Suggest Treatment For Premature Ejaculation And Erectile Dysfunction

Brief Answer:
At this age physical cause of erectile dysfunction is less likely

Detailed Answer:
Hello XXXXXXX

Thanks for writing to us and clear questions.

First of all clarification about masturbation.

Masturbation is natural and normal thing. 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 future sexual activity. So there is no need at all of suppressing your desire by avoiding masturbation. Just continue it when you desire. Practice makes the man perfect. Masturbation becomes problem only when someone get addicted to it and they need to do it at the cost of his routine daily wok or study.
You have already quit masturbation since 6 months. In your case I do not think that masturbation is cause of current problems.

- However still let me know your frequency of masturbation at that time(a lot means?).

For your problem of premature ejaculation(PME) and erectile dysfunction (ED) performance anxiety may be responsible.

- Do you feel that there you have performance anxiety? I have explained about the same below.
For good erection constant exciting erotic feelings must be present in mind. If your mind is diverted to something else apart from sex, erection is going to lose. Many times due to fatigue, stress, physical problem or excessive workload man cannot perform well in sex. This is not permanent failure but only occasional problem. When person becomes apprehensive about such occasional failure and constantly thinks about his ability do successful sex while he goes for sex his mind diverted from exciting feelings and penis loses erection. This anxiety might be responsible for failure of intercourse. This is called performance anxiety.
This is purely psychological problem, no physical/pathological problem at all.

Let me know some more information:

- Are you married?If yes provide detail history of sex life. If not married, let me know if you have girlfriend and sex-life.

- Do you have any physical illness?

- Is there any history of history of smoking or alcohol?

- Is there any difficulty in urinating?

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

- Is there morning erection present?

- Are you able to masturbate with satisfaction?


Ans 1:

Premature Ejaculation (PME) or early discharge defined when male partner ejaculates early before the female partner reaches to orgasm. There is no absolute time by which we can diagnose PME. It is relative term and female partner is the best judge.

There are medicinal and non-medicinal approaches to treat 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.
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:

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

If I were your treating doctor I would suggest clomipramine to start with.


Ans 2:

Treatment of erectile dysfunction:
5- PDE inhibitor group of medicines like sildenafil or tadalafil are used. 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 preferred in patients with blood pressure.

You can use 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 ED.You should take it after meal twice a day. If you feel some improvement in 15 days you should continue for at least 2 months. You may get this medicine over the counter as it is vitamin product.

Serum testosterone level should be checked once. If it is low, supplement can be given.

Diabetes should be ruled out by blood sugar check up.

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.So 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.

If I were your treating doctor I would like to start sildenafil and tetrafol plus.And after 3-4 successful attempts of sex I would stop sildenafil.


Ans 3:

It is likely due to your basic allergy problem as you mentioned in medical history. No need to worry about the same. You should consult dermatologist once for this.


Ans 4:

It is likely due to stress of sexual problems. In my opinion give yourself a break. Avoid sex/masturbation for 2-3 weeks completely, do other activities like sports, yoga, mediation, outing with family-friends and then restart sex life.

Hope I have answered your query, I will be happy to help further.

Regards,
Dr.Chintan Solanki.

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