Dapoxetine: a new option in the medical management of premature ejaculation

Marked personal distress or interpersonal difficulty as a consequence of PE; and. While researching Kamagra online, you may have come across Super Kamagra, another unlicensed treatment that’s marketed to men experiencing ED. Click to view a preview and subscribe below. There are many herbs and supplements, but often there is no substantial evidence or clinical studies to support their claims for effectively treating ED. In study subjects whose blood pressure was not controlled, the reduction was greater, although this reduction was not associated with hypotensive symptoms in the majority of subjects. Its invention gave a start to other Sildenafil Citrate analog’s inventions like Fildena. Unlike the men’s Viagra that works by improving the blood flow into the penis, the pink pill works on the brain. Do not push the tablet through the foil. Among them is Peyronie’s disease, which leads to ED due to curvature of the penis. Similarly, significant improvements were observed in the mean PEP index score 0.

17 PATIENT COUNSELING INFORMATION

The effect of sex was evaluated and was not significant. Pay for your VIAGRA prescription and mail copy of original pharmacy receipt cash register receipt NOT valid with product name,date, and amount circled to: VIAGRA Savings Offer, 2250 Perimeter Park Drive, Suite 300, Morrisville, NC 27560. It is also known to reduce blood pressure, which may improve blood flow to the penis. When meeting with any health professional, it is important for you to share the following information. It improves blood flow to the penis, and its effects can last for up to 4 hours, although the effect will likely be stronger after 2 hours. The best time to take Cialis depends on whether you’re taking it once a day or only as needed. Do not share sildenafil with other people, even if they have the same condition as you. Before you take ADDYI, tell your doctor about all of your medical conditions, including if you. Although specific interaction studies were not conducted for all medicinal products, population pharmacokinetic analysis showed no effect of concomitant treatment on sildenafil pharmacokinetics when grouped as CYP2C9 inhibitors such as tolbutamide, warfarin, phenytoin, CYP2D6 inhibitors such as selective serotonin reuptake inhibitors, tricyclic antidepressants, thiazide and related diuretics, loop and potassium sparing diuretics, angiotensin converting enzyme inhibitors, calcium channel blockers, beta adrenoreceptor antagonists or inducers of CYP450 metabolism such as rifampicin, barbiturates. Keep in mind that Viagra isn’t approved in the United States to treat PE. Peel back the foil and take the tablet out. Cialis is FDA approved to treat the following in males. Take your prescribed dosage of Viagra only once a day and no more than once in 24 hours. It’s the second libido enhancing medication on the market for women. Mixing it with amyl nitrite, another vasodilator, is particularly dangerous and potentially fatal. 5 mg/day for daily use or 10 mg dose every 72 hr for use as needed. Please note that all PharmacyChecker accredited online pharmacies tier 1 and non tier 1 meet the same high standards as identified in the PharmacyChecker Verification Program. View Pharmacy Profile. Does this affect liver function. Depending on your age, height and weight, the cause and the severity of your ED, you may be prescribed a higher dose of 20mg. Not allwomen will experience similar improvement in their HSDD. It’s available in four strengths: 2. Have a serious liver problem. In order for our online pharmacy team to ensure this product is appropriate for you to buy we will ask you to complete a questionnaire with a few simple questions. Most AEs were mild to moderate in severity, and few subjects across groups reported severe 3% or serious ≤1% AEs.

Pharma Hermetic Hair Recovery Program 20 x 2ml Ampoules

So if you’re taking other medications to reduce your blood pressure, taking Cialis along with them may cause a larger drop in blood pressure. Get the latest pharma news delivered to your inbox. But they’re prescribed for different reasons. Idelalisib will increase the level or effect of tadalafil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Yohimbine is another type of herbal Viagra that could have benefits for erectile dysfunction. If you want to crush, split, or chew Viagra tablets, ask your doctor or pharmacist if this is safe to do. Learn about the dosage of Viagra for erectile dysfunction ED. No drug–drug interactions associated with dapoxetine have been reported. Yes, you can get a Cialis prescription online. In order for our online pharmacy team to ensure this product is appropriate for you to buy we will ask you to complete a questionnaire with a few simple questions. Allergies to Ingredients. In a randomized double blind study, Berman et al administered sildenafil to 202 postmenopausal women with a primary diagnosis of FSAD and possibly associated secondary FSDs. The frequency of nausea is decreased after a high fat meal. CIALIS helps increase blood flow to the penis and may help men with ED get and https://velvaereapotek.com/hartap/ keep an erection satisfactory for sexual activity. While orgasms may not provide a direct reproductive benefit, the pleasure may help improve mood and relieve stress. 001, and compared with placebo, have a significantly higher end point and a greater change from baseline across all domains of IIEF. Clinically proven to treat men with erectile dysfunction ED.

