/system.

2. Since you are suffering both from premature ejaculation [PE] and erectile dysfunction [ED] thus following is/are recommended guidelines:

A. FOR ERECTILE DYSFUNCTION

i. start with perineal exercises: while urinating, stop the flow of urine, start again, stop & start again 4-5 times.
ii. take: milk and milk products, ghee, makhan, cheese, curd, black grapes, pears, raisins, dates, almonds, walnut, XXXXXXX pomegranate, carrot, banana, apricots, musk melon, amla, coconut, pistachio, turnip, potato, onion, lady finger, radish, old brown rice, peas,garlic, bottle gourd.
iii. avoid: sour and cold substances, tobacco [in any form], brinjal, tandori roti, red chilies, heavy and food which require long hours to digest, jaggery and its items, deep fried food.
iv. before starting treatment take:
. take trifla churan [3 gm] with lukewarm water before retiring to bed for 15 days
. Singly you can use: [after 15 days]:
- Ashwagandha: best regarded as adaptogen with aphrodisiac properties which may be due to testosterone like effects, thus prescription drug available for same is/are: Ashwagandha churan, Ashwagandha lehyam.
- In Compound form:
i. Vigomax capsules [Charak]: 1 capsule daily with breakfast or at bed time
PS. Recent studies indicate Vigomax was effective in restoring sexual function in men with ED of varied etiologies.
ii. Tentex forte tablets [Himalaya]: 2 tablets twice daily for 3-4 weeks. treatment may be prolonged depending upon the response.
PS. is a non hormonal and safe sexual stimulant and acts on higher brain centers to improve libido, the antis tress, adaptogen action of tentex forte helps alleviate anxiety associated with sexual desire.
iii. take tablet mentat [himalaya] 2 tab twice a day [since ED is a psychosomatic disorder] thus tranquility of mind is important.
iv. perineal exercise [pelvic floor programme] is a noninvasive alternative for the treatment of patients with ED by clearing venous occlusion. [will help to achieve full erection afterwards] It also helps to strengthen the muscles and splincters involved in erection and ejaculation.

PS. Before prescribing medication especially for ED, the patient should be evaluated for any cardio vascular diseases, thus have an appointment with a Cardiologist for any potential risk of a cardio vascular event, so that Ayurveda medicines/herbs can be incorporated in your daily routine. [as you are already taking metoprolol for hypertension]

B. FOR PREMATURE EJACULATION
1. Two very common features of men who consistently ejaculate rapidly:
- High sexual excitement and high psychological anxiety thus: reduce the sensation of Glans, by applying Lignocaine Ointment or by wearing a condom.

PS. the cheapest and easiest method to decrease the sensitivity of the penis is to wear two or more condoms.
. Divert the mind to non-sexual activities like sports or business matters.
. Perineal Exercise: as explained earlier.

- Ejaculation and Orgasm can be voluntarily controlled. You have to learn to recognize the sensations prior to orgasm and stop.

Stage I: Man is advised to masturbate himself, and when ejaculation is near, stop. Allow the erection to subside. Start again. Repeat this number of times before allowing ejaculation. Practice for 2-4 weeks.

Stage II: Learn the same with your partner.She will masturbate you near orgasm, stop when you indicate, wait for erection to subside, then start again.Repeat this a few times & then allow ejaculation. Practice for 2-4 weeks

Stage III: Follow the same method for intercourse, initially with female superior position and then with male superior position. The principle is to stop before ejaculation, wait for the erection to subside & then start again. Practice for 3-4 months, or more till perfect control is achieved.

PS. You may consult an Ayurveda Physician there for " Tantric Vajroli" which is a very easy, very effective method to have a full control over ejaculation
. Belly breathing: Lie comfortably on a bed, on your back. Loosen [if any] tight clothing. Place one hand on your abdomen and the other on your heart. Now take a deep slow breath that you can feel all the way down to your abdomen. Breathe as if you are drawing breath down through your body, into your legs and toes. This time tested exercise will help allay anxiety, increase the ability to relax and activate the benevolent energies of the parasympathetic nervous system. [duration: 10 minutes]

. Ayurveda Physician usually treat the patient on line of ": Shukragat Vata" which is characterized by a group of clinical presentations either with the impairment of ejaculation or with seminal abnormalities i.e.
i. The line of treatment should be based on 'vrishya', 'medhya', 'shukrastambhaka', and 'vatahara' properties. You may Consult a good Ayurveda Physician or Hospital in and around your place.

C. you can either take M-UP capsules or any of the medicines listed above in section A of ED [i.e. vigomax or tentex forte] but, but whatever you take make sure to regularly use it with tablet mentat.

D. Tadalfil is Contraindicated [CI] in men with cardiac disease i.e. people having hypotension,unstable angina,heart failure,uncontrolled arrhythmias, or HYPERTENSION.

Dr. Munish
Naimittika

direct online link: bit.ly/drmunishsood

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