Brief Answer:
Treatment is there for both ED and PME

Detailed Answer:
Hello XXXXXXX

Thanks for writing to us. I can understand your concern.

I want to mention here detail of the treatment for erectile dysfunction (ED) and premature ejaculation (PME). The answer will be long but it is needed for your understanding. I also want some more information to help you further.

Medical treatment for ED:

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.

Another 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. You should take it after meal twice a day. If you feel some improvement in 20 days you should continue for at least 2 months. You may get this medicine over the counter as it is vitamin product.

There are some natural lifestyle measures which help to improve blood flow to penis and overall sexual performance.

- The most important factor is healthy heart. Regular exercise and avoidance of fatty fast food are important measures to prevent heart disease. Regular walking, swimming or running overall improves blood flow to whole body circulation including penis and keep the mind fresh.

- Good healthy food is also an important aspect. Bananas, Garlic, dry fruits (they contains vitamins), eggs, cow milk, cow butter are good food which may help in erectile dysfunction.

- Avoid smoking and alcohol. Low amount of alcohol can help in increasing blood flow but more amount can cause opposite effects. So better to avoid the same.

As you are likely form XXXXXXX I would like to also mention ayurvedic medicine option. Tentex forte is the medicine which is used for ED. No side effects have been reported.

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.

Let me know some information:

- Since when are you married?

- Since when are you suffering from this problem? How was previous sex life?

- How did problem start? Any specific incidence was there?

- Do you pay more attention to erection while trying for intercourse?

- Do you have any physical illness, specifically diabetes or high blood pressure?

- Is there any history of smoking or alcohol?

- Is there any difficulty in urinating?

- How is relationship with your partner? Any emotional or social problem is there?

- Is there morning erection present?

- Are you able to masturbate?


I will be happy to help further after getting response.

Regards,

Dr.Chintan Solanki

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Brief Answer:
your problem seems psychological likely

Detailed Answer:
Hello XXXXXXX

Thanks for information and sorry for delayed response.

From history it seems that your problem is more psychological. You cam masturbate, you have erection while watching porn as well as morning erection; all these factors rule out possibility of any physical problem. There is no possibility of testosterone problem. However for assurance and to get back confidence you can go for morning serum testosterone level (free+total) testing.

Performance anxiety may be playing role in your problem.

Sometime due to fatigue, lack of mood, situational problem or environmental changes man can fail in sex. It is normal phenomenon. However when this failure makes person apprehensive about erection, sex life is affected. This is called performance anxiety. After such failure when person actively thinks about erection or success of intercourse during sex his mind is likely diverted to such thoughts. For constant erection continuous exciting/romantic/erotic feelings should be there in mind. If mind diverted to concern about erection, erection would not be possible.

While doing sex keep yourself relax.

Whenever you go for sex, spare enough time in foreplay. You should not think actively about erection, your mind must be occupied with sexual/romantic feelings. During foreplay your partner should try to arouse you and note that your penis gets erection or not. When she feels that penis is sufficiently erect she herself should try to put erect penis in vagina gradually and you should continue your foreplay feelings without being conscious about erection. You must try to enjoy and only enjoy.

If your partner is not aware about this situation you can do on your own. You just should try to do sex without being conscious about erection. Enjoy without thinking of your ability of maintaining erection and you will succeed or not.

In any case in future you will fail after multiple attempts; medicines are there to get confidence.5-PDE inhibitor group of drug like sildenafil or tadalfil is useful. I describe details about that already. After 3-4 successful attempts you can do sex without medicine.

Apart from this if you want to take supplement at present, my recommendations are as below.

If I were your treating doctor I suggest one tablet of tetrafol plus after meal twice daily for two months and one tablet tentex forte daily at night with a cup of milk for 4 weeks.

Hope you are clear now.

Take care.

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Brief Answer:
no side effects

Detailed Answer:
Dear XXXXXXX

The supplements I mentioned do not cause side effects and you will not have cold due to that.

And as I explained do not give attention to erection, just try to enjoy. That will also help.

I am sure you will be fine soon.

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 if you wish you can contact me directly on this site with following link:
http://bit.ly/drchintansolanki

by clicking on 'Ask me a question' on same page with three follow up questions.


All the best and take care.

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