Abstract

Tadalafil may cause a sudden decrease or loss of hearing. Health shouldn’t have to wait. View Pharmacy Profile. If you have benign prostatic hyperplasia and erectile dysfunction, the dose remains one 5 mg tablet taken once a day. Abbreviations: Cmax, maximum plasma concentration; Tmax, time to peak concentration; T1/2, half life; AUC, area under the curve. If you have any problems with the way your liver works, or if you have any problems with the way your kidneys work. It’s often the first erectile dysfunction medication that doctors turn to. Consistent with the effects of PDE5 inhibition on the nitric oxide/cyclic guanosine monophosphate pathway, PDE5 inhibitors, including LEVITRA, may potentiate the hypotensive effects of nitrates. Get emergency medical help or ask someone to get emergency medical help for you if the symptoms do not go away or if you feel like you could faint lose consciousness. Gifts for mum: your ultimate gift guide for any occasion. The result was consistent with a previously conducted similar study in Ethiopia 1. There is no permanent cure for premature ejaculation, but you can treat it. The starting dose for daily use Cialis is 2. Viagra won’t make you last longer in bed or have more orgasms than your body can safely handle. The people in the study took the survey after 4 weeks. These patients were defined as elderly and were compared with patients <65 years of age. Before starting Viagra, talk with your doctor about any blood pressure problems you have. Each tablet contains 1,000 mg of ginseng. Presents with a purpose: alternative Christmas gift ideas. Some older research suggests that it may help treat ED symptoms, but more research is needed to draw definitive conclusions. For people who are going through menopause or have gone through it, estrogen replacement therapy may help boost low libido. VIAGRA may affect the way other medicines work, and other medicines may affect the way VIAGRA works, causing side effects. And while some of these supplements are are not backed by science, others are proven to support sexual health. There are no medications approved for use in the UK to treat female sexual dysfunction. Last accessed Febuary 2024.

Products and Services

In females, sildenafil may also increase blood flow to the genitals. If you already use medicine for high blood pressure hypertension, sildenafil could make your blood pressure go too low. Treatment for erectile dysfunction with Cialis tadalafil is available from. Figure 3 shows the results of the change in the IIEF IS. The side effects of this drug include. Counterfeit Viagra, despite generally being cheaper, can contain harmful substances or substances that affect how Viagra works, such as blue printer ink, amphetamines, metronidazole, boric acid, and rat poison. You should always consult your doctor or another healthcare professional before taking any medication. Visit childrens health. Concomitant use with alpha blockers. Search for a doctor, location, condition or treatment. Therefore, consult your doctor before taking it. Female sexual arousal disorder is a type of sexual dysfunction that makes it hard to get aroused. And are there other medications that can help women of all ages enjoy a satisfying and pain free sex life. The FDA has only approved Vyleesi and Addyi to treat FSIAD, and only in premenopausal females. Visit hair styling tools. In real world setting dapoxetine treatment discontinuation was high.

About Medical News Today

Blood and urine tests may be needed to check for unwanted effects. Sleigh the season with our go to gift guide for her. An example of a guanylate cyclase stimulator is riociguat Adempas. Case reports of type A and B aortic dissection have also been reported with sildenafil abuse 17. It is not possible to determine whether these events are related directly to these factors or to other factors. Mild and transient differences in colour discrimination blue/green were detected in some subjects using the Farnsworth Munsell 100 hue test at 1 hour following a 100mg dose, with no effects evident after 2 hours post dose. You can report side effects to the FDA at or by calling 800 FDA 1088. It is usually taken with or without food one hour before sexual activity. If you’re sexually aroused, Viagra should work to help you get or keep an erection within 30 minutes to 2 hours. The blue diamond tablet shape and Viagra Connect® are registered trademarks. Generic tadalafil is available at much lower cost, from 40p per tablet. We’re now transferring you to the website of our trusted partner, Chemist Direct, to complete your purchase. Strong CYP3A4 inhibitors. Call your doctor for medical advice about side effects. View Pharmacy Profile. View Pharmacy Profile. For medication approved in the UK, it must undergo stringent testing to make sure it’s safe and works. Multiple dosing of dapoxetine 60 mg/day for 6 days did not inhibit the metabolism of a single 40 mg dose of omeprazole. 13 thoughtful wedding day gifts for all budgets. Breastfeeding individuals should also consult with their healthcare provider, as Sildenafil is excreted in breast milk, and potential effects on the nursing infant are not well understood. The patient should avoid food saturated in high fats as it will delay the effect of the drug.

