Brief Answer:
Probably your refractory period is long

Detailed Answer:
Hello XXXX,

Thanks for writing to us.

In males there is called refractory period after ejaculation and orgasm. This is the period during which it is physiologically impossible for a man to have additional orgasms.The penis may be hypersensitive and further sexual stimulation may feel painful during this time frame.While the refractory period varies widely among individuals, ranging from minutes to days, most men cannot achieve or maintain an erection during this time. Many perceive a psychological feeling of satisfaction and are temporarily uninterested in further sexual activity.

There are suggested hormonal,neurotransmitter and muscle fatigue theories to specify refractory period.Average period duration varies from 15 to 45 minutes. But it can be less like 1 minute and more like 1 day also.In your case this period is likely around of 1 day.

This is natural phenomenon,not dysfunction we can say(though it is affecting your sexual activity more than once in a day) and no specific treatment for the same.

5-PDE inhibitor drugs like sildenafil or tadalafil can reduce refractory period but they are used only when there is erectile dysfunction. In your case erection is absolutely normal.So using the same may cause more pain.

Sometime low level of testosterone can cause such pain. You should go for serum testosterone level investigation once for assurance. If it comes normal, you are fine. If it comes low, supplement can be given.

Mechanism of penile muscle dilation required role of nitric oxide.By considering this aspect I want to recommend one vitamin supplement without any side effect.
It is vitamin supplement containing pyridoxal-5-phosphate, mecobalamin and l-methylfolate (trade name tetrafol plus). You should take it after meal twice a day. If you feel some improvement in 15 days you should continue for at least 2 month. You may get this medicine over the counter as it is vitamin product.

Hope I have answered your query, I will be happy to help further.

Regards,
Dr.Chintan Solanki.

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Brief Answer:
you can consult psychiatrist/sexologist

Detailed Answer:
Hello,

Thanks for follow up.

No need to worry about marriage life. You can perform well.There are other ways to satisfy female if she needs more.You ca consult doctor before marriage for counseling.

Tetrafol plus may help in your leg pain also if it is due to vitamin B12 deficient.This pain is not likely related to penis pain. It may be related to your sex/masturbation position.Stop amway nutrilite for a while if you go for tetrafol plus.

Slight bending up to 10 degree in erect penis is normal if it is not painful.

By degree psychiatrist is sexologist. You can consult the same for your all these problems.

For your premature ejaculation I would like to brief you treatment aspect.

Premature Ejaculation (PME) or early discharge 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.

There are medicinal and non medicinal approaches to treat 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 (duralast)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 counseling 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 using condom while sex helps in delaying ejaculation by reducing sensitivity of glans penis.

--Topical application of anesthetic gel/spray. For this you have to consult doctor.

Feel free to discuss further.

Regards,
Dr.Chintan Solanki.

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Brief Answer:
need to rule out urinary tract infection

Detailed Answer:
Hi,

Thanks for question.

Tingling/slight burning, urge to urinate suggest urinary tract infection.

You should go for urine routine micro investigation.If report comes positive need of suitable antibiotic according to doctor's advice.
If report comes normal opinion of surgeon/urologist should be take for further evaluation and investigation of urogenital infection.
Continue drinking of water until then.
Hope this answers your concern.

Take care,.

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