Common treatment options for premature ejaculation include behavioral techniques, topical anesthetics, medications and counseling. Keep in mind that it might take time to find the treatment or combination of treatments that will work. Behavioral technique Pelvic floor exercises Male pelvic floor muscles Weak pelvic floor muscles might impair your ability . Condoms Condoms might decrease penis sensitivity, which can help delay ejaculation. "Climax control" condoms are available over the counter. These condoms contain numbing agents such as benzocaine or lidocaine or are made of thicker latex to delay ejaculation. Medications: Topical anesthetics Such as benzocaine, lidocaine or prilocaine, are sometimes used to treat premature ejaculation. These products are applied to the penis 10 to 15 minutes before sex to reduce sensation and help delay ejaculation. Oral medications sildenafil 50/100mg or tadalafi 10/20mg , 15 to 20min before. Alone or with SSRI/Dapoxetine sometime Clonafit if Anxiety is prominent. Behavior therapy /Couple therapy.
Go for stepwise approach...... STEP 1 : SEE IT'S SUBJECTIVE OR TRUE PE. Subjective PE to be treated with.... (i) Counselling (ii) Behavioral therapy (avoiding masturbation, reading porn books, watching porn contents, avoiding foreplay before sex, diverting mind during coitus, healthy thinking) (iii) Use of "Climax Condom" (thick latex condom or condom with anaesthetic jelly). /Apply anaesthetic jelly on glans prior to intercourse. (iv) Anxiolytic In True PE go to next step. STEP 2 : R/O SYSTEMIC ILLNESS. It includes...... -Spinal injury -CNS /Peripheral neuropathy -LUTS/Prostatovesiculitis -Thyroid disease -Hyperprolactinemia -CLD -CKD -Dyslipidemia -Cardiac illness -DM -HTN etc If 'YES' treat it accordingly. If 'NO' then go to next step. STEP 3 : R/O ERECTYLE DYSFUNCTION If 'YES' then treat with..... (i) PDE5i (ii) +/- Dapoxetine /Paroxetine /Fluoxetine (iii) CoQ10 Enzyme (iv) Kegel's exercise (v) Behavioral therapy (vi) Anaesthetic gel / Climax condom If 'NO' then treat same way excepting the 'PDE5i'. In non response go to next step. STEP 4 : SEMEN ANALYSIS AND FREE TESTOSTERONE. Advise free testosterone if semen analysis shows low sperm count. If it's decreased then give 'TRT'. In non response go to next step. STEP 5 : IDIOPATHIC PE. Treat with Clomiphene citrate 25 mg for 3 months.
As per my understanding, Please get his TOTAL & FREE TESTOSTERONE LEVELS DONE. What I feel is that most of the cases of PME actually also suffer from ED. Let me brief over here that these levels are also misleading because of the methodological issues and the reference range choosen by the laboratories. On a CLIA system the MODE value is around 800 ng/dl (with a range if 400-1600) in general and on ELISA/ELFA system, it is 600 ng/dl (with a range if 270-1070). Most of the laboratories now a days have adopted to CLIA but are still referring ranges designed for ELISA / ELFA systems which are misleading to we treating physicians. Certain literature also mention that most of these cases of PME are in fact ED. Also, I would like to see his prolactin levels below 18 ng per ml
Tell him to practice abstinence from sex for at least 6 weeks, neither masturbation nor real sex. That will cause a lot of improvement. Also tell him to stop seeing porn in this period, as now a days porn induced sexual dysfunction or performance anxiety is common. Kegel's exercise is OK. These are conservative methods. Pharmacological approch would be to use Combination of Tadalafil & Dapoxetine (10/20+30) on alternate days. Tadafil-D can be used on alternate days. If he is having coexisting anxiety disorders, treatment of those would be needed. For that Alprazolam or Clonazepam can be used on short term basis along with Propranolol.
He is hyperexcited personality probably nymphomanic should receive counseling and psychotherapy and if needed anxiolytic drugs
Better to stop RCA and give fluoxetine 20 mg or paroxetine CR 12.5mg on daily basis. Rest to continue as advised.
reassurance and councelling required. Needed anxiolytic drugs.
TD Pill (Tadalafil + Dapoxetin) will be helpful.
Reassurance and counselling required.
