Brief Answer:
need to reduce weight, go for serum testosterone and penile doppler

Detailed Answer:
Hello XXXXXXX

Thanks for writing to us.

You are young man. As such there is no direct relation between jaundice and erectile dysfunction.

Penis during erection 2.5 inches is small. Normal size of penis in flaccid state is 2 to 4 inches (5 to 10 cm) while in erect position 3 to 7 inches (9 to 15 cm). It varies according to body structure and race. Size of penis does not matter much for satisfying partner if it is more than 3 inches.
Anterior 2-3 inches of female vaginal wall is sensitive to sexual stimuli. Only 3.5 inches of erect penis is sufficient to satisfy female.
Considering these facts I request you to measure penis size again in normal state and in full erection state and revert back to me. I recommend penile doppler to check vascularity of penis.

For erectile dysfunction I recommend to go for serum testosterone level.

You have responded well to some ayurvedic medicines that mean your problem is less likely physical and more psychological. Please let me know details of ayurvedic medicine you have taken.

After jaundice overall body weakness is there and that may be responsible for your problem. In that case you just need supplements.
You can use medicine cum vitamin supplement containing pyridoxal-5-phosphate, mecobalamin and l-methylfolate (trade name tetrafol plus)is very helpful in my patients. It has shown improvement in 50-60% patients of mine with ED. You may get this medicine over the counter as it is vitamin product. You should take it twice a day after meal for 2 months.

- In which circumstance have you tried sex with girlfriend? Were you relax or in hurry?

- Have you done masturbation? If yes since when, what is frequency and how successful is it? Currently are you enjoying masturbation?

- Do you have any case papers or reports of past penile injury if yes please upload.

I will response further after you can answer the information I asked.

Regards,

Dr.Chintan Solanki.

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Brief Answer:
you can start supplements and increase frequency of masturbation

Detailed Answer:
Hi,

Thanks for information and sorry for delayed response.

Some response with ayurvedic medicines was there it means your problem is curable.

As described above start tetrafol plus. At present you are doing masturbation less. To see the response of medications you should go for sex or need to increase the frequency of masturbation.

It was first time exposure to sex and you ejaculated early that is absolutely fine. It is normal. Practice makes the man perfect.

If you can attempt sex I recommend taking tadalafil before 2 hours.5-PDE inhibitor group of drug like sildenafil or tadalafil is useful for erectile dysfunction. Person can take it before 2 hours of sex for good erection. These are prescription medicines and you need to consult doctor for the same. If you can succeed with that, your problem is absolutely curable.

I still recommend following reports.

- Serum testosterone
- Semen analysis
- Penile doppler

Also let me know

- Do you have any problem in urinating?

- Do you have any habit of alcohol, tobacco or smoking?

- Is there any specific stress in life?

I will be happy to guide further after your response.

Take care.

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Brief Answer:
go for testing in early morning with empty stomach

Detailed Answer:
Dear XXXXXXX

Thanks for follow up.

I have already mentioned some details about supplement in first response. As it is vitamin product no side effect will be there. You should take it twice a day after meal for 2 months. To treat your problem from root we need to diagnose the cause. As such it seems only psychological problem from available history. If mentioned investigation will come normal, your problem is psychological and it can be treated with the supplement what I mentioned as well as with sex related counselling.

It is good that you do not have any bad habit or stress. But irritation during urine should be evaluated. Go for urine routine-micro investigation also to check for infection.

Dear XXXXXXX at age of 28, erection without significant stimulation is not possible. With kissing you cannot get full erection as penis gets adapted to such arousal stimuli. You can have full erection if you aroused fully during masturbation or sex with sufficient erotic stimuli.
The supplement I told will help to increase your desire as well as performance.

You can get tests done without prescription. You just need to write it on paper and go to laboratory. Yes better to give sample on empty stomach and in early morning. Medicine is also vitamin and you can get the same without prescription.

If still any query there, I will be happy to answer. If not, you can close the discussion and if feasible give your feedback and rating so I can improve my service. In future you can contact me directly on this site if you wish with this link:
http://bit.ly/drchintansolanki
by clicking on 'Ask me a question' on same page at the same cost with three follow up questions.

All the best.

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Brief Answer:
report is normal

Detailed Answer:
Hi XXXXXXX

Thanks for providing report. It is absolutely normal.

Size of penis permanently can only increase with surgery. 5-PDE inhibitor medicine I described before can help in increasing size during sex.

Early discharge during masturbation is normal. However early discharge during sex is called premature ejaculation and it can be treated.

I want to provide brief information about the same.

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 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. 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.

At present I recommend tetrafol plus.

All the best.

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Brief Answer:
it is available online

Detailed Answer:
Hi XXXXXXX

Thanks for follow up.

As such there is no alternative of this medicine.

You can ask your chemist to order tetrafol plus of Sun Pharma for you. I think it is possible as XXXXXXX is city.

Or other option is there. You can ask your doctor to write prescription for the same and you can purchase the same online from below link through that prescription.

http://www.yyyyyyyyyyyyyy.com/searchdrug?keyword=TyyyyyyyyyS%20TABLET%2010%27Syyyyyyyyyyyyyy=All%20Drugs

All the best.

http://bit.ly/drchintansolanki

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Brief Answer:
Welcome

Detailed Answer:
You are welcome XXXXXXX

Hope you will be fine soon. Let me know your progress.

Http://bit.ly/drchintansolanki

Take care.

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