#MedicalCase

Delayed ejaculation treatment (Sexology)

Dr. Devendra., MCH UROLOGY, MS SURGERY, MBBS

 

Medical Case Details:

28 year male Patient with Delayed or at times no ejaculation, leading to painful experience for wife, dissatisfaction of husband and extramarital sexual exposure with similar problem.

When he has ejaculation it is normal in volume and experience.

 


    Discussions


    Dr. Udaya Nath Sahoo
    General Practitioner

    Hi, before proceeding to the topic in detail please do following investigations :-
    1)Check CBC with differential & ESR
    2)Check [Fasting blood sugar,testosterone,TSH,T3,T4,Aldosterone]
    3)Check [MRI] scan to ruled out spinal cord issues
    4)Do a detailed clinical exam [Neuro+Urological]
    I hope this will be enough for a diagnosis
    Thanks,

    ▲ 1
    04.Feb, 09:30pm

    Dr. Alok Vinod Kulkarni
    Psychiatrist

    Apart from the aforementioned investigations, also get a fasting lipid profile done. Also examine for peripheral pulses to rule out peripheral vascular disease. It seems more like a Generalised Retarded Ejaculation. It is not situational because as per history he is not able to ejaculate even with a different partner. We have to establish if it is acquired or lifelong retarded ejaculation. Ask for recent stressors, negative life events. Rule out performance anxiety (spectatoring). Rule out Major Depressive Disorder. After organicity is ruled out, patient may be started on Dual Sex Therapy as prescribed by Masters and Johnson. Aim should be to reduce spectatoring and to focus on the arousal sensations. A specific set of exercises are prescribed which the couple should practice in the privacy of their homes. 4 way roundtable sessions precede and follow each exercise period. Couple should not deviate from the prescribed exercises. Eventually, intercourse is added to the exercise period. No much scope for pharmacological agents in this case unless there is clear cut depression or anxiety. Choose Bupropion, Mirtazapine or Aripiprazole in conjunction with Tadalafil, if at all a drug is indicated.

    ▲ 1
    04.Feb, 11:46pm

    Dr. Gaurav Mohan Jadhav
    Ayurveda Specialist

    We have very good ayurvedic treatment
    if you wish we can discuss

    09.Feb, 08:34pm

    Dr. Arvind Guru
    General Surgeon

    I think you would have already done a detailed physical exam and found NAD.
    It would be interesting to know however the onset, progression and duration of this complaint. Also did it start after he had an extra marital sex ?
    Doesn't seem to be a neurological problem. Substance abuse or Performance enhancing meds needs to be checked out. The guilt of extramarital relationship and painful experience of partner can itself be the cause of problem. Also the dyspareunia can be due to lack of lubrication.

    ▲ 1
    15.Feb, 02:27am

    Dr. Anmol Singh
    General Practitioner

    Please reply with following details
    History of masturbation frequency & any change in pattern as excessive masturbation leads to decreased sensation which is not sufficiently achieved with vaginal intercourse
    Presence or absence of morning erection
    History of substance use(alcohol) or medications use
    Any history suggesting depression or mood disorders
    Preoccupation with any thought
    As previously commented, it doesn't seem to be situational
    Retarded ejaculation is mostly due to psychological problems and is the third most common cause of male sexual problems
    After the investigation, advise to consult a psychiatrist

    15.Mar, 12:39pm

    Dr. Mehwish Mursaleen
    Psychologist Counsellor

    Sensate focused sex therapy is recommended by a psychologist

    27.Apr, 02:40pm

    Dr. Ishwar Mahadev Yamgar
    Ayurveda Specialist

    We need to councsil both partner and side by we can go with ayurvedic medicine to improve his sperm quantity and releasing the sperm while intercourse is there any history of addicitons ? Any drug histroy from how many months he is facing this problem
    plz provide following details so as we can cure it surely
    Thank u

    26.Dec, 01:04pm



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