Premature Ejaculation | Questionnaire

Kindly Tell Us Your Age

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Under 18

18-25

26-64

65 or above

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Could you specify the duration for which you've been experiencing premature ejaculation?

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From my first sexual encounter

More than 6 months

Less than 6 months

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How regularly does premature ejaculation affect you?

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Every time I engage in sexual activity

More than half the times I engage in sexual activity

Less than half the time during sexual activity

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How soon after penetration do you typically ejaculate?

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Less than 2 minutes

Between 2 and 5 minutes

Between 5 and 10 minutes

10 minutes and above

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Would you say you have control over when you ejaculate?

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Yes, I can control when I ejaculate

I can control when I ejaculate sometimes

No, I cannot control when I ejaculate

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Has premature ejaculation caused distress or difficulties in your sexual relationships?

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Yes

No

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Have you previously tried any medication for premature ejaculation such as Paroxetine 20mg, Dapoxetine 30mg,Dapoxetine 60mg, Delay spray, Delay wipes, or any other treatment?

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Yes/ other

No

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We appreciate you sharing your past experiences with premature ejaculation treatment. Could you please provide more details about the type of treatment you underwent, how long you were on it,and how it impacted you? Were there any side effects? This information will help us understand your situation better and offer the most suitable treatment.

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It's important to note that taking multiple medications for premature ejaculation at the same time may lead to undesirable effects, such as lower blood pressure, headaches, dizziness, blurred vision, confusion, fainting, and feeling sick.

I Confirm

I Do Not Confirm

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Are you always able to achieve and maintain an erection when you desire?

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Yes

No

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Are you currently under any treatment for erectile dysfunction?

Yes

No

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Please specify your current medication for erectile dysfunction:

Tadalafil (Cialis or generic)

Sildenafil (Viagra or generic)

Vardenafil (Levitra or generic)

Avanafil (Stendra or generic)

other

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Taking medications or erectile dysfunction concurrently with treatments for premature ejaculation can potentially lead to lower blood pressure. Possible side effects may include headaches, dizziness, blurred vision, confusion, fainting, and feeling sick.

I confirm that I will not combine these medications.

I cannot confirm.

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Do you regularly use any of the following recreational substances?

Ecstasy
LSD
Cocaine
Methamphetamine
Poppers

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Yes

No

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Do you have any allergies to the following?

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None of these apply to me

Serotonin reuptake inhibitors i.e priligy

Lactose

Lidocaine or other local anesthetics

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Our tablets contain minuscule amounts of lactose. If you have previously taken a tablet formulation without any symptoms, it's unlikely that you'll experience adverse effects from the lactose in our tablets.

I'm comfortable with proceeding to be assessed for a prescription

I can't tolerate even small amounts of lactose

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Please inform us about any major illnesses, ongoing medical conditions, medications (prescribed or over-the-counter) you take, allergies to medication, or surgeries. This information is necessary for our clinicians to ensure the prescribed treatment is safe for you.

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I have a major illness, ongoing medical condition, allergy to medication, or take prescribed or over-the-counter medication to inform you about.

I do not have a major illness, ongoing medical condition, operation, allergy to medication, or take prescribed or over-the-counter medication to inform you about.

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Please provide more information about your condition or medication.

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Would you like us to inform your GP about your treatment?

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Yes

No

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Please provide your GP's name and address.

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Thank you

For Answering

Thank you for answering questions about your health and experiences with Premature Ejaculation. Your responses will assist our licensed clinicians in determining if a prescription for premature ejaculation treatment could be appropriate for you. They will promptly review your answers and get back to you with suitable suggestions.

Before Submitting Your Answers, PleaseAcknowledge The Following:

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You Were Assigned Male At Birth.
You Have Disclosed Any Serious Illnesses Or Operations You Have Had.
You Have Disclosed Any Prescription Medication You Currently Take.
You Will Only Use The Recommended Method Of Hair Loss Treatment And Not Combine More Than One Different Medication For This Condition.
You Are Aware That You Should Not Take Finasteride If You’re Trying For A Baby.
You Accept Our Terms & Conditions, Privacy Policy, And Terms Of Sale.
You Currently Live In The UK.
You Are Using This Service Of Your Own Free Will.
Will Read all patient information leaflets available
You Agree To The Terms Of Service, Terms Of Subscription, And Privacy Policy.

