Brief Answer:
your concern is purely psychological

Detailed Answer:
Dear XXXXXXX

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

I want to clarify about masturbation and size of penis.

Masturbation is safe. Masturbation is natural and normal thing. It is done by 70-95% of the males mostly before marriage as well as when wife is away, in menses or pregnant after marriage. and 30-45% females in the world. It is not at all harmful. Frequency of masturbation done by an individual varies from once a day to once a week. It depends upon individual libido, wish and timing. It neither causes any weakness nor any problem in sexual activity. It does not affect penis size at all.

Normal size of penis in flaccid state is 2 to 4 inches (5 to 10 cm) while in erect position 4 to 7 inches (10 to 15 cm). It varies according to body structure and race. Size of penis does not matter much for satisfying partner.
Anterior 2-3 inches of female vaginal wall is sensitive to sexual stimuli. Only 3.5 inches of erect penis is sufficient to satisfy female. The average girth for an erect penis is 12-13cm (4.7-5.1 inches).

Many young men like you feel apprehension about post marital sex life. It just needs counselling and assurance.

Let me know more.

- What is your penis size in flaccid and in erect state?

- Do you have any experience of sex? If yes describe details and when did you do your last successful intercourse?

- How much time is there between full erection and ejaculation, during sex as well as during masturbation?

- Do you have any habit of alcohol, tobacco or smoking?

- Do you have any physical illness?

From you history seems that there is no physical problem.

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

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Brief Answer:
go for serum testosterone level and start supplements

Detailed Answer:
Hi XXXXXXX

Thanks for follow up.

From your history I recommend going for serum testosterone level. Go for fasting free and testosterone level. If deficiency is there supplement can be given.

I also want to clarify about performance anxiety if it is there.

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/masturbation 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 masturbation 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 ejaculation. You must try to enjoy and only enjoy. This is also applicable for early ejaculation.

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. Person can take it before 2 hours of sex for good erection. After 3-4 successful attempts he will have confidence and person can do without help of medicines later on. These are prescription medicines and you need to consult doctor for the same.

For a while you can use 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 ED. You may get this medicine over the counter as it is vitamin product. You should take it twice a day after meal for 2 months.

Early ejaculation (pme- premature ejaculation) can also be treated.

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.

--Topical application of lignocaine anesthetic gel/spray. For this you have to consult doctor.

I recommend clomipramine in your case.

Feel free to discuss further.

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