Are you purchasing this medication for yourself?
Are you over 18 and under 65 years old?
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Have you previously been diagnosed with premature ejaculation?
Do you have difficulty or poor control over ejaculation?
Over the last six months, in the majority of intercourse attempts, have you prematurely ejaculated?
Are you experiencing mental or emotional distress because of premature ejaculation?
Do you normally ejaculate within 2 minutes of vaginal penetration?
Do you have any of the following conditions?
Do you take any of the below medication?
Please specify which medication you are currently taking
Do you take any other medication or have any other medical conditions?
Please list all medications you take and medical conditions you have
Do you use any recreational drugs?
Please specify any recreational drugs you are currently taking
Do you have any allergies?
Please specify any allergies
Do you have a hereditary intolerance to galacotose, lapp lactase deficiency or glucose-galactose malabsorption.
I will read the patient information leaflet before using any provided treatments.
I agree that
I understand that Menschem will not inform my GP of this consultation, unless specifically requested via emailing info@menschem.co.uk (please include GP name, address, and email address).
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