All you need to know about Premature Ejaculation

Many of the sexual issues are primarily not big problems. However, because of the taboo and inhibition around them, they are not discussed openly, hence they also fail to get resolved and become bigger. In fact most of the times there are no visible symptoms of any functional problems. Many of them are very basic issues and because of ignorance, myths, and social taboos lead to development of anxieties, distress and further worsening of the problem.

Often men are concerned about their performance in bed with their partner. They worry about- how best then can do, masturbation habits, size of penis and sperm quality. 

Consequences of Premature ejaculation (PE): 
Both you and your partner may end up experiencing highly unsatisfactory sex. In fact, it can significantly increase anxiety, which may deteriorate the problem. 

PE is one such sexual issue. It's not a disease; Not at all..!! 
If a person is sexually fit and experiences normal erections but just fail to hold the orgasm/ discharge for reasonable time then he is suffering from premature ejaculation. It's  a very normal problem, which if managed properly it can be easily resolved.

We will discuss this PE in 4 parts covering: what it is in actual, how does it happen, how to approach to resolve this problem with behavioural methods, exercise, techniques and medical remedies present in both modern and alternative medicine. 
Let s understand the problem in this 1st part!

What is Premature Ejaculation? 

Premature (early) ejaculation also referred to as rapid ejaculation; also called as early discharge. 
PE is the most common type of sexual dysfunction in men younger than 40 years and seen across all age groups. In elderly men (>60 years) erectile dysfunction is more common. A study conducted by the Journal of Sexual Medicine revealed that this condition is almost equally prevalent in sexually active men of all age groups. 
If a man experiences uncontrollable ejaculation (discharge of semen from your penis) either before or shortly after sexual penetration (usually within 1-2 minutes of penetration), he may be suffering from PE. The Mayo clinic at the United States defines PE as a condition in which  a man  always or nearly always ejaculates within one minute of penetration."

Instances of PE:
An occasional instance of premature ejaculation might not be cause of concern, but, if the problem occurs more than 50% of attempted sexual relations signifies existence of abnormal pattern for which treatment is required.

Premature ejaculation takes place with negligible sexual stimulation and even before the desire 
to ejaculate. Another way of describing PE by most therapist or clinicians is the occurrence of ejaculation sooner during sexual intercourse than he or his partner would like. 

This broad definition thus avoids specifying a precise  normal  duration for sexual activity and reaching a climax. The duration of sexual activity is highly variable and depends on various factors specific to each individual. Take a situation, a male may reach orgasm after 7 to 8 minutes of sexual intercourse, but if his partner is able to achieve climax mostly in 5 minutes and both are satisfied with this timing, then this is not defined as PE. 

Alternatively, a male might delay his ejaculation for up to 15- 20 minutes of sexual intercourse, but if his partner, even with foreplay, requires 25-30 minutes of total sexual activity before reaching climax, he may still consider his ejaculation premature because his partner has not been satisfied (at least, not through intercourse). But in routine practice this kind of situation is NOT called as PE. So every individual and every couple is unique. Same individual may have different sexual behaviour with different partners and different circumstances. Varied situations and varied places of performing the act have a vital role to play in determining the outcomes of individual sexual performance/s.



Knowing Premature Ejaculation - PART 1: Understanding What is PE

Tuberculosis is an opportunistic infection caused by the bacteria Mycobacterium tuberculosis. The infections occurring in people with weak immunity as compared to the people with a healthy immune system are called as opportunistic infections. As, HIV enters the human body, it replicates and weakens the immune system which in turn increases the risk of contracting Tuberculosis in people already suffering from HIV infection.

An HIV and Tuberculosis co-infection occurs when an individual has both, the HIV infection and an either latent or active TB disease simultaneously.  Each disease acts in speeding up the progress of the other, when HIV and TB infection is present together in the body. HIV infection speeds up the progression from latent to active Tuberculosis, Mycobacterium tuberculosis also accelerates the progression of replication and spread of the HIV infection.

