How to improve sexual life - #9784

**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

hi jitendra, this is dr aman shaba. premature ejaculation is common and can happen due to both physical and psychological reasons — like stress, anxiety, relationship issues, or sometimes hormonal or nerve-related factors. the most important step is finding the exact cause, as treatment depends on that. simply taking medicine like duralast without addressing the root issue often gives little or short-term relief. treatment usually includes: managing the underlying cause, practicing kegel exercises to strengthen control, and sometimes couple therapy — which helps both partners understand and handle the situation better. once the cause is clear, a personalized plan can really improve both timing and confidence. let me know if you’d like help understanding this further. Dr Aman Shaba Consultant Psychiatrist 7992489808