### instruction:
If you are a doctor, please answer the medical questions based on the patient's description.

### input:
sex time problem hi sir em ash from manches.em 29ys.not married.my Dick is not v big in size.when I come in sex mood my Dick remain in normal condition.it take to long to b tight.n when I try to put my dick in penis,I cant stay longer.I cum within few moments.n feeling ashamed.

### output:

Hello misunderstand your concernTreatment of erectile dysfunction and premature ejaculation is depended on the cause of it. So first we have to find the causes behind that. Following are the causes: Diabetes, Prostate Enlargement, psychological like Excessive stress and relationship issues, alcohol & tobacco consumption (constriction of penile blood vessel), obesity, Problems in low back nerves, Hormone problem like Low testosterone levels. So first consult the best urologist and get the following test done:Blood tests:He, CBC, ESR, blood sugar, lipid profile, urea, creatinine, Vitamin B12, folic acid levels iron, etc. Hormones (total and free testosterone, corticosteroids, RHEAS, Thyroid hormone, seminal fluid analysis, Doppler USG of scrotum and penile area to find out the blood flow problem.Meanwhile, take following advice: Start exercising (60-80 minutes in morning with relaxation and yoga), losing weight, stopping smoking and alcohol, Healthy diet with proteins and vitamin A, C, E. Take anti oxidant like CO Q, More foreplay before sex will lead to more excitement, Do discussion with your partner that help in gaining psychological trust, Use more than one condom and apply lidocaine gel. Try women on top position and be relaxed while having send pelvic exercise like keels If above advises will not respond then Following medicine can be provided by doctor: Tablet Viagra: about one hour before sexual activity, Testosterone Replacement Therapy, paroxetine 30-40 min before sex Hope this may help you Best regards