Dr. Kapur B

Ejaculation can be considered premature if it happens within 1 minute of penetration or if you are unable to control your ejaculation. There are several reasons that can contribute to premature ejaculation like performance anxiety, excessive excitement, relationship issues and hypersensitivity of the skin. To treat premature ejaculation, it is important to determine the cause and stress that can be a potent reason that is preventing you from 'lasting' long. Premature ejaculation can be life long or acquired.

The effects of stress on the mind

Stress can create havoc in your life and it is closely related to sexual dysfunctions. It is caused not only by rigorous emotional turmoil, daily factors like work or school can also lead to continuous stress, which may pile up to have a profound effect on your mind and body. Stress tends to alter the brain chemistry by triggering hormones like Cortisol, Norepinephrine, Serotonin and many others that signal the nervous system and endocrine to put the body in a state of anxiety which leads to weakening of the ejaculation reflex arc.

The effects of stress on the body

Increased level of stress causes the heart rate to drop and the body is stimulated to produce excess blood sugar, adrenalin and chemicals. If your stress is caused due to work, your body will respond to it by diverting blood towards the important organs like hands and legs and your concentration might also improve under stress. However, stress can diminish your ability to enjoy sex, heighten your sensitivity to stimulation and pain and increase impotence.

How stress causes premature ejaculation

Stimulation of the sympathetic nerves and hormonal imbalance caused by stress create an urge to ejaculate. Generally, this urge is enhanced by mental and sensory stimulation till orgasm is reached. One is likely to engage in sex with an amplified urge to ejaculate because the nerves have already been exhausted which leads to an early climax. Men with premature ejaculation has shown significant impact on self esteem and self confidence and many people confirm high levels of anxiety connected to sexual or intimate situations with a partner.

In a recent-published survey investigating the female partner's perception of premature ejaculation and impact on relationship break ups, relationship quality and sexual satisfaction among females, many of them confirmed that premature ejaculation was the main reason for break ups.

Hormonal disturbances in Thyroid, Prolactine, Erectile dysfunction, Penile anomalies, Prostate disease, Lower urinary tract infection can also cause premature ejaculation.
 
Reducing stress is an important step to cure premature ejaculation. Premature ejaculation can be treated with medications, counseling, diet and exercises. If you wish to discuss about any specific problem, you can consult a Sexologist.

Diagnosis & Management of Behavioural Disorders in Children

Disruptive behavioural disorders are complicated and may include many different factors working in combination. For example, a child who exhibits the delinquent behaviours of Conduct Disorder may also have ADHD, Anxiety, Depression, and a difficult home life. 

Diagnosis methods may include:

1. Diagnosis by a specialist: Paediatrician, Psychologist or Child Psychiatrist.
2. In-depth Interviews with the parents, child and teachers.
3. Behaviour check lists or standardised Questionnaires.
4. A diagnosis is made if the child’s behaviour meets the criteria for disruptive behaviour disorders in the Diagnostic and Statistical Manual of Mental Disorders from the American Psychiatric Association.

It is important to rule out acute stressors that might be disrupting the child’s behaviour. For example, a sick parent or victimising by other children might be responsible for sudden changes in a child’s typical behaviour and these factors have to be considered initially.

How can habit disorders affect behaviour?

Most children develop certain repetitive behaviours at an early age, but it is the frequency, persistence or its effects on the overall well-being of the child which could qualify it as a ‘Disorder’. These habits include

1. Repetitive sucking of the thumb
2. Biting of the nails
3. Hitting his own self
4. Pulling at his own hair
5. Holding on to his breath just for the sake of it

This refers to the behavioural issues of your child which cause the child to misbehave more often; this can be due to a variety of reasons such as Improper Parenting, Persistent Family problems, child abuse or Neglect, or any other incident that has traumatised the child in the past, both psychological problems or Medical illnesses etc.

Preventive Measures:

1. Respect Others Space - Your child may be very excited to tell you about some special event or happening in school, but teach him not to interrupt you when you are at work. He must learn to respect other people’s space and have patience while dealing with people. Otherwise, he would not be able to take rejections and thus be inconsiderate in his attitude.
2. Adjustment with Peers - Monitor how he behaves with his playmates. Stop him when he happens to fight with his playmates or fights with them aggressively and teach him how exactly to behave with people.
3. Firm Discipline - You should deal with stubbornness with a bit of high-handedness. Look at your child right into the eye and tell him what is expected of him. Be tough, but not rude.
4. Balance Independence - Monitor his use of PCs, laptops and mobiles. Well, that doesn’t mean you need to loom over everything he does on his gadget, but do try to watch over the content whether it is inappropriate or not. But remember to never really pry and barge into his privacy. Respect that and you can still humour him.

Treatment of behavioural disorders in children

Untreated children with behavioural disorders may grow up to be dysfunctional adults. Generally, the earlier the intervention, the better the outcome is likely to be.  Treatment is usually multifaceted and depends on the particular disorder and various factors contributing to it, which may include:

1. Parental education – For example, teaching parents how to communicate with and manage their children.
2. Family therapy – The entire family is helped to improve communication and problem-solving skills.
3. Cognitive behavioural therapy – To help the child to control their thoughts and behaviour.
4. Social training – The child is taught important social skills, such as how to have a conversation or play cooperatively with others.
5. Anger management – The child is taught how to recognise the signs of their growing frustration and given a range of coping skills designed to defuse their anger and aggressive behaviour. Relaxation techniques and stress management skills are also taught.
6. Support for associated problems – For example, a child with a learning difficulty will benefit from professional support.
7. Use of Reinforcement – Many children with behavioural disorders experience repeated failures at school and in their interactions with others. Encouraging the child to excel in their particular talents (such as sport) can help to build self-esteem using positive reinforcements both verbal and non-verbal.
8. Medication – To help control impulsive behaviours if required so. If you wish to discuss about any specific problem, you can consult a psychologist.