Brief Answer:
Need some more details

Detailed Answer:
Hello and welcome to Healthcare Magic. Thanks for your query.

I will certainly help and advise you regarding your problem. In order to guide you better, can you please provide the following clarifications...

- How long have you been having this problem?

- How frequently does this problem happen? Does it happen only in certain situations or everytime you are sexually aroused?

- How long are you able to perform sexual intercourse?

- Are you married? Do you have any problems or stress in your relationship?

- Do you suffer from anxiety, negative thoughts or low mood?

- Do you smoke or consume alcohol or any other drugs?

- Do you have any other medical problems or are you on any medication currently?

Please get back to me with these details, so that I can advise you in a better way.

Regards,
Dr. Jonas Sundarakumar MBBS., DPM., MRCPsych.(U.K.)
Consultant Psychiatrist & Sexologist

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Brief Answer:
Advise given for your sexual problems...

Detailed Answer:
Hello and welcome to Healthcare Magic. Thanks for your query.

From your description of your symptoms, I can see that you are having two problems:
1) Erectile dysfunction
2) Premature ejaculation

Now, there can be a variety of causes for these problem - both medical causes as well as psychological causes. So, the first and most important step in management is proper evaluation. This will include a detailed medical, sexual, personal and social history, a thorough physical examination and certain investigations, as per the necessity. This is both informative to the doctor and serves as an opportunity to educate the patient and clarify his doubts.

Firstly, any medical causes (like diabetes, hormonal problems, blood flow problems, vitamin deficiencies, etc.) need to be ruled out. For this, you may need to undergo a few blood tests. But, considering your young age and considering the mild nature of your problems, it is unlikely that you may be having a major medical cause for your erection problem.

I would also like to let you know that in more than 80% of cases of erectile dysfunction, psychological factors also play a major role in causing or aggravating the problem. Stress, anxiety, fears and doubts regarding sexual performance, feelings of sexual inadequacy, self-doubts, guilt, past negative sexual experiences, etc. can all affect sexual functioning and performance.

Now, regarding treatment, it has to be targeted according to the findings on evaluation. If there are any underlying medical problems resulting in the erectile dysfunction, then those problems have to be first treated. If the problem is more psychological, then removing the person's doubts and fears, and improving his self-confidence levels will also definitely help in improving sexual performance. Also, there are certain medication which improve the blood flow to the penis and promote better erection, such as Sildenafil, Vardenafil and Tadalafil.

Regarding your other sexual problem of pre-mature ejaculation, this is actually a very common problem in young males. Don't worry, your problem of premature ejaculation can be controlled by regularly practicing certain sexual techniques or by taking medication for a short period. I would like to give you the following advise to overcome your problem:

1) Firstly stop becoming more anxious about this problem - because if you feel more anxious and worried or if you keep having doubts that you may not be able to perform properly, then this anxiety itself will worsen the problem. So, during sexual intercourse try to stop worrying and "monitoring" your sexual performance. Just try to be relaxed and enjoy yourself. Don't keep on thinking "How long am I going to last?" "Will I ejaculate too quickly?" "Will I be able to satisfy my parrtner?, etc. One more suggestion is to arouse your partner well before starting intercourse. So, you can increase and spice-up your foreplay and make sure that you start penetration only after your partner is fully turned on. When your partner is fully aroused and involved, then things keep flowing smoothly and effortlessly, and you don't have to be constantly anxious if you are satisfying your partner or not.

2) The second solution for pre-mature ejaculation is to reduce the "hypersensitivity" of the penis. For this, there are certain specific sexual techniques which can reduce this hypersensitivity. The "stop-start technique" or "squeeze technique" have been proven to be successful in reducing this hypersensitivity and increasing the ejaculatory time.

In the stop-start technique, the penis is stimulated (by sexual intercourse or by masturbation) till a point when you feel close to orgasm. At that point, the stimulation is stopped for some time and after a small gap, it is continued. This process is repeated repeated a few times.

In the squeeze technique, the penis can be stimulated by hand (by masturbation or by your partner) till a point when you feel close to orgasm. At that point, the lower part of the head of the penis is squeezed tightly with the index finger and thumb around for a few seconds till the erection decreases. Then the stimulation is restarted and the process is repeated a few times.

Both these techniques, if practised regularly can definitely prolong the time for ejaculation.

3) The third solution is to try medication. There are certain medication like Prilyxet, which can help you control premature ejaculation. The usually recommended dosage of Prilyxet is 30mg, once a day and can be taken for a short period of time till your problem improves.

If you follow these suggestions, then I'm sure that you will be able to gradually control your problem of premature ejaculation.


Wish you all the best.

Regards,
Dr. Jonas Sundarakumar MBBS., DPM., MRCPsych.(U.K.)
Consultant Psychiatrist & Sexologist

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