Brief Answer:
Advise and recommendations given

Detailed Answer:
Hello and thanks for your query.

I am Dr. Jonas Sundarakumar, Consultant Psychiatrist & Sexologist and I will be helping you with your health queries. I understand that you are worried about two problems - 1) your habit of tobacco chewing and 2) your sexual problem of premature ejaculation.

Regarding your problem of tobacco chewing, this appears to be a serious problem since you say that you are using it more than 20 times a day. I hope you are aware of the very harmful consequences that can arise from chewing tobacco.

For your tobacco chewing habit, I would recommend two treatments: one is nicotine replacement therapy and the second is the tablet Bupropion. I will elaborate on how these two treatments can be taken to help in quitting tobacco.

Firstly, the person has to set a date to quit. Before this date, it is advisable to slowly start decreasing the frequency of using tobacco as much as possible. The person also has to make up his mind and be firm that on that set date, he is going to quit.

Then, two weeks before that date, the person has to be started on the tablet Bupropion. This tablet has been proven to be helpful in tobacco cessation and works by decreasing the craving or urge to use tobacco. It is usually started at 75mg twice a day and after 2 weeks, it is then increased to 150mg twice a day.

Then, from the date of quitting onwards, the nicotine replacement therapy is started. In my clinic, for patients who are chewing tobacco, I recommend using a Nicotine patch and using Nicotine chewing gums whenever the person gets an irresistible urge to chew tobacco. After a period of 4 to 6 weeks, the nicotine replacement therapy is gradually tapered down and then stopped.

The above combination treatment regime has been found to be the most effective in tobacco cessation.

Regarding your second problem of premature ejaculation, I would first like to reassure you that this is not a serious problem. The fact is that it is very common and faced by a majority of young males before marriage. The remedy for this problem is to regularly practice certain sexual techniques / exercises.

The first technique / exercise is called the stop-start technique. Here the penis is stimulated (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 next technique, called the squeeze technique, the penis is stimulated (by masturbation) 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.

If you practice these two techniques regularly, your ejaculatory control will improve significantly..

In case, you very worried about your sexual performance after marriage, you can try medication for a short term. There is a tablet called Dapoxetine which can be taken 1 hour before sexual intercourse and it increases the time taken for ejaculation. So, if your problem of premature ejaculation is severe, then you can ask a doctor for a prescription for the medication.

I hope I have clarified all your queries.

Wish you all the best.

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

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