Sexual Health & Disorders Online Doctors Consultation — page 3

**Outpatient Consultation – Urology / Sexual Health** **Patient Name:** [Jitendra Chaudhary] **Age/Sex:** 25 / Male **Date:** 12-04-2025 **Chief Complaint:** The patient presents with a one-year history of premature ejaculation. He reports that his intravaginal ejaculatory latency time (IELT) is less than one minute, and he has been self-administering Dapoxetine (Duralast 60 mg) without significant improvement. The concern is affecting his confidence and his partner’s satisfaction. **Assessment and Provisional Diagnosis:** The clinical features are consistent with **primary premature ejaculation (PPE)**. The absence of benefit from Dapoxetine may be due to inconsistent use, psychological overlay, or unaddressed lifestyle/stress factors. There is no reported erectile dysfunction or systemic illness at this time. **Treatment Plan:** The patient is advised the following: 1. **Tab. Dapoxetine 30 mg** to be taken **1–3 hours prior to intercourse**, initially starting with the lower dose to monitor response and tolerability. May increase to 60 mg if needed. 2. **Topical desensitizing agent** such as **lidocaine-prilocaine spray** (apply to glans penis 10–15 minutes before intercourse and wash off before penetration). 3. **Pelvic floor exercises (Kegel exercises)** – daily practice to strengthen control over ejaculatory muscles. 4. **Behavioral techniques** such as the **Start-Stop** and **Squeeze** methods during foreplay or masturbation practice. 5. **Lifestyle optimization**: Avoid tobacco, excessive alcohol, and reduce stress through regular exercise and adequate sleep. 6. **Tab. Clonazepam 0.25 mg at bedtime** for 2–3 weeks, if anxiety or performance stress is significantly contributing (only under supervision). 7. **Psychosexual counseling** – Consider referral if anxiety, guilt, or relationship stress is significantly impacting performance or recovery. **Investigations (if no response in 4–6 weeks):** - Serum testosterone - Thyroid profile - Blood sugar levels **Follow-Up:** Review after 3–4 weeks to assess response to therapy and adjust medications accordingly. Long-term prognosis is good with combined medical, behavioral, and psychological approaches. Dr Shayeque Reza MD 9800280276

Hello Vyom, Thanks for sharing openly — that's a lot you're dealing with, and it's important to take a full view of your health. Let's break things down step by step to help you understand what's going on and what can be done. I’ll keep it clear and respectful Your Current Health Overview** -Age**: 40 -Height/Weight**: 162.5 cm / 79 kg (BMI: around 30 — borderline obese) - **Conditions**: - **Diabetes** (can affect nerves, blood flow, hormones) - **Hepatitis C treatment ongoing** (can affect testosterone levels and energy) - **Leg treatment ongoing** - **Sexual Health Issues**: - Weak or inconsistent erections - Ejaculation within 1 minute (likely premature ejaculation) - Penis size: 4 inches length / 4 inches girth (within average range when erect) - Concerns about semen/sperm quality and fertility Why These Problems Might Be Happening** 1. **Erection & Hardness Problems** Caused by: - **Diabetes** damaging blood vessels and nerves (diabetic neuropathy) - **Hepatitis C or its treatment** lowering testosterone - **Stress/anxiety or performance pressure** - **Obesity** (impacts testosterone, blood flow) - **Poor sleep, smoking, alcohol, or lack of exercise** # 2. **Premature Ejaculation** - Very common in men with anxiety, diabetes, or low testosterone. - Can also happen when there's infrequent sex or oversensitivity. ### 3. **Penis Losing Erection Before or During Sex** - Blood flow issue, weak pelvic floor muscles, or nerve damage from diabetes. - Can also be psychological. ### 4. **Semen/Sperm Quality (Fertility)** - Hepatitis C, diabetes, obesity, age, and medications can reduce sperm count and quality. - The only way to know accurately is through a **semen analysis** (done in fertility clinics/labs). **What You Can Do** **1. Get Medical Tests** **Blood sugar (HbA1c)** — check diabetes control **Testosterone level** — low T causes erection/fertility problems *Semen analysis** — to check fertility *Liver function tests** — since you're on Hep C treatment - **Penile Doppler test** (if erection issues continue) **2. Lifestyle Steps** **Lose weight slowly** (aim for 70–72kg) — even 5-7kg down can help erections and hormones - **Walk daily** or light exercise if allowed with your leg condition - **Avoid smoking, alcohol**, or junk food - **Sleep 7-8 hrs** — helps testosterone and performance **3. Sex-Related Help** - Try pelvic floor exercises (Kegels) for better control and hardness Thank You Dr Shayeque Reza MD 9800280276

Period is painful or painless ? If BMI is toward to obese than 1stly lose weight do exercise, live stressless lyf

There is no medicine proved to make longer, and 4 inch is long enough. You can try exercising. Try massaging with coconut oil. This can help better blood flow .

Hi Varun, Thanks for reaching out. Given your concerns—low stamina, low libido, premature ejaculation, history of excessive masturbation, and existing health issues like oral cancer and BPD—a detailed evaluation is very important. Both physical and mental health factors can affect sexual health, so we need to assess hormone levels, psychological factors, and overall wellbeing before planning any treatment. Please consult a psychiatrist and a urologist/sexologist for a complete evaluation. With the right care, these issues can be managed. You can also book for online consultation. Take care, Dr. Aman Shaba Consultant Neuropsychiatrist 7992489808

Erectile dysfunction (ED) is a common problem in men with diabetes, especially as they get older. Diabetes can affect the nerves and blood vessels that are necessary for achieving and maintaining an erection. First get an ultrasound KUB done , pre and post urine by a radiologist. Treatment may include lifestyle changes such as improving blood sugar control, losing weight, and increasing physical activity. Medications like phosphodiesterase-5 inhibitors (such as sildenafil, tadalafil, or vardenafil) may also be prescribed to help improve erectile function. In some cases, other treatments such as vacuum devices, penile injections, or surgery may be recommended. Get your HBA1C done and monitor your blood sugar regularly

Dear Sushil ji, Jo symptoms aap bata rahe hain jaise balls me jyada latakpan, nse jyada dikhna aur timing ki problem – inke peeche kai wajah ho sakti hain, jaise nerves ki kamzori, hormonal changes, ya stress. Iska sahi treatment tabhi possible hai jab proper diagnosis ho. Aapko ek baar urologist se physical check-up karwana chahiye, aur agar zarurat ho to sexologist ya psychiatrist se bhi consult karna chahiye. Sirf symptoms dekh kar dawai lena sahi approach nahi hai. Pehle reason clear karna zaroori hai, tabhi long-term solution milega. Take care, Dr. Aman Shaba Consultant Neuropsychiatrist 7992489808

How long is the duration you are suffering with this condition ?