Premature Ejaculation Treatment in Pune

Sexual Problems

Premature Ejaculation


PE – Modern disease review

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Premature Ejaculation (PME or PE) occurs when a man Experiences orgasm and ejaculates (expels semen) sooner during sexual intercourse than he or his partner would like Ejaculates within a small duration (may be a few seconds) after starting sexual activity or with minimal stimulation of penis PE is defined as – Ejaculation which always or nearly always occurs prior to or within about one minute (International Society for Sexual Medicine) Ejaculation occurring within 15 seconds from the beginning of sexual intercourse (International Classification of Diseases – ICD-10)


Synonyms:
  • Early ejaculation, quick ejaculation
  • Rapid ejaculation
  • Rapid climax
  • Premature climax
  • Ejaculatio praecox
Causes:

Exact cause of PE is not known. It occurs due to a complex interaction of psychological and biological factors.

Psychological Causes:
You may have some early sexual experiences. These experiences tend to establish a pattern which becomes difficult to change in later part of life. These include: To avoid being caught in the act – Hurry to reach climax (masturbating quickly during adolescence) and finish off with oomph factor (ejaculating) while trying to avoid being discovered in the act Guilty feelings that make you to rush through sexual encounters Unresolved Oedipal conflict / complex – Emotions and ideas that the mind keeps in the unconscious via dynamic repression that concentrates upon a child’s desire to have sexual relations with the parent of the opposite sex (i.e. males attracted to their mothers and females attracted to their fathers)

  • Erectile dysfunction – Some men may be anxious or develop a fear of getting an erection and also to maintain it during intercourse. Such men may develop a pattern of ejaculating in a hurry. Over a period of time it becomes difficult to change the pattern.
  • Anxiety – either about sexual performance (performance anxiety) or related to any other issues
  • Relationship problems between you and your partner
  • Passive aggression (indirect expression of hostility)
  • Depression
Biological causes:
  • Abnormal hormone levels
  • Abnormal levels of neurotransmitters (brain chemicals)
  • Abnormal reflex activity of the ejaculatory system
  • Thyroid problems
  • Prostatitis
  • Inflammation and infection of the prostate gland and / or urethra
  • Inherited traits
  • Nerve damage from surgery or trauma (rare)
  • Having too little sex

Physiological mechanisms: Serotonin receptors Genetic predisposition Elevated penile sensitivity Nerve conduction atypicalities Others: Side effects of some drugs and medications New partner Long time since last ejaculation


Symptoms - Uncontrolled ejaculation either before or shortly after intercourse begins

  • Ejaculation occurs before the person wishes it (inability to delay or control ejaculation for more than 1 minute after penetration, can occur even during masturbation and other sexual situations also)
  • Ejaculation occurs with minimum stimulation
  • Lifelong (primary) PE occurs all or nearly all of the times beginning with your first sexual encounters
  • Acquired PE has the same symptoms but develops after you have had previous sexual experiences without ejaculatory problems
  • Natural variable PE – characterized by periods of rapid ejaculation as well as periods of normal ejaculation

Diagnosis: Diagnosis is usually made on the basis of clinical symptoms.
PE is caused due to different causes. Your doctor may order some lab tests to rule out any other medical problems. Your doctor will conduct a thorough medical examination and discuss sexual history with you. He or she may also want to talk to your partner.

Diagnostic criteria –

You are sure to be suffering from PE if you:
Always or nearly always ejaculate within one minute of penetration
Are unable to delay ejaculation during sexual intercourse all or nearly all of the time
Feel distressed and frustrated, and tend to avoid sexual intimacy as a result.

Risk Factors:

The below said factors may increase
risk of PE – Erectile dysfunction – ED is trouble getting or maintaining an erection (occasional or consistent). Fear of losing erection may cause you to consciously or unconsciously hurry through sexual encounters. Health problems – If you have a serious or chronic medical condition, such as a heart disease, you may feel anxious during sex and may unknowingly rush to ejaculate Stress – emotional or mental strain limits your ability to relax and focus during sexual encounters.

