Professional Assessment: The presenting symptoms strongly suggest premature ejaculation (PE) combined with erectile dysfunction (ED), with primary differential diagnoses including psychological factors (performance anxiety, stress), neurological conditions, or hormonal imbalances (particularly testosterone levels). The pathophysiological mechanism likely involves both psychogenic and organic components, potentially affecting both the ejaculatory reflex and erectile maintenance pathways, which is somewhat unusual for this age group and warrants further investigation. Given the patient's young age (28), key risk factors to consider include psychological stressors, lifestyle factors (smoking, alcohol, drug use), underlying cardiovascular conditions, and possible endocrine disorders. Additional testing indicated includes: comprehensive hormonal panel (testosterone, prolactin, thyroid function), basic metabolic panel, cardiovascular assessment, and psychological evaluation; urological examination may also be warranted to rule out anatomical abnormalities.
Urgency Level Assessment: This presents as LOW to MODERATE urgency, requiring medical evaluation within 1-2 weeks but not immediate emergency care. The described symptoms (premature ejaculation and erectile difficulties) are not life-threatening but could indicate underlying psychological factors or medical conditions that should be evaluated by a primary care physician or urologist. Red flags would include severe pain, blood in semen/urine, or sudden onset with trauma - none of which are reported here. The patient should schedule an appointment with their primary care doctor within 2 weeks for proper evaluation and referral to urology if needed, but emergency care is not required unless symptoms significantly worsen or new concerning symptoms develop.
For premature ejaculation and erection issues, I recommend starting with a combination of behavioral techniques and medication. Use the "stop-start" technique during self-stimulation and sexual activity, combined with Kegel exercises (3 sets of 10 repetitions daily) to strengthen pelvic floor muscles. Consider using topical desensitizing sprays containing lidocaine 10-15 minutes before intercourse, and/or taking selective serotonin reuptake inhibitors (SSRIs) like dapoxetine which can help delay ejaculation. For additional treatment recommendations, ask in the chat.
not specified
Ask any medical question and get instant AI-powered analysis from Alex and Julia, our medical AI doctors.