HIV infection and Tuberculosis are totally different type of infectious diseases. HIV is a viral infection and TB is a bacterial one. An HIV infected person will not contract TB unless a contact happens with a TB infected person. TB spreads via droplet infection and is communicable. If a person lives in a country with a high prevalence rate of TB, an HIV patient is highly susceptible to contracting the infection. In the similar manner, a person suffering from TB gets infected with the HIV infection only through the blood and bodily fluids borne route, with unprotected sexual intercourse with an HIV infected individual being the most important cause.

Amongst all the other opportunistic infections, TB occurs at an earlier stage in the course of an HIV infection than most other opportunistic infections. Mortality rate in the co-infected patients is more than twice that of HIV infected individuals without a TB infection. Even if a patient is undergoing anti-retroviral therapy, the death rates remain high in co-infected individuals.The natural history and course of TB gets altered in people with an infected immune system. The damage to immunity due to HIV infection causes a drastic reduction in the pathogen killing capacity of the body. In such patients if there is no anti-retroviral treatment prescribed, then the latency period between the infection and progression of disease gets eliminated. 

An active phase of TB is observed in such individuals progressing within a short span of time, ranging from weeks to months, rather than years as it normally should be spanning. Risk of progression from a latent stage to an active stage of TB is around 10-15 times greater in an HIV infected individual as compared to the non-infected person. Such individuals also communicate the disease more rapidly to others.Pulmonary tuberculosis in an HIV infected person can present similar symptoms like that of a classic TB disease. However, a co-infection can sometimes show less presenting TB symptoms, where even the chest X-ray scans can be observed to be normal. A  subclinical  phase of Tb in co-infected patients can cause delay in the diagnosis of the symptoms and subsequently affect the prognosis due to lack of timely treatment.

Social stigma and discrimination has caused an obstacle in provision of adequate treatment for people with HIV. Proper counseling  and initiatives taken to provide indiscriminate care can aid in identification of co-infection and earlier stages. Anti-retroviral treatment teamed up with anti-tubercular drug regimen is prescribed and a successful treatment for drug sensitive cases of TB can be provided with medications for 6-8 months.

How HIV & TB  Are Related?

There are some commonest misconceptions about infertility and these misconceptions should be eliminated as soon as possible so that the actual facts can be known. There are many online sites where you can find detailed information on the scientific explanations regarding infertility and you can follow them.

List of myths and facts regarding infertility

1. Myth: The menstrual cycle of a woman is for 28 days.
Fact: Normal cycle ranges between 21 to 36 days.

2. Myth: A woman can have pregnancy on the day one of menstrual cycle.
Fact: The released eggs remain viable for almost 12-14 hours and a woman can get pregnant after an intercourse done two days after ovulation and five days before ovulation.

3. Myth: Infertility occurs due to stress.
Fact: Ovulation can surely get delayed due to hormone suppression, but infertility does not occur due to stress.

4. Myth: Sperms stay active for few hours.
Fact: Sperms stay alive at least for five days.

5. Myth: Men with a higher sexual drive will have a normal sperm count.
Fact: There is no relation in between fertility and virility. Sometimes, it has been found that men having a higher sex drive do not produce sperms.

6. Myth: Women have to wait for three months to conceive after stopping the usage of contraceptive pills.
Fact: As soon as a woman stops pill usage, hormonal levels go back to normal condition, as a result of which ovulation begins immediately.

7. Myth: Only females have infertility troubles.
Fact: Both women and men suffer from infertility troubles as per the current scientific studies.

8. Myth: Ovulation occurs in a woman on the 14th day of menstrual cycle.
Fact: Ovulation can be calculated by counting 14 days backwards from the past menstrual cycle's last day.

9. Myth: Daily sex can increase conceiving chances.
Fact: During ovulation, having sex each day, especially in between 12 to 16th day of the cycle can be the best timing.