Pros of DHEA supplements

Medications dispensed from outside the U. Visit pregnancy and maternity. Counseling with a sex therapist may be helpful for men with performance anxiety. Medically reviewed by. Sildenafil, British National Formulary NICE. To learn more about ED, see our men’s health hub. Coadministration of apalutamide, a strong CYP3A4 inducer, with drugs that are CYP3A4 substrates can result in lower exposure to these medications. Women with HSDD have low sexual desire that is troubling to them. This may not be a complete list of medicines that can interact with sildenafil. Alternative medicine advocates have long celebrated ginseng as a powerful aphrodisiac, meaning it’s thought to boost desire and sex drive. Sildenafil Liqrev, Revatio is used to improve the ability to exercise in adults Liqrev, Revatio and children 1 year of age and older Revatio with pulmonary arterial hypertension PAH; high blood pressure in the vessels carrying blood to the lungs, causing shortness of breath, dizziness, and tiredness. 2 reflected a moderate level of concern, but being under the care of a specialist and the clear warning messages on the pack shown above and in the PIL see below were felt to be strong mitigating factors. Making lifestyle changes, such as eating a nutrient dense diet and getting regular exercise, may help improve ED without medication. Daily use of SSRIs increases geometric mean IELT by 2. And you should never take Cialis more than once a day. Sildenafil works on erection problems by increasing blood flow to the penis. Tell your healthcare provider if you have any of these side effects that bother you. Note: For more information about the potential negative effects of Cialis, see the “Cialis side effects” section above. MedPage Today is among the federally registered trademarks of MedPage Today, LLC and may not be used by third parties without explicit permission. Former NHS GP in Bristol. Cialis can work for up to 36 hours in your body. Certain chemicals in this plant may promote the relaxation of the body’s smooth muscles, helping produce an erection. Visit eye health and conditions. The incidence of headache was most frequent during week 1, but the incidence was no greater in patients treated with tadalafil 40 mg than in those treated with tadalafil 20 mg daily 24% and 29%, respectively; Fig. Dapoxetine+tadalafil is not intended for use in women. Mazaheri Nia L, Iravani M, Abedi P, Cheraghian B. For full safety information, please read the patient information leaflet that comes with your medication – Cialis taken before sex PIL, Cialis Daily PIL. Cialis tends to be more expensive as a branded medicine.

