Brief Answer: Dose and timing need adjustment Detailed Answer: Hello XXXX, Thanks you for sending in your query. Viagra (sidenafil) is available in doses of 25, 50 and 100 mg. It is important to know what dosage you are taking and approximately how long before the sexual act do you take it. In most patients the recommended dose is 50 mg taken an hour before sexual activity. However this can vary from 4 hours to 30 minutes before the sexual act depending on effectiveness and tolerance. You might have to assess your dosage and timing of intake accordingly. Hope this answers your query. Please do write in if you have any doubts. Dr.A.Rao Kavoor

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Brief Answer: Psychosexual counselling and sex therapy can help Detailed Answer: Hello XXXX, Thanks for writing in with an update. The sildenafil (Viagra) that you take is the maximum permissible dose allowed per day. So we shall discuss the other points which can help you. As you might be aware, older couples need accurate information about the physiological changes associated with ageing. They include the biological changes of ageing, negative cultural expectations, medical or surgical problems, the effects of drugs, and mental illnesses such as depression, psychosis and dementia. I guess you're one of the lucky few if you do not have to take medications for any medical illnesses. The phase of ejaculation ("come") undergoes changes which result in a decline in the intensity of orgasm and in the propulsive force of ejaculation. The volume of the ejaculate may be reduced by 50%. Sex drive and performance vary widely between individuals of the same group and the maintenance of sexual activity depends on factors such as regular sexual activity, the presence of a willing sexual partner, the absence of a major physical illness and the integrity of the relationship. What you are experiencing might be termed as retarded ejaculation. It is important to know where exactly any intervention would help you the most. It would be most suitable to take psychosexual counselling and or sex therapy. Sex therapy reasearch approaches to retarded ejaculation continue to emphasize the importance of masturbation in the treatment of retarded ejaculation. Men who are unaware or unable to become aroused are taught through masturbation and/or partner stimulation to experience increasing levels of arousal through a combination of improved/increased “friction and fantasy.” For others, the focus is on masturbatory retraining, integrated into sex therapy. Masturbation can serve as a type of “dress rehearsal” for sex with a partner. This is an area you may choose to explore and might be of help. You may alter the style of masturbation (“switch hands”) and approximate (in terms of speed, pressure, and technique) the stimulation likely to be experienced through manual, oral, or vaginal stimulation by his partner. To increase satisfactory outcomes from treatment, your partner needs to cooperate with the therapeutic process, finding ways to pleasure you that enhance arousal and that can be incorporated into your lovemaking. Sexual fantasies may have to be realigned so that thoughts experienced during masturbation better match those occurring during coitus. Efforts to increase the attractiveness and seductive/arousing capacity of the partner and to reduce the disparity between the man’s fantasy and the actuality of sex with his partner may be useful. Hope this answers your query. Please do write in if you have any doubts. Dr.A.Rao Kavoor

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Brief Answer: Welcome Detailed Answer: Hi XXXX, You're most welcome. Regards Dr.A.Rao Kavoor

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