Brief Answer:
Clarifications needed.

Detailed Answer:
Hi,

Please clarify the following:

How long are you having this problem?

How many minutes are you able to perform intercourse without a condom?

Do you have any anxiety of fear about performing poorly during sex?

Do you have any medical problems?

Do you smoke, drink alcohol or use any drugs?

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Brief Answer:
Advise given

Detailed Answer:
Hello and thanks for your clarifications.

From the description of your sexual problem, it appears that you are suffering from Premature ejaculation. The common causes for premature ejaculation are:
1) A hypersensitive response of the penis
2) Subconscious anxiety / fears / doubts about inadequate sexual performance (called as "performance anxiety")

Don't worry, your problem of premature ejaculation can be controlled by regularly practicing certain sexual techniques or ejaculatory control exercises.

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 or exercises 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.

One more good exercise that will improve ejaculatory control is Kegel's exercises. Here the person tightens his perineal muscles in the same manner in which he would hold on if he has to urgently withold stools and urine. Contract your perineal muscles and hold like this for 5 seconds, then relax for 5 seconds. Repeat this for 10 times.

3) Another option is to try medication for a short duration till you gain better control and confidence. There are certain medication like Dapoxetine (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.

You should also avoid opiates, alcohol or any other substances. If you are overweight, you should also reduce weight.

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
Consultant Psychiatrist & Sexologist

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Brief Answer:
Keep medication as a back-up option

Detailed Answer:
Hi,

In my opinion, I would advise you to first try all the other suggestions that I have given and keep medication only as a back up option. But don't worry, it is a safe medication and does not cause any significant side effects or any harm to the body. It will not affect your sexual desire or your penis in any way. Usually, the medication is advised to be taken about 1 hour before sexual intercourse and the duration of treatment would be a few weeks, till you regain your confidence. But still my policy is to avoid medication as much as possible and that is why I had mentioned it as the last option.

Regards,
Dr. Jonas Sundarakumar
Consultant Psychiatrist & Sexologist

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