There is no side effect of masturbation 90 percent does it wonder drug Viagra start with 25 mg go up to 800 mg 1 hr before sex utilising side effect of trazonil 50 hs aswaganda powder half tsf bd suggested by urologist
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Friends Many patients have #sexual#Problems but they are hesitant and don't want to share with anyone not even to their Doctor which can lead to many more health problems..so don't be hesitant and no need to worry just contact me for ur problem.... #sexual problems, refers to a problem during any phase of the sexual response cycle that prevents the individual or couple from experiencing satisfaction from the sexual activity. The sexual response cycle has four phases: excitement, plateau, orgasm, and resolution. While research suggests that sexual dysfunction is common (43% of women and 31% of men report some degree of difficulty), it is a topic that many people are hesitant to discuss. Fortunately, most cases of sexual dysfunction are treatable, so it is important to share your concerns with your partner and doctor. What Causes Sexual Problems? Sexual dysfunction can be a result of a physical or psychological condition. Physical causes: Many physical and/or medical conditions can cause problems with sexual function. These conditions include diabetes, heart and vascular (blood vessel) disease, neurological disorders, hormonal imbalances, chronic diseases such as kidney or liver failure, and alcoholism and drug abuse. In addition, the side effects of certain medications, including some antidepressant drugs, can affect sexual desire and function. Psychological causes: These include work-related stress and anxiety, concern about sexual performance, marital or relationship problems, depression, feelings of guilt, and the effects of a past sexual trauma. Who Is Affected by Sexual Problems? Both men and women are affected by sexual problems. They can occur in adults of all ages. Among those commonly affected are seniors, which may be related to a decline in health associated with aging. How Do Sexual Problems Affect Men? The most common sexual problems in men are ejaculation disorders, erectile dysfunction, and inhibited sexual desire. What Are Ejaculation Disorders? There are different types of ejaculation disorders, including: Premature ejaculation -- This refers to ejaculation that occurs before or very soon after penetration. Inhibited or retarded ejaculation -- This is when ejaculation is slow to occur. Retrograde ejaculation -- This occurs when, at orgasm, the ejaculate is forced back into the bladder rather than through the urethra and out the end of the penis. Premature ejaculation, the most common form of sexual dysfunction in men, often is due to nervousness over how well he will perform during sex. In some cases, premature and inhibited ejaculation are caused by a lack of attraction for a partner, past traumatic events, and psychological factors, including a strict religious background that causes the person to view sex as sinful. Certain drugs, including some antidepressants, may affect ejaculation, as can nerve damage to the spinal cord or back. Retrograde ejaculation is common in males with diabetes who suffer from diabetic neuropathy (nerve damage). This is due to problems with the nerves in the bladder and the bladder neck that allow the ejaculate to flow backward and into the bladder. In other men, retrograde ejaculation occurs after operations on the bladder neck or prostate, or after certain abdominal operations. In addition, certain medications, particularly those used to treat mood disorders, may cause problems with ejaculation. This generally does not require treatment unless it impairs fertility.Dr. Rajesh Gupta4 Likes7 Answers
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An 65 year old gentleman presented with blackish discolration of great toe and nail since 15days A/w Foul smelly pus discharge, non healing ulcer which is painless and surroundings edema. Non healing ulcer surround by callus on bilateral medial aspect of heel region. With Bilateral cellulitis. By occupation he is a bus conductor H/O Type 2 DM since 15 Year’s HTN since 10 year and DPN since 12 Year’s After detailed examination his Sugars are uncontrolled Dyslipidemia Acute kidney injury ABI is normal 1.0 TBI I couldn’t examine in this patient VPT reviled he has severe neuropathy in both legs But no deformity as such (no Neuroarthropathy) Ecg is normal So I diagnosed this case as Infective Gangrene of right Hallux Neuropathy ulcer over bilateral medial ascpect of heel region Callus over left plantar aspect of fore foot Treatment Debridement done Cefperazone+ Saulbactum inj intravenous started Statin, Aspirin and clopidogrel tablets started ACE inhibitors also started For sugar control premix insulin twice and OHA triple combination started..... Doctors please kindly suggest of anything else I need to changeDr. Anudeep Puvvula13 Likes23 Answers
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A 30 year old man suffering from premature ejaculation problem and erectile dysfunction problem all respected doctors please suggest ayurveda and Homeopathic remedies thankDr. A.a Sheikh1 Like27 Answers
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A 56/M pt present to ED with the c/o moderate uneasiness and heartburn. He had been diagnosed with type 2 diabetes mellitus 4 years earlier. He is suffered from Hypertension, Dyslipidemia, diabetic nephropathy, diabetic retinopathy and peripheral neuropathy. Currently His medications included Telma 40, Ecospirin AV Gold 20 and metformin O/E BP 150/80 mmHg, reduced vibration sense in his feet. ECG is performed, based on ecg findings, Pt denied chest, arm or jaw pain or discomfort; shortness of breath; palpitations; nausea; indigestion or sweating. In view of the ECG changes, What is the most likely diagnosis and treatmentDr. Z. V. Anwer5 Likes19 Answers