Choosing an OTC Pain Reliever: What to Consider

Dapoxetine is a potent SSRI which is administered on demand 1–3 h prior to planned sexual contact. Cases of non arteritic anterior ischaemic optic neuropathy, a rare condition, have been reported spontaneously and in an observational study in connection with the intake of sildenafil and other PDE5 inhibitors see section 4. Women with HSDD have low sexual desire that is troubling to them. If you do not have a plastic syringe or spoon, ask your pharmacist for one. Physicians should also discuss with patients the increased risk of NAION among the general population in patients with a “crowded” optic disc, although evidence is insufficient to support screening of prospective users of PDE5 inhibitor, including VIAGRA, for this uncommon condition. Hims Hard Mints are a discreet alternative to erectile dysfunction pills. The goal was to have a lower score, which indicates that people have had fewer and less severe symptoms of BPH. If this daily dosage doesn’t work well enough to treat your ED, your doctor may increase it to 5 mg a day. Patients with a stroke within the last 6 months. The treatment plan will offer a more detailed list of possible side effects. Your doctor will watch you closely if they prescribe testosterone. It works to treat ED by blocking PDE5. A study was conducted in which the blood pressure and heart rate response to 0. Because of this very wide range of potential prices, we chose the next least expensive option, Jolt Gel, as our winner for cost. The body converts L arginine into the chemical nitric oxide. Dapoxetine PriligyTM, Johnson and Johnson, Raritan, NJ is the first and only product licensed for the treatment of premature ejaculation PE in men aged 18–64 years. Viagra can temporarily lower your blood pressure after you take the drug. Cialis is effective at improving erectile function over the course of therapy. Additionally, it is not recommended for low libido caused by other health conditions or medications. Lemonaid Health is a national online doctor’s office. With thoughtful planning and healthcare provider collaboration, significant cost reductions are possible while maintaining treatment effectiveness. View Pharmacy Profile. You can buy online without a prescription in the trusted pharmacy below. The safety and efficacy of combinations of sildenafil with other PDE5 Inhibitors, or other pulmonary arterial hypertension PAH treatments containing sildenafil REVATIO, or other treatments for erectile dysfunction have not been studied. It’s completely free and you will be able to buy Sildenafil after completion. It is not known if vardenafil passes into breast milk. Visit prescription support. Support for this browser is being discontinued for this site. Of participants reporting ‘good’ or ‘very good’ perceived control over ejaculation.

Bluechew

This includes any possible side effects not listed in this leaflet. This will help them determine if sildenafil is right for you. If the effect of 30 mg is insufficient and the side effects are acceptable, the dose may be increased to the maximum recommended dose of 60 mg. Depending on the medication, you can arrange for same day pickup at your pharmacy or order the medication to be delivered to your door. If you are struggling with low libido or erectile dysfunction, don’t continue to try medications that may be dangerous – schedule an appointment at 843. Continue with Rex MD. Modify Therapy/Monitor Closely. Serious Use Alternative 1vardenafil and givinostat both increase QTc interval. Erectile dysfunction ED is a common condition that affects men worldwide, often leading to stress and decreased quality of life. You are encouraged to report negative side effects of prescription drugs to the FDA. In a small size placebo controlled study of patients with documented early age related macular degeneration n=9, sildenafil single dose, 100mg demonstrated no significant changes in visual tests conducted visual acuity, Amsler grid, colour discrimination simulated traffic light, Humphrey perimeter and photostress. Yohimbe has been linked with a number of side effects, including. This survey is being conducted by the WebMD marketing sciences department. This is to ensure your doctor has a full picture of your medical history before prescribing. Many male enhancement pills claim to increase your sexual stamina, allowing you to have sex for longer before you reach orgasm and ejaculate. Sundowning: What to know if your loved one with dementia experiences late day symptoms. The penis is one of the areas where this enzyme works. Viagra is a popular medication for treating erectile dysfunction ED in men. In addition to decreased blood pressure, these side effects can include.

Cialis®Rx

Get the latest research here. Individual responses to our Male Enhancer Supplement vary. 001 vs placebo, Table 2. Erectile dysfunction treatment. Kilinc et al reported that moderate physical activity longer than 30 min at least 5 times a week leads to ejaculation delay in patients with premature ejaculation. ErrorEmail field is required. Without sexual stimulation, and therefore lack of activation of the NO/cGMP system, sildenafil should not cause an erection. Take it as prescribed.

