Brief Answer:
Clomipramine is better option with behavioural approaches

Detailed Answer:
Hello Surendar,

Thanks for writing to us. I can understand your concern.


You have already tried depoxetine but no improvement. I would like to brief you about early ejaculation and its treatment.

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.

Confido is an ayurvedic product and recommended for premature ejaculation.
You can take it with milk every day for 2 months.

If I were your treating doctor I would recommend clomipramine and confido at present with behavioral approach whichever applicable.

You also mentioned about short and thin penis.

Please tell me length and girth of your penis during normal and erect state.

Tadalafil is given for erection problem.

Let me know more information.

- Since when problem is there?

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

- Is your partner wife or girlfriend? If girl friend, how often and in which situation you enjoy the sex?

- When did you do your last successful sex?

- What is frequency of sex/ masturbation?

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

- Is morning erection present?

I will be happy to help further after your response.

Regards,
Dr.Chintan Solanki.

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Brief Answer:
depoxetine is long acting drug, no need to take it daily

Detailed Answer:
Hi,

Thanks for follow up.

Your length of penis is fine. You have done successful intercourse last night means there is no significant problem.

Depoxetine is long acting drug and in many patients it works on second day also. I do not recommend taking it daily.

You already told that no improvement with depoxetine. In clinical practice I also find clomipramine is more useful than depoxetine.

Please start clomipramine instead of depoxetine and you will likely get the results.

Take care.

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