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DIABETIC NEUROPATHIES. Diabetic neuropathies are a family of nerve disorders caused by diabetes. WHAT CAUSES DIABETIC NEUROPATHY. Nerve damage is likely due to a combination of factors. 1.METABOLIC FACTORS. : hyperglycemia, long duration of diabetes, abnormal blood fat levels and low levels of insulin. 2.NEUROVASCULAR FACTORS : Neurovascular factors leading to damage of blood vessels that carry oxygen and nutrients to nerves. 3.AUTOIMMUNE FACTORS : Causes inflammation of nerves. 4.MECHANICAL FACTORS : Injury to nerves as in carpel tunnel syndrome. 5.INHERITED TRAITS : That increase susceptibility to nerve disease. 6.LIFESTYLE FACTORS : Smoking, alcohol. SYMPTOMS. Symptoms depends on the type of neuropathy and which nerves are affected.Symptoms involve sensory,motor and autonomic nervous system. 1.Tingling, numbness or pain in the toes,feet,legs,hands,arms and fingers. 2.Wasting of muscles of hand or feet. 3.Indigestion, nausea, vomiting, diarrhea,c constipation. 4. Dizziness or fainting due to a drop in blood pressure after standing or sitting up. 5.Problems with urination. 6.Erectile dysfunction. 7.Weakness. TYPES OF NEUROPATHY. Diabetic neuropathy can be classified as 1.Peripheral neuropathy. 2.Autonomic neuropathy. 3.Proximal neuropathy. 4.Focal neuropathy. PERIPHERAL NEUROPATHY. Peripheral neuropathy,also called distal symmetric neuropathy or sensorimotor neuropathy ,is nerve damage in arms and legs.Symptoms are *Numbness or insensitivity to pain or temperature. *A tingling,burning or prickling sensation. *Sharp pains or cramps. *Extreme Sensitivity to touch. *Loss of balance and coordination. Peripheral neuropathy also causes muscle weakness and loss of refle guyxes.Blisters and sites may appear on the numb areas of the foot because pressure or injury goes unnoticed.I f an infection occurs and is not treated promptly,the infection may spread to the bone and the foot may need amputation.Many amputations can be prevented if minor problems are treated in time. AUTONOMIC NEUROPATHY. Autonomic neuropathy affects the nerves that control the heart,blood pressure and blood glucose levels.Autonomic neuropathy also affects internal organs causing problems with digestion,respiration. urination,sexual response and vision. 1.HYPOGLYCEMIA UNAWARENESS. Normally,symptoms such as shakiness,sweating and palpitations occurs when the blood glucose levels drop below <<70 mg/dl.In people with autonomic neuropathy,symptoms may not occur making hypoglycemia to be recognized. 2.HEART & BLOOD VESSELS. Damage to the nerves in the cardiovascular system interferes with the body's ability to adjust blood pressure and heart rate. Due to this,blood pressuremay drop sharply after standing or sitting,causing a person to feel light headed or faint. Damage to nerves that control heart rate makes the heart rate to stay high , instead of rising and falling in response to normal body functions and physical activity. 3.DIGESTIVE SYSTEM. Nerve damage to the digestive system most commonly causes constipation. Damage can also cause the stomach to empty slowly,a condition called GASTROPARESIS. Gastroparesis can lead to persistent nausea and vomiting,bloating and loss of appetite. Gastroparesis also makes blood glucose levels to fluctuate widely ,due to abnormal food digestion. Nerve damage to the OESOPHAGUS MAKES SWALLOWING DIFFICULT. Nerve damage to bowels can cause constipation alternating with uncontrolled diarrhea, 3.URINARY TRACT & SEX ORGANS. Autonomic neuropathy often affects the organs that control urination and sexual functions. Nerve damage can prevent the bladder from emptying completely , allowing the bacteria to grow in bladder and kidneys causing urinary tract infections. When the nerves of the bladder are damaged,urinary incontinence may result because a person may not be able to sense when the bladder is full or control the muscles that release urine. Autonomic neuropathy also leads to decreased sexual response in men and women. A man may have erectile dysfunction or may reach sexual climax without ejaculating normally. A woman may have difficulty in arousal,lubrication or orgasm. 5.SWEAT GLANDS. Nerve damage may cause improper working of sweat glands.It can also result in profuse sweating at night or while eating. 6.EYES. Due to autonomic neuropathy,pupils become less responsive to changes in light.A s a result,a person may not be able to see well when light is turned on In a dark room or have trouble driving at night. PROXIMAL NEUROPATHY. Proximal neuropathy//lumbosacral plexus neuropathy //femoral neuropathy //diabetic amyotrophy causes pain in the thighs,buttocks,hips or legs,usually on one side of the body. FOCAL NEUROPATHY. Focal neuropathy appears suddenly and affects specific nerves,most often in the head,torso or leg. Focal neuropathy is painful and unpredictable.and occurs most often in older adults with diabetes. However,it tends to improve itself over weeks or months and does not cause long term damage. Focal neuropathy can cause *Inability to focus the eye. *Diplopia. *Aching behind the eye. *Bell's palsy. *Severe pain in the lower back and pelvis. *Pain in the front of the thigh. *Pain in the chest and stomach. *Pain on the outside of the shin or inside of the foot. *Chest pain and abdominal pain is mistaken for heart attack or appendicitis. CAN DIABETIC NEUROPATHIES BE PREVENTED. THE BEST WAY TO PREVENT NEUROPATHY IS TO KEEP BLOOD GLUCOSE LEVELS AS CLOSE TO THE NORMAL RANGE AS POSSIBLE.MAINTAINING SAFE BLOOD GLUCOSE LEVELS PROTECTS NERVES THROUGH OUT THE BODY.Dr. Suvarchala Pratap16 Likes23 Answers