Kindly Tell Us Your Age

Could you specify the duration for which you've been experiencing premature ejaculation?

How regularly does premature ejaculation affect you?

How soon after penetration do you typically ejaculate?

Would you say you have control over when you ejaculate?

Has premature ejaculation caused distress or difficulties in your sexual relationships?

Have you previously tried any medication for premature ejaculation such as Paroxetine 20mg, Dapoxetine 30mg,Dapoxetine 60mg, Delay spray, Delay wipes, or any other treatment?

It's important to note that taking multiple medications for premature ejaculation at the same time may lead to undesirable effects, such as lower blood pressure, headaches, dizziness, blurred vision, confusion, fainting, and feeling sick.

Are you always able to achieve and maintain an erection when you desire?

Are you currently under any treatment for erectile dysfunction?

Please specify your current medication for erectile dysfunction:

Taking medications or erectile dysfunction concurrently with treatments for premature ejaculation can potentially lead to lower blood pressure. Possible side effects may include headaches, dizziness, blurred vision, confusion, fainting, and feeling sick.

Do you regularly use any of the following recreational substances?

Do you suffer with any of the following health conditions?

Are you currently taking any of the following medications?

Do you have any allergies to the following?

Our tablets contain minuscule amounts of lactose. If you have previously taken a tablet formulation without any symptoms, it's unlikely that you'll experience adverse effects from the lactose in our tablets.

Please inform us about any major illnesses, ongoing medical conditions, medications (prescribed or over-the-counter) you take, allergies to medication, or surgeries. This information is necessary for our clinicians to ensure the prescribed treatment is safe for you.

Please provide more information about your condition or medication.

Would you like us to inform your GP about your treatment?

Please provide your GP's name and address.

Thank you

For Answering

Before Submitting Your Answers, PleaseAcknowledge The Following:

1000+

1000+

Premature Ejaculation?

We’ve got you Covered

Rich H.

Kindly Tell Us Your Age

Could you specify the duration for which you've been experiencing premature ejaculation?

How regularly does premature ejaculation affect you?

How soon after penetration do you typically ejaculate?

Would you say you have control over when you ejaculate?

Has premature ejaculation caused distress or difficulties in your sexual relationships?

Have you previously tried any medication for premature ejaculation such as Paroxetine 20mg, Dapoxetine 30mg,Dapoxetine 60mg, Delay spray, Delay wipes, or any other treatment?

It's important to note that taking multiple medications for premature ejaculation at the same time may lead to undesirable effects, such as lower blood pressure, headaches, dizziness, blurred vision, confusion, fainting, and feeling sick.

Are you always able to achieve and maintain an erection when you desire?

Are you currently under any treatment for erectile dysfunction?

Please specify your current medication for erectile dysfunction:

Taking medications or erectile dysfunction concurrently with treatments for premature ejaculation can potentially lead to lower blood pressure. Possible side effects may include headaches, dizziness, blurred vision, confusion, fainting, and feeling sick.

Do you regularly use any of the following recreational substances?

Do you suffer with any of the following health conditions?

Are you currently taking any of the following medications?

Do you have any allergies to the following?

Our tablets contain minuscule amounts of lactose. If you have previously taken a tablet formulation without any symptoms, it's unlikely that you'll experience adverse effects from the lactose in our tablets.

Please inform us about any major illnesses, ongoing medical conditions, medications (prescribed or over-the-counter) you take, allergies to medication, or surgeries. This information is necessary for our clinicians to ensure the prescribed treatment is safe for you.

Please provide more information about your condition or medication.

Would you like us to inform your GP about your treatment?

Please provide your GP's name and address.

Thank you For Answering

Before Submitting Your Answers, PleaseAcknowledge The Following:

1000+

1000+

Your safety is our top priority.

Unfortunately, we can’t offer you any Premature Ejaculation medication.

Did you make a mistake?

Premature Ejaculation?

We’ve got you Covered

Rich H.

Thank you

For Answering

Your safety

is our top

priority.