10. Myth: Fertility troubles occur at 35.
Fact: Peak fertility timing in a woman's life is 20 and this might continue until late 30s. Fertility troubles might even arrive at a younger age. With age, conception chances get declined, especially after 35.

Myths & Facts About Infertility

The human immunodeficiency virus or hiv is a virus which causes hiv infection and leads to" acquired immunodeficiency syndrome" or aids. Hiv is transmitted by different means and ways.


Unprotected sex is a primary mode of transmission of the hiv virus from an infected person to a healthy person. Unprotected sex refers to having sexual intercourse without using a condom or any other mode of protection. It leads to hiv transmission along with other sexually transmitted infections.


How does hiv occur from unprotected sex?
While having sex without protection, the hiv present in the body fluids such as blood, sperm, vaginal fluid, pre-cum or anal mucus of an hiv infected patient can pass on to the body of his/her partner. The transmission occurs through the membranes of the penis in men, vagina in women, the rectum and also through mouth and throat. It is more likely for an hiv patient to pass on the virus during the first few months after getting infected. This is because the virus spreads over body fluids during this stage.


Which types of sex are more risky?
Hiv is transmitted the most by having vaginal or anal sex. Anal sex accounts for being the riskiest because the lining present in the anus is much more delicate than the vaginal lining. It is prone to more damage, easily. There are two types of anal sex: receptive anal sex and insertive anal sex. Receptive anal sex is more risky.


Hiv can also be acquired from oral sex. This can happen in case the person giving oral sex has ulcers in the mouth, sore and bleeding gums. In case the person receiving the oral sex is already infected, the other person gets hiv.


A person who has sex with multiple partners regularly is at a high risk of getting hiv because of unprotected sex.


Prevention
Getting hiv from unprotected sex can be avoided if you use these precautions:


- condoms
Condoms offer the precaution against hiv infection from anal or vaginal sex. They should be used by men before any kind of sexual contact to restrict the passing of semen or fluid, which may be infected by hiv.


- lubricants
Sex is made easier by using lubricants and reduces the risk of tearing in the vagina or anus due to friction. The risk of a condom breaking is reduced using lubricants.


- dental dams
This is another precautionary device, which is a small sheet of plastic. It has to be placed to cover the mouth of the vagina or anus and reduce the risk of hiv transmission.
Unprotected sex is the primary cause of hiv and people who do not take precautions before sex are likely to be infected by hiv.

HIV and Sex

Sexual problems might mean you have a broken heart, literally. The most common sexual problem in men is erectile dysfunction (ED). Erectile dysfunction affects >30% of men between 40 and 70 years of age. There are several different causes of ED, including depression, low testosterone, neurological problems, and some medications, such as beta blocker but the most common cause is a problem with the blood vessels called atherosclerosis.
Erectile dysfunction is frequently a sign of atherosclerosis, that can be the first clue to heart disease in men. It usually comes 3 to 5 years before a heart attack, so after ED is diagnosed, there is time to treat atherosclerosis and prevent a heart attack.
Sexual Activity and Cardiovascular Disease
Decreased sexual activity and function are common in patients with CVD and are often interrelated to anxiety and depression. In fact research has proved that there is a strong link between erectile dysfunction and heart disease. Studies have shown that if a man has ED, he has a greater risk of having heart disease. For instance, in one study, 57% of men who had bypass surgery and 64% of men hospitalized for a heart attack had had ED.
Several having ED can predict that a man will probably have heart disease symptoms within five years. In fact, having ED is as much a risk factor for heart disease as a history of smoking or a family history of coronary artery disease.
The Stockholm Heart Epidemiology Programme (SHEEP) study of post-MI patients (50% women) found that those who were sedentary had a higher risk of MI with sexual activity (relative risk 4.4) than did those who were physically active (relative risk 0.7).
How is the Heart and ED Related?
Deposition of cholesterol in the arteries causing atherosclerosis is taken as the most important reason for ED as the plaque formation reduces the blood flow in the penis, thereby affecting the erection process. However the latest studies show that ED is also due to the dysfunction of the inner lining of the blood vessels (endothelium) and smooth muscle. This causes inadequate blood supply to the heart and the penis which also aids in arthrosclerosis. Hence ED and heart disease are found to be inter related.
What to do?
If you are suffering from ED or heart disease , it is best to discuss your concerns with a specialist - for the heart a cardiologist and for the ED a urologist.

