I suffer from poor erection and premature ejaculation. Please advise treatment.

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Before I proceed I would like to know the following important things. Dosage and duration of each medicine tried till date. Details of any medical illness such as hypertension, diabetes, cardiac illness, asthma among others. Do you get early morning erections? If yes, how frequent and how intense?

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Kindly send me the reports of a yearly check-up. In case you do multiple reports please attach following reports such as CBC (complete blood count), blood sugar, urea creatinine, LFT (liver function test), lipid profile, serum testosterone, serum prolactin, LH (luteinizing hormone), and FSH (follicular stimulating hormone).

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We will take the final decision after seeing the reports but considering this fact I feel USG (ultrasound) abdomen with pelvis is also required. So please request the diagnostic center to carry out USG abdomen with the pelvis.

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First of all, I would like to state that the problem is organic and it needs to be treated. I mean to say that the problem is not in your head (otherwise known as psychological). The cause of the problem are much fold but the following are possible causes such as high cholesterol, high stress, low testosterone, high oxidative stress resulting in endothelial dysfunction as evidenced by penile doppler study. For the management, I feel following things should help you. Take Tablet Coenzyme Q 100 mg one tablet per day and Tablet Tetrafol Plus (L-Methylfolate) twice a day. Avoidance of fatty foods. Cholesterol is high but diet management is quite good to bring it back to normal.

Do regular physical exercise. To manage the oxidative stress and improve the vascularity, use antioxidants such as Revival or any of them which suits you. Take plenty of fluids. Use citrus fruits and most importantly stress management. In addition, I will recommend a low dose of Tadalafil (2.5 mg per day). This is prescription only medication and you may need to see a doctor to get a prescription. I understand that this causes a headache but 2.5 mg is unlikely to cause a headache as a side effect. I also recommend the use of Paroxetine 12.5 mg at bedtime. This will manage the premature ejaculation as well as depression to large extent. This is again prescription-only medication and you need to follow above procedure to buy it from the market.

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Although it is not possible to predict complete recovery in such situations, most individuals need treatment ranging from three to twelve months as minimum duration. You are not supposed to continue same treatment and it is advisable to follow up regularly every 15 to 30 days. Depending upon the response the course may be extended or shortened. An alternative of citrus fruits includes Vitamin C tablets (available with brand name Limcee 500 mg). Regarding cure, this again depends upon the extent of damage and response to different medications in a timely manner. Since the problem is long-standing, the prognosis is slightly guarded (not that great).