Brief Answer:
it is premature ejaculation

Detailed Answer:
Hello XXXXXXX

Thanks for writing to us.

You seem to be suffering from early ejaculation. In medical language it is called premature ejaculation.

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.

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 these medicines. 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. 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. 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.

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.

In general clomipramine is the first choice.

Let me know more information.

- Since when problem is there?

- How did problem start? Any specific incidence was there?

- Do you have any physical illness, specifically diabetes or high blood pressure? If yes describe details with medicines.

- Do you have any habit of tobacco use, smoking and alcohol? If yes, provide details.

- When did you do your last successful sex?

- Is there any difficulty in urinating?

- How is relationship with your partner? Any emotional or social problem is there?

- What is duration of early discharge (let me know past and current duration)?

- What is your wife's opinion about this problem?

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

I will be happy to help further after your response.

Regards,
Dr.Chintan Solanki.

---