Brief Answer:
Follow below steps

Detailed Answer:
Hello,
Thanks for your query.
I appreciate your efforts for medical consultation in so much distress.

Important aspects of your query are:
•     34 year old male
•     Known case of Premature ejaculation (PME) and Erectile dysfunction (ED)
•     Complaints of: Poor sexual frequency due to ED
•     Currently on Zandu Vigorex

In treatment Erectile dysfunction (ED) first step is to identify cause of the problem. Erectile dysfunction can be a result of a psychological or physical problem.

Psychological causes: Most common cause in young patients like you. These include performance anxiety, emotional weakness, inferiority complex, stress and emotional trauma. Men with psychological problem usually have normal nocturnal erections and erections upon awakening, whereas men with physical problem often do not.

Physical causes: Include neurological disorders, alcoholism, smoking, hormonal imbalances, diabetes, hypertension, blood vessel disease and chronic diseases.

Your main problem is not of erection only, but it is for sustaining erection. In this testosterone and prolactin have very little role. These hormones mainly affect sexual desire clinically.

I will describe some simple measures which you can incorporate and these should help you:
-First of all, quit smoking (if you are taking any)
-Eat a healthy diet rich in vitamins, minerals and antioxidants: fruits, milk and eggs
-Exercise, particularly aerobic exercise (like: Jogging, skipping and cycling) for atleast 30 minutes daily. It will increase blood flow all over body and will reduce stress.
-Get evaluated for diabetes, high blood pressure, heart or thyroid conditions, poor circulation, penile venous incompetency and neurological problem as these issues affect erection.
-As you mention stress in life. Stress is one of the common reason for erection problem in young population. To manage it start yoga and meditation after learning from nearby specialist.
-Continue stop-start technique for premature ejaculation.
-The commonly prescribed drug by the doctors is sildenafil (Viagra) or Tadalafil (Megalis), which causes erections to be stronger and long lasting, but should be taken after prescription. It is important to rule out medical conditions specially related to cardiovascular system before starting such treatment. Both of these medicines have excellent result in physical causes of erectile dysfunction.

If there is no improvement in stress with yoga/meditation then in person evaluation and examination by psychiatrist may be necessary in your case to treat psychological cause of ED, specially stress.

I hope this information has been both informative and helpful for you. In case of any doubt, I will be available for follow ups.

Wish you good health.
Regards,

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