Brief Answer:
likely premature ejaculation due to reduce frequency of sex/masturbation

Detailed Answer:
Hello XXXX,

Thanks for writing to us.

According to the latest diagnostic criteria by DSM 5, premature ejaculation should be defined when there is ejaculation within one minute after entering tin to vagina or even before penetration.

When there is less frequency of sex or masturbation , there is accumulation of semen in your seminal glands and prostate. Because of more than enough quantity this semen comes out instantly while it gets sexual stimulation.

Treatment for PME in general:

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 counselling 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 use of condom while sex helps in delaying ejaculation by reducing sensitivity of glans penis.

--Topical application of lignocaine anesthetic gel/spray. For this you have to consult doctor.

To help you more specifically I need to know more.

- Since when problem is there?

- How did it start, any specific incidence or gradually?

- What is frequency of sex/masturbation?

- Do you pay more attention towards ejaculation/erection while having sex?

- Do you have any stress or any physical problem?

I will be happy to help further after your response.

Regards,
Dr.Chintan Solanki.

---

Brief Answer:
performance anxiety is playing role

Detailed Answer:
Hi,

Thanks for information.

From history it seems that your problem is due to performance anxiety.

Sometime due to fatigue, lack of mood, situational problem or environmental changes man can fail in sex. It is normal phenomenon. However when this failure makes person apprehensive about erection, sex life is affected. This is called performance anxiety. After such failure when person actively thinks about erection/ejaculation or success of intercourse during sex/masturbation his mind is likely diverted to such thoughts. For constant erection without ejaculation continuous exciting/romantic/erotic feelings should be there in mind. If mind diverted to concern about ejaculation, early ejaculation occurs.

While doing masturbation keep yourself relax.

Whenever you go for sex, spare enough time in foreplay. You should not think actively about erection/ejaculation, your mind must be occupied with sexual/romantic feelings. During foreplay your partner should try to arouse you and note that your penis gets erection or not. When she feels that penis is sufficiently erect she herself should try to put erect penis in vagina gradually and you should continue your foreplay feelings without being conscious about ejaculation. You must try to enjoy and only enjoy.

I have mentioned already some behavioral approaches. You can also use kegel exercise and method of the same is easily available on internet. It

If I were your treating doctor I would like to start clomirpramine at this point to make you confident and simultaneity would like to advise behavioral approaches.

Hope this answer will help, feel free to discuss further.

All the best.

---