Brief Answer:
please explain more details

Detailed Answer:
Hello,

Thanks for writing to us. I can understand your concern. To guide you in right direction I need more details.

- Are you married?
If yes duration of marriage?
If not married, provide details about sex life with girlfriend. Where and in which circumstances you do sex?

- What are the problems? Is your erection is not proper enough? How many seconds do you last? are you able to satisfy your partner?what is size of penis in flaccid and erect state?

- How did problem start? Any specific incidence was there?

- Do you pay more attention to erection while trying for intercourse?

- Do you have any physical illness?

- How is relationship with your partner? Any emotional or social problem is there?

- Is morning erection present?

- Is there any history of smoking or alcohol?

- Is there any difficulty in urinating?

- When did you do successful intercourse last?

- Is there any history of masturbation? If yes, how was pleasure/orgasm during masturbation?

I will be happy to help further after your response.
Regards,
Dr.Chintan Solanki.

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Brief Answer:
problem is psychological likely

Detailed Answer:
Hi,

Thanks for information.

Your problem is due to performance anxiety likely.

Sometime due to fatigue, lack of mood, situational problem or environmental changes man can fail in sex. It is normal phenomenon. This is called performance anxiety. After such failure when person actively thinks about erection or success of intercourse, 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/ejaculation, erection becomes weak or lost.
Try to enjoy without being conscious about erection or ejaculation.
While doing sex 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.

For your information I would like to brief you about treatment of PME.

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 0-30 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.

Confido is an ayurvedic product and recommended for premature ejaculation.
You can take it with milk every day for 2 months.

If I were your treating doctor I would recommend confido at present with behavioral approach whichever applicable.

In future if you wish you may go for clomipramine.

Take care.

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Brief Answer:
following links are there, clomipramine can be used

Detailed Answer:
Hello,

I am really sorry for delayed response.

Kegel exercise is pelvic floor muscle strengthening exercise. You can learn easily from internet. I suggests following links to my patients.

http://www.yyyyy.com/urinary-incontinence-oab/kegel-exercises-treating-male-urinary-incontinence

http://www.yyyyyyyyy.org/healthy-lifestyle/mens-health/in-depth/kegel-exercises-for-men/art-0000

As I mentioned you can go for clomipramine for premature ejaculation.
Other method you can learn from following links.

http://www.yyyyyyyyyy.com/stop-start.html

https://www.yyyyyy.com/uk/how-to-delay-ejaculation.html

All the best.

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