Brief Answer:
clomipramine for early discharge

Detailed Answer:
Hello,

Thanks for writing to us.

First of all I want to clarify about duration for premature ejaculation.

Premature Ejaculation (PME) defined when male partner ejaculates early before the female partner reaches to orgasm. There is no absolute time by which we can diagnose PME. It is relative term and female partner is the best judge.

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.
There is no maximum duration as it is individual thing according to age, body physique, environment, partner and mood.

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 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.

In ayurvedic products confido can be used for premature ejaculation. It is likely available over the counter without prescription.

If I were your treating doctor I would recommend clomipramine and confido. You can take the same with problem of high blood pressure and pancreas.

As such there is no medicine which can increase basic natural size of penis. No evidence supports such pills effectiveness. Only surgical intervention can increase the size of penis.

Please do not use enlargement/enhancement penis pills.

Let me know your size of penis in flaccid and in erect phase so I can guide you further.

Note: There are pills which can increase size of penis if there is erectile dysfunction.5- PDE inhibitor group of medicines are used for this purpose which includes sildenafil or tadalafil. It is proven drug for male erectile dysfunction. One of them should be used 2 hours prior to sex. They cause headache, stuffy nose nausea and gastric discomfort like common side effects. Proper physical check-up of cardiac system should be done by a doctor before starting the same. These are prescription medicines and you need to consult doctor/psychiatrist/sexologist for the prescription. Tadalafil is safer in patients with high blood pressure.


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

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