Independent reviews

In comparison, people who took a placebo had their scores improve by a much lower amount. LEVITRA is formulated as orange, round, film coated tablets with “BAYER” cross debossed on one side and “2. Reviewed 24 January 2024 by Dr Ruch Karunadasa. No special requirements. One advantage Cialis has over Viagra and Levitra is its 17. But animal studies don’t always predict what will happen in humans. Meets Patient’s editorial guidelines. Some dietary supplements sold online contain ingredients that are not listed on the label, and these ingredients could be dangerous for some people who take them. Heartburn is a common side effect of Cialis. Il pompelmo e il succo di frutta al pompelmo possono peggiorare gli effetti collaterali. ScriptSave WellRx is another healthcare company offering a program that allows you to use a personalized discount card to get discounts on Levitra and other medications at major retail pharmacies. Kamagra 100mg Tablet relaxes the smooth muscles by inhibiting Phosphodiesterase type 5. Significant improvement in ejaculatory control with dapoxetine 30 mg or 60 mg, as compared with placebo, was found in all RCTs in Table 3. Priligy dapoxetine is a temporary solution, not a cure. Most of these side effects are mild and will gradually resolve with time, but some side effects can be more serious. Using the supplement as directed can also help to ensure best results. These results demonstrated that the effect of VIAGRA on the primary endpoint was statistically non inferior to placebo. There’s also no evidence that it works for women. Seven single medications paroxetine, fluoxetine, dapoxetine, sertraline, sildenafil, tadalafil and placebo and five combination therapies were included tadalafil with sildenafil, tadalafil with fluoxetine, paroxetine with sildenafil, dapoxetine with mirodenafil, and sildenafil with fluoxetine. Visit no7 personalised skin analysis. The active ingredient in Viagra is sildenafil. Due to the similarities between male and female sexual response, several studies have assessed the effects of sildenafil citrate Viagra® in women affected by female sexual arousal disorder. PE is usually a temporary condition that doesn’t pose any physical health risks. Some hormone medicines that aim to relieve GSM symptoms could help make sex more comfortable. Medicines are sometimes prescribed for purposes other than those listed in a Patient Information leaflet. Some may require a prescription from an independent physician, some may be able to write you a prescription after some screening questions, and others may not require a prescription at all.

Women’s health

However, caution should be exercised when using tadalafil in patients treated with any alpha blockers, and notably in the elderly. If you notice changes with ejaculation while you’re taking Viagra, tell your doctor. This allows us to give you strong recommendations for products that offer good value for your money. Priligy Dapoxetine is rapidly absorbed and has a short half life which minimizes the adverse effects that are common to the SSRI’s. Depression and anxiety treatment. Scientists have also not established safe and effective dosages for propionyl L carnitine. This is how long it takes for you to have the highest level of medication in your body. This article will use the terms “male,” “female,” or both to refer to sex assigned at birth. Nursery Advice Service. Mild side effects of Viagra can include. You should not take more than one dose of Cialis per day. Please fill in this survey opens in a new tab. Minor/Significance Unknown. We recommend that you do not solely rely on the information presented and that you always read labels, warnings, and directions before using or consuming a product. The effects can last for up to 24 hours. The most comprehensive solution to manage all your complex and ever expanding tax and compliance needs. These additional articles might be helpful. Learn about your options so that you and your doctor can choose the one that’s best. Along with a free consultation, REX MD is one of the most affordable online services to get ED medications from. Special Delivery 1pm Guaranteed. We’re now transferring you to the website of our trusted partner, Chemist Direct, to complete your purchase. 4% of patients who discontinued dapoxetine treatment complained of lack of efficacy which was consistent with the main reasons for discontinuation of dapoxetine or SSRIs in phase 3 clinical trials. Do not take any of these medications more than once in a 24 hour period. The main reasons for discontinuation were the cost and disappointment that treatment was required every time adequate sexual function was required.

Customer Care

Many of us look forward to holiday meals, but it’s easy for these feasts. This adds weight to the proposal for a single, unified definition of PE. Taking a single tablet provides reliable erection support for an entire day and night, and may even allow for spontaneity the next day. As of 27 March, people in the UK have been able to purchase the medicine from local pharmacies off prescription. Store the medicine in a closed container at room temperature, away from heat, moisture, and direct light. You can also search for this author in PubMed Google Scholar. Chief Business Officer. Bonchurch resident appeals after Isle of Wight council blocks redevelopment. “Addyi is a great addition to our relationship. Sildenafil may cause allergic reactions, which can be serious. Reporting of suspected adverse reactions. Uživatelé si mohou vybrat z různých příchutí, což zajišťuje příjemnější zkušenost. GIFT THE DIOR DREAMShop now. It’s one of the most effective ED treatments available, working for up to 74% of men who take it. Take it as your healthcare provider recommends, which is usually between 30 minutes to four hours before planned sexual activity. It is owned and operated by ABSM Healthcare Ltd Company Reg.

