Brief Answer:
please ask your question regarding sexual health

Detailed Answer:
Hello xxxxxxxxxx,

Thanks for writing to HCM.

I am Dr. Chintan Solanki practicing as psychiatrist-sexologist-deaddiction specialist.

Please ask your sex related problem with relevant details.

I would like to help you after your response.

Regards.

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Brief Answer:
we need to evaluate the factors for low desire

Detailed Answer:
Hi,

There are many causes of low sex desire :
Physical causes: medical diseases ( diabetes and neurological diseases), medications ( blood pressure medications, antihistamines and antidepressants), alcohol and smoking, urinary problem, spinal problem.
Psychological causes: mental health problems, such as anxiety or depression, stress, guilt about enjoying sexual experiences, past sexual or emotional abuse, relationship issues.

Let me know if you have any of such causes.

In general to improve sex desire healthy mind and fit body are important.

I recommend two capsules of tentax royale every night with one cup of milk to improve sexual desire.

Also provide more information about your sex life.

- Are you married?
If yes duration of marriage and since when are you suffering from this problem? How was previous sex life?
If not married, provide details about sex life with girlfriend. Where and in which circumstances you do sex?

- Since when are you suffering from low desire?

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

- Is there any problem of erectile dysfunction of premature ejaculation?

- Do you have any physical illness, specifically diabetes or high blood pressure?

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

- Is there morning erection present?

I will be happy to help further after getting response.

Regards,

Dr.Chintan Solanki

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Brief Answer:
behavioral modifications with medicines

Detailed Answer:
Hi,

Thanks for information.

As morning erection is present there is no possibility of any physical cause likely.

First of all clarification about masturbation.

Masturbation is natural and normal thing. It is done by 95% of the males in the world, mostly before marriage as well as when wife is away, in menses or pregnant after marriage. 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.

You have problem of erectile dysfunction and occasional premature ejaculation.

I want to mention here detail treatment for erectile dysfunction (ED) and premature ejaculation (PME). The answer will be long but it is needed for your understanding.

Medical treatment for ED:

5- PDE inhibitor group of medicines like sildenafil or tadalafil are used. One of them should be used 2 hours prior to sex. I prefer tadalafil in patient with hypertension and diabetes. These are prescription medicines and you need to consult doctor/psychiatrist/sexologist for the prescription.

Another 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. You should take it after meal twice a day. If you feel some improvement in 20 days you should continue for at least 2 months. You may get this medicine over the counter as it is vitamin product.

There are some natural lifestyle measures which help to improve blood flow to penis and overall sexual performance.

- The most important factor is healthy heart. Blood is pumped in to body by heart. Regular exercise and avoidance of fatty fast food are important measures to prevent heart disease. Regular walking, swimming or running overall improves blood flow to whole body circulation including penis and keep the mind fresh.

- Good healthy food is also an important aspect. Bananas, Garlic, dry fruits (they contains vitamins), eggs, cow milk, cow butter are good food which may help in erectile dysfunction.

- Avoid smoking and alcohol. Low amount of alcohol can help in increasing blood flow but more amount can cause opposite effects. So better to avoid the same.

As you are likely form XXXXXXX I would like to also mention ayurvedic medicine option. Tentex forte is the medicine which is used for ED. No side effects have been reported.

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. Master and XXXXXXX technique can also be learnt from qualified sexologist/Psychiatrist which includes sessions in couple as it is couple sex therapy. It can help in prolongation of time.

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.

In ayurvedic products confido can be used for premature ejaculation. It is likely available over the counter without prescription.

IN CONCLUSION:
If I were your treating doctor I would like to give tetrafol plus, tentex forte daily for ED with tadalafil before sex for 4-5 attempts to boost your confidence and clomipramine for PME.
But lifestyle and behavioral approaches are the main thing to be followed for healthy sexual life overall for long term.

If still any query there, I will be happy to answer. If not, you can close the discussion and if feasible give your feedback and rating so I can improve my service. In future you can contact me directly on this site if you wish with this link:
http://bit.ly/drchintansolanki
by clicking on 'Ask me a question' on same page.

Take care and all the best.

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Brief Answer:
I am not sure but likely available

Detailed Answer:
Hi,

I am sorry for delayed response due to busy work schedule.

Tadalafil and clomipramine are likely available there, you just need to consult doctor. For tetrafol plus I have mentioned contents you can ask pharmacist to give any supplement with these content if tetrafol plus is not available. And tentex forte is an ayurvedic product by Himalaya Company. You can ask your pharmacist for the same or you may purchase online.

Wish you good health.

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