Brief Answer:
Below steps will help you.
Detailed Answer:
Hello,
Thanks for your query.
I appreciate your efforts for medical consultation in so much distress.
Important aspects of your query are:
• 48 year old male
• Known case of
Erectile dysfunction (ED) and
Premature ejaculation (PME)
• Currently on Tfil10 mg for erection and sustinex 30 mg for ejaculation
• Complaints of: Poor response to PME
Premature ejaculation is a very common and treatable problem. Premature ejaculation is diagnosed when ejaculation time is less than 3 Min, or both partners are not satisfied with sex.
Premature ejaculation (PE) is common problem and depends on multiple factors like:
*Psychological factors: most common. The psychological factors may include stress, performance anxiety and
depression
*Medical causes: Reflex activity of ejaculatory system,
thyroid problems,
diabetes,
hypertension, excessive alcohol use and neurological causes.
Following steps will be helpful for treatment:
-Treatment of above conditions (if present) after examination.
-In many persons woman on top position increases ejaculation time, so try this position and experiment with other positions also.
-Start jogging in morning for 20-30 minutes daily, as it reduces performance anxiety and improve blood circulation.
- Try distracting yourself when you feel you are about to ejaculate. Take a deep breath and stay relaxed during intercourse.
- Do not worry about performance and talk to your partner openly about any apprehensions if you have. Conversation with partner during sex also delay ejaculation.
- Stop-start technique- In stop start technique, near ejaculation stop all movements, relax and think about something else. Then wait for 1 minute before starting movements. According to number of stops, ejaculation time will come under your control.
-Squeeze- pause technique: squeeze the end or the tip of the penis for 10 to 20 seconds when you are close to ejaculation and then resume stimulation after withholding for half a minute.
-Sustinex contain
dapoxetine. It is used 1-2 hour before sex. Check if you are taking it at-least 1 hour before sex. Try to check response by taking it 2 hour before sex. It is a SSRI group of medicine and used on demand basis. If response is poor then you can also try other SSRI medicine which is taken daily like escitalopram 5mg.
-Condoms with desensitizing creams (marketed as Kohinoor extra time) help in increasing ejaculation time.
I hope this information has been both informative and helpful for you. In case of any doubt, I will be available for follow ups.
Wish you good health.
Regards,
Note: For further guidance on mental health,
Click here.