Complications::

PE alone doesn’t increase your risk of health problems. It can on the other hand cause many problems in your personal life – Stress and relationship problems Fertility problems.

Concept and Ayurvedic treatment for premature ejaculation


I have tried to compare a few conditions explained in Ayurveda with early ejaculation. They are as below explained –

Shukragata Vata

Shukragata Vata is one close condition which resembles PE. It is one of the forms of Gatavata condition wherein the morbid Vata gets illegal entry into any tissue or organ of a body producing some disturbances in the normal functioning therein. In due course of time, if Vata is not eliminated from those target tissues or victimised organs, serious diseases can set in. In this condition, the morbid Vata enters Shukra (semen) and causes the below said deformities – Kshipram munchati – Semen gets ejaculated very quicklyShukram badhnati – Semen doesn’t get ejaculated at all

These 2 contrasting presentations are due to the unpredictable nature of Vata. Both presentations of Shukragata Vata puts man in an awkward and embarrassing position during sexual intercourse. This further leads to mental derangements and lack of interest or forcible withdrawal from sexual encounters. This also shows us that PE is one of the features of Shukragata Vata and doesn’t constitute the whole disease. When the first condition i.e. the semen getting discharged too early happens on a regular basis owing to excessive motivation and stimulation of sex organs and loss of mind control over ejaculation as caused by chala guna (nature of mobilising or causing hyper-motivation) of morbid Vata, it needs to be addressed as a disease. Thus in established PE, the chala guna of Vata is severely disturbed and out of control.

Treatment of Shukragata Vata:

Shukragata Vata is treated on the basis of 2 principles – Controlling the Vayu and Strengthening the Shukra and genital system. Acharya Charaka advices to administer the below said in Shukragata Vata – Harshana – Exhilarating treatment and counselling to the patient Balakara chikitsa – The medicaments enhancing bala (strength and immunity of the body) should be given. Balya group of drugs can thus be considered in tackling PE. The below said are the best strength promoting drugs (Balya) –Ashwagandha, Bala, etc. Shukrakaram – Medicines and treatments which could enhance the quality and quantity of Shukra (semen) should be administered. This indicates that Vajikara dravyas (aphrodisiacs can be used in tackling PE. The concept of Vajikarana in treating PE will be explained in the coming passiges. The best Shukrakara dravyas are – Milk, ghee, madhur –snigdha ahar, etc.

  • Sarpi – Ghee
  • Madhura dravya – Drugs which have sweet taste
  • Snigdha Dravya – Drugs which are unctuous (which cause oleation)
  • Jeevaka, Rishabhaka, Meda, Mahameda, Kakoli, Ksheerakakoli, Mudgaparni, Mashaparni, Jivanti Madhuka
  • Kapikachchu, Masha, Vidari kanda, Svarna bhasma, Rasa sindoora etc
  • Vajikarana – Aphrodisiac therapy

    Vajikarana is the name given for Ayurvedic aphrodisiacs. They not only boost up the sex health, they also tone up the genital system. It provides horsepower with a perspective of sexual performance. Vajikarana is both a Swasthasya urjaskara (restoring health in already healthy individuals) and Artasya Roganut (disease alleviating and modifying type of medicines).

    They promote physical and mental health. They can be readily used in alleviating PE. The best Vajikara medicines in the business with respect to quick ejacuiaton are: Ashwagandha , Kapikachchu, Shilajit, Vidari, Shatavari, musali, Vanga Bhasma, Masha – Black gram, Gokshura, Milk, ghee, etc.

  • Rasayana

    Rasayana is a name given to those medicines / drugs which rejuvenate the tissues in the body (including reproductive tissue), maintain their proper formation, qualitative and quantitative maintenance and delay the process of ageing. Like Vajikarana, these Rasayana’s too act as Swasthasya Urjaskara and Artasya Roganut medicine and tone up the physical and mental health to optimum. They also relieve the stress, anxiety and depression associated with sexual performance; relax the nerves and helps alleviate PE. The best Rasayanas for PE are: Ashwagandha, Guduchi, Brahmi, Shankapushpi, Amla, etc

  • Shukra sthambana

    These are the medicaments which delay the ejaculation and at the same time help in controlling excessive sexual drive and anxiety related to it. Haritaki , Jatiphala, Puga / Kramuka etc.
    Sthanik chikitsa (Local application): The below said can be applied over penis as a remedy in PE:-Sri Gopala taila, Balashwagandhadi taila.

