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Suggest treatment for premature ejaculation

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Posted on Mon, 18 Jul 2016
Question: I am suffering from Pre-mature ejaculation. I believe this started very early in my sexually active life. Post marriage it sometimes time get better after repeated sex but mostly it is unsatisfying. Erection is mostly proper but once ejaculated it looses oflate due to stress somewhat less erection but drive is Okay.
doctor
Answered by Dr. Chintan Solanki (53 minutes later)
Brief Answer:
Premature ejaculation can be treated

Detailed Answer:
Hello XXXXXXX

Thanks for writing to us.

According to the latest diagnostic criteria by DSM 5, premature ejaculation (PME) should be defined when there is ejaculation within one minute after entering tin to vagina or even before penetration. Please clarify that is this your problem or are you asking that you are not able to do sex soon after doing once.

Treatment for 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 this medicine.

Initially say for 0-30 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.

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. Kegel exercise also helps in some cases. You can learn the same from internet.

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. This is the mechanism why you can do well while you do second time. Or just increasing the frequency of sex will also help.

Another approach:
-Use of condoms. It reduces sensitivity of glans penis and delays the ejaculation.

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

If I were your treating doctor I would like to give clomipramine.

Viagra is used for erectile dysfunction and not for PME. If you feel that your erection is good, you do not need it.

Hope I have answered your query, I will be happy to help further.
Regards,
Dr.Chintan Solanki.

Above answer was peer-reviewed by : Dr. Nagamani Ng
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Follow up: Dr. Chintan Solanki (2 hours later)
Thanks Doctor !

1:Yes My problem is ejaculation at very early stage(sometimes before penetration as well). Now a day Erection is medium but not as good.
Also as soon as I start sex even before proper erection some fluid(greasy) keeps on coming not sure if it is normal.

2: What should be dosage of clomipramine ( mg or strength)

3: In addition to this , of late after ejaculation once it takes 3-4 hours to get good erection again. This problem was not earlier.

Note:- While masturbating also I have observed ejaculation quickly.

doctor
Answered by Dr. Chintan Solanki (3 hours later)
Brief Answer:
that fluid is precum and it is for lubrication

Detailed Answer:
Hi,

Thanks for follow up.
If your erection is that much that you can enter in vagina easily and satisfy your wife it is ok. You need treatment for premature ejaculation.
Greasy fluid is precum. It is couper's gland secretion from penis which comes out for lubrication during arousal before actual intercourse.

Clomipramine is prescription drug and you need to take prescription form local doctor. I am sorry that I cannot provide online prescription. For your information 10 mg dose is used for this purpose and it may be increased up to 25 mg in some cases.

Late erection second time is due to refractory period.
In males there is called refractory period after ejaculation and orgasm. This is the period during which it is physiologically impossible for a man to have additional orgasms. The penis may be hypersensitive and further sexual stimulation may feel painful during this time frame. While the refractory period varies widely among individuals, ranging from minutes to days, most men cannot achieve or maintain an erection during this time. Many perceive a psychological feeling of satisfaction and are temporarily uninterested in further sexual activity.

There are suggested hormonal, neurotransmitter and muscle fatigue theories to specify refractory period. Average period duration varies from 5 to 45 minutes. But it can be less like 15 minute and more like 1 day also. As age increases refractory period increases in many males. This is likely happening in your case.

With treatment during masturbation also you can increase the duration of ejaculation.

Feel free to discuss further.

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

Psychiatrist

Practicing since :2007

Answered : 2406 Questions

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Suggest treatment for premature ejaculation

Brief Answer: Premature ejaculation can be treated Detailed Answer: Hello XXXXXXX Thanks for writing to us. According to the latest diagnostic criteria by DSM 5, premature ejaculation (PME) should be defined when there is ejaculation within one minute after entering tin to vagina or even before penetration. Please clarify that is this your problem or are you asking that you are not able to do sex soon after doing once. Treatment for 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 this medicine. Initially say for 0-30 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. 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. Kegel exercise also helps in some cases. You can learn the same from internet. 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. This is the mechanism why you can do well while you do second time. Or just increasing the frequency of sex will also help. Another approach: -Use of condoms. It reduces sensitivity of glans penis and delays the ejaculation. - Topical application of lignocaine anesthetic gel/spray. For this you have to consult doctor. If I were your treating doctor I would like to give clomipramine. Viagra is used for erectile dysfunction and not for PME. If you feel that your erection is good, you do not need it. Hope I have answered your query, I will be happy to help further. Regards, Dr.Chintan Solanki.