Brief Answer:
PE can be treated

Detailed Answer:
Hello,

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

Normal size of penis in flaccid state is 2 to 4 inches while in erect position 4 to 6 inches. It varies according to body structure and race. Size of penis does not matter much for satisfying partner.
Anterior 3 inches of female vaginal wall is sensitive to sexual stimuli. Only 3.5 inches of erect penis is sufficient to satisfy female. Hope you are clear about concern of size of penis now.

As such there is no medicine which can increase basic natural size of penis. No evidence supports such pills effectiveness. Only surgical intervention can increase the size of penis permanently.

Note: There are pills which can increase size of penis if there is erectile dysfunction.5- PDE inhibitor group of medicines are used for this purpose which includes sildenafil or tadalafil. You are already taking sildenafil. 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. Tadalafil is safer in patients with high blood pressure.


Premature ejaculation can be treated.

According to the latest diagnostic criteria by DSM 5, premature ejaculation should be defined when there is ejaculation within one minute after entering tin to vagina or even before penetration.

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. Kegel exercise also helps in some cases. You can learn the same from internet.

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.

I recommend clomipramine in your case.

Hope I have answered your query, I will be happy to help further.
Regards,
Dr.Chintan Solanki.

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