  • Panchakarma

    Bahya Chikitsa (External treatments): Abhyanga, Taila dhara (Pizhichil), Taila Shiro dhara, Shiro vasti, Shiro Abhyanga, Shiro, Shiro lepa, etc.

    The above said treatments will control the functions of Prana Vayu which governs the other Vayu’s. thus the Apana Vayu functions are controlled. Stress, anxiety and depression are said to be the causative or triggering factors for PE. These treatments control the variations happening at the mind level and enable one to have a control over ejaculation and have a satisfying sexual experience.

    Ksheera dhara, Shashtika Shali Pinda
    Sweda (Navarakizhi), Swedana
    Virechana – Therapeutic purgation
    Vasti – Enemas
    Uttara Vasti – Enemas (decoction or oil) given through urethra

Modern Treatment options for PE


PE is a common sexual complaint and also a treatable condition. When it happens infrequently it is not a point of concern. Treatment approach towards PE includes: Counselling Medications Adapting sexual techniques that delay ejaculation Treatment of PE more or less depends on its nature and classification.

Doctor should differentiate PE as a symptom and PE as a syndrome before considering treatment options. Only individuals with lifelong PE with IELT (Intra-vaginal Ejaculation Latency Time) shorter than 1-1.5 minutes (normal – 6 ½ minutes in 18-30 years old) should require medication as a first option along with or without therapy. For those in other categories, treatment should consist of:

Patient reassurance (counselling) Behaviour therapy Psycho - education to explain that irregular early:

Treatments

Self-help and Behavioural techniques

  • Masturbating and ejaculating an hour or 2 before intercourse (helps delay ejaculation during sex)
  • Distraction methods – Focus attention away from sexual stimulation. Avoiding intercourse for a period of time and focusing on other types of sexual play (extending foreplay or intervening / repeating foreplay techniques again when there is ejaculatory response)
  • Thrust more slowly
  • Withdrawal of penis at the ejaculatory response and re-starting after the response ceases
  • Using more than 1 condom

Topical anaesthetics – Application of numbing creams and sprays such as lidocaine over the penis before sex (Possible side effect – temporary loss of sensitivity and decreased sexual pleasure, allergy)

Oral medications

Antidepressants – Ex. Sertraline, Paroxetine, Fluoxetine, Clomipramine etc (possible side effects – nausea, dry mouth, drowsiness, decreased libido etc) Analgesics – like Tramadol delays ejaculation (may have same side-effects like antidepressants) Phosphodiesterase-5 inhibitors – Sildenafil (Viagra, Revatio), Tadalafil (Cialis, Adcirca) or Vardenafil (Levitra, Staxyn) {possible side-effects – headache, facial flushing, temporary visual changes and nasal congestion} Counselling.

Talking with mental health provider about your relationships and experiences, details of sex life etc Helps best when combined with drug therapy Others: Cutting down on the use of alcohol, tobacco, illegal drugs Communication with your partner Use condom to reduce stimulation of penis.

Change positions and bring varieties in sexual intercourse Psychoanalysis – According to Freudian theory – rapid ejaculation was a symptom of underlying neurosis. Man suffers unconscious hostility (noe strong evidence) towards women, so he ejaculates rapidly, which satisfies him but on the other hand frustrates his lover who is unlikely to experience orgasm that quickly. PE could be cured by psychoanalysis The theory was not successful in curing PE.

  • Kegel exercises – to strengthen the muscles of the pelvic floor
  • Masters and Johnson’s ‘stop-start technique’ and ‘squeeze technique’
  • Focus exercises
  • Mind/body coordination exercises
  • Masturbation exercises
  • Deep breathing
  • Whole body massage
  • Study – Men who have PE have a faster neurological response in the pelvic muscles.

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