How Erectile Dysfunction and Cardiac Problems are Related

Erectile dysfunction (ed) occurs when the man is unable to achieve or maintain his erection of penis to meet his or his partner's sexual satisfaction. 
The problem is often faced by newly married men. Fortunately with experience, most of them are able to overcome this problem. Again it is increasingly common with increased age. 

So, what are the causes. In some male, it is psychological, caused by anxiety, depression, stress, marital disharmony etc. Use of alcohol and smoking will aggravate the problem. Psychological causes can happen at any age but more common at younger age. But in some cases, it is associated with serious diseases, especially at old age. It has been seen that in apparently healthy male ed is the first sign of heart disease. So, if you have ed, make sure that i's not caused by your heart problem. Again diabetes is another important cause. Excessive weight gain will also cause hormonal imbalance and thus problems in erection. Some hormone may also cause ed like thyroid, prolactin and even testosterone (male sex hormone). If you have chronic diseases like liver or kidney disease, it may also lead to ed. Diseases of nerves and spines should also be kept in mind. Sometimes, infections or tumour in private parts (prostate, testis etc) will also add to ed. Other diseases of penis like abnormalities in blood vessels can also be responsible, especially in young guys. Apart from these, some surgeries in abdomen and some drugs (like drugs to lower blood pressure, antidepressants, hormonal drugs etc) will also cause ed.

Now, what you can do? if you want to suffer silently, you will land up in other problems like problem in sexual life, problem in family relationships, depression and even inability to make your partner pregnant. But do all men with ed have to go to doctor? initially, the men should try life style modifications like avoiding smoking and alcohol; avoiding stress and anxiety; making good understanding with partner and also reducing weight. The partner should also have sympathetic attitude to the husband who is having ed.

But if still the issue is not resolved you have to consult doctor. It's not a mater of hesitation or embarrassment, as you may think. Rather it is needed to ensure that you are healthy. So, your doctor will talk to you, will check you and try to find out if any cause is there or not (like heart disease, diabetes, hormones etc). He may order some basic tests to ensure that everything is alright. After that he will advise you the treatment. If the cause is found, treatment of the cause (like diabetes) may cure ed. Even if no cause is found, ed can be treated by various ways.

But should you try the drugs shown in television or newspaper? remember, drugs used in ed have important side effects and we advise drugs only when it is absolutely necessary. In most cases simple measures like stress reduction, exercise help. Sex counseling of both the partners helps a lot. And if still ed persists, we advise drugs. There are variety of drugs, all are having own advantages and disadvantages. Particularly sildenafil group of drugs can affect heart and retina. So, we always practice caution before prescribing such drugs. And when patients are advised such drugs we advise to inform us when he feels eye problems, chest pain, fainting or even painful persistent erection of penis (" priapism").

There are other drugs that can be applied directly over penis. Testosterone group of drugs are prescribed only in selective cases as they have serious side effects and even they can reduce the size of your testes. In some cases where drugs cannot be given or drugs fail, we advise penile implants or artiificial pump to maintain erection. Finally in very few cases, where blood vessels of penis is blocked, we can cure it by some operations. 

So, if you feel ed, don't get depressed. At the same time don't feel embarrassed to take medical help. Today's embarrassment may harm you in future. So, get cured and enjoy your personal life.

Erectile Dysfunction

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