Customer Care

Sildenafil should not be taken if you are taking certain other medications due to serious and potentially life threatening interactions. CIALIS tablets are for oral use in men only. This may occur along with dizziness and ringing in the ears. Unlike other SSRIs used to treat depression, which have been associated with high incidences of sexual dysfunction,59,60 dapoxetine was associated with low rates of sexual dysfunction. Ask someone to drive you or call 999 and ask for an ambulance. Summer is the time of year we all wait for. Chickenpox Vaccination Service. In particular, make sure that you discuss any of the following. Note: Sex and gender exist on spectrums. This website uses cookies. This is an open access article distributed under the terms of the Creative Commons Attribution License CC BY. Great value over the counter treatment similar to Viagra. Potential for interaction with thioridazine. Dapoxetine is a drug designed to treat premature ejaculation PE and is the generic name for branded medication Priligy. Your doctor may decide not to treat you with this medication or change some of the other medicines you take. Usually, after sexual stimulation in a male, there is a release of nitric oxide, which increases levels of a regulatory agent in cells called cyclic guanosine monophosphate cGMP. Kamagra Effervescent Tablets packed as 7 tablets are a soluble form of an erectile dysfunction remedy which is a leading and popular aid to enhance sexual performance, and counter erectile dysfunction. Verywell / Anastasia Tretiak. Concurrent use of CYP 3A inhibitors or inducers can significantly alter the concentration of serum PDE 5i changing the side effect profile, effectiveness of the medication, or severity of drug interactions 21. In particular, female sexual arousal disorder FSAD belongs to the so called “female sexual interest/arousal disorder” and is one of the most prevalent subcategories of FSDs. But, there isn’t enough proof to say for sure that using sildenafil to treat other female health conditions is safe or effective. If you think your brand name prescription has been filled with a generic, talk to your pharmacist. Vigora tablet works by increasing the blood flow to the male genital organ penis, along with sexual stimulation, helping to attain a desired erection. Period delay online treatment. Patients randomly received 12 weeks of treatment with sildenafil citrate 50 mg or placebo. The NCCIH states that yohimbe can interact with certain medications, including a class of antidepressants called monoamine oxidase inhibitors MOAIs. Urogenital: increase in erection, priapism. But it’s important to be aware that many men can ease, or even reverse, ED by making simple lifestyle changes — such as losing excess weight and quitting smoking — that also are likely to boost their overall health and reduce their chances of developing diabetes, cardiovascular disease, and metabolic syndrome.

Norcal Community Media advertising leadership oversees sponsored, native, and paid content on this platform, ensuring its quality, relevance, and helpfulness for our audience

Dapoxetine absorption was rapid, and was not affected by coadministration of tadalafil or sildenafil. Tell your healthcare provider about all medicines that you take or have recently taken. The CGI also called the patient reported global impression of change in some studies comprises just one item, ie, “Compared to the start of the study, how would you describe your premature ejaculation now. By week 12, mean average IELT had increased to 3. Active ingredient: sildenafil citrate. When VIAGRA is taken with a high fat meal, the rate of absorption is reduced, with a mean delay in Tmax of 60 minutes and a mean reduction in Cmax of 29%. Please visit our site again at that time. Do not take CIALIS if you are already taking nitrates. This may not be a complete list of medicines that can interact with sildenafil. Some side effects may occur that usually do not need medical attention. AHFS® Patient Medication Information™. Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. High blood pressure in your lungs. Cialis is broken down in your body by an enzyme in your liver called CYP3A4. If you often forget doses, it may help to set an alarm to remind you. Adjust tadalafil dose for PAH; if on Stribild, start tadalafil 20 mg/day; avoid tadalafil when starting Stribild; for ED, a single dose of tadalafil not exceeding 10 mg in 72 hr. Therefore, treatment for erectile dysfunction, including LEVITRA, should not be used in men for whom sexual activity is not recommended because of their underlying cardiovascular status. Below are some answers to frequently asked questions about Cialis dosages. Please read and accept to continue. Article Google Scholar. Stay on top of latest health news from Harvard Medical School. Monitor Closely 1tadalafil increases effects of amiloride by pharmacodynamic synergism. Cialis Together is actually the same as ordinary Cialis, but branded and supplied in a different way. If the manufacturer’s information is correct, it also contains sildenafil, so is unlikely to work for women. While both Fildena and Viagra come in various strengths, the standard starting dose for both is often 100mg. 5 rated perfumes and aftershaves. But if you’re a guy focused on getting the job done without sacrificing value, generic sildenafil will definitely be your huckleberry. You can also search for this author in PubMed Google Scholar. Getting treated for ED may treat premature ejaculation, or you may need to get treatment separately.