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Dr. Andrew Rynne

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Suggest treatment for premature ejaculation

Answered by
Dr. Chintan Solanki


Practicing since :2007

Answered : 2406 Questions

Posted on Mon, 1 Jun 2015 in Sexual Health
Question: My wife wants me to perform longer than few minutes. Probably 30 minutes or more. My erection does not last more than 10 minutes. I am 50+ and slight BP. One doctors told me to have Duralast 30 mg to keep a longer duration of erection.....please advise. Thanks.
Answered by Dr. Chintan Solanki 23 minutes later
Brief Answer:
treatment for early ejaculation is availble

Detailed Answer:
Hello Mr. Mital,

Thanks for writing to us.

You seem to have problem of premature ejaculation.

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.

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 (duralast)has been used specifically for PME and should be taken before 2 hours of sex when required.Yes you can take duralast without much discomfort.No issue with blood pressure.I have used in many patients but due to unavailability of the same its use is limited.
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.

Hope I have answered your query.Feel free to discuss further about doubts.

Dr.Chintan Solanki.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
Follow up: Dr. Chintan Solanki 52 minutes later
There are times when I simply don't want to have sex and my wife needs it. I cannot get an erection or even if I do manage to get an erection, after a couple of minutes, my penis goes flaccid/ limp without any orgasm. How do I address this situation? Duralast?
When I was younger or a few years ago….my wife had to tell me to come faster and not keep on prolonging the rub….things are quite afferent now…..she wants me to go on longer….lol!
Is this age related?
Answered by Dr. Chintan Solanki 37 minutes later
Brief Answer:
duralast will not help in this

Detailed Answer:

Thanks for follow up. Thanks for clarifying your question.

For constant erection to be present during sex continuous exciting and romantic feelings should be there in both partners' mind. If mind diverted to something else erection likely to loose.Same is happening with you.You mentioned that when you are not ready but go for sex, problem occurs.For this your wife has to do something which can excite you. It may be some favorite food, changing her clothes which make you aroused or something else which you can both discuss,find and follow. Without readiness in mind if you go for sex, problem will be there.

Age of course can have effects on sexual life.It decreases overall capacity and desire.
In females after menopause sometime due to hormonal changes as well as relaxed feelings of not having menses more, sexual desire increases.This may be the reason in your wife's case. Best answer of her increasing needs can be given by only her only.

There are medicines when problem of erectile dysfunction is there.They even can help when you do not have desire but you want to go for sex to satisfy your partner. Duralast cannot help in this.

5- PDE inhibitor group of medicines like sildenafil or tadalafil(cialis) 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 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.

Hope this answers your query.

Feel free to discuss further.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

The User accepted the expert's answer

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