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

Vaginismus is a condition where vaginal contractions and squeezes may be caused due to pain during intercourse or due to the insertion of objects like tampons. This mildly uncomfortable condition is also characterised by spams and other symptoms like the feeling of coming up against a thick wall which can cause pain. This may be due to a variety of reasons starting from infections to anxiety. To a large extent, the treatment of this condition depends on the cause. Following are the various ways in which this condition can be treated.

    Sex Therapy: A sexologist or an expert who specialises in psychosexual medicine can help in treating this condition by conducting a series of counselling sessions where psychoanalysis will help in understanding and unravelling the cause of the condition. This may be followed by CBT or cognitive behavioural therapy. This kind of therapy usually helps in reprogramming the brain after the root cause for the condition is known. 
    Exercises: During sex therapy, the doctor may also teach you various kinds of exercises and vaginal trainers that can help you in strengthening the pelvic floor and relaxing the muscles as well. These vaginal trainers are especially helpful in equipping you suitably so that you can relax your vagina and let the insertion happen. Vaginal trainers consist of four smooth balls of plastic which can be inserted with the help of lubricants to help in stretching the vagina. 
    Relaxation: Getting yourself to relax is also a matter of exploration and touching, which can help you understand the kind of touch and the exact areas that make you tense. During sex therapy, you may be taught a technique known as progressive relaxation. This mode includes tensing and relaxing your muscles as you explore by inserting a finger. 
    Sensate Focus: This is a part of sex therapy and involves your partner. In this method, you will be asked to abstain from sex and touch each other without going to the genitals and other private parts. This will help in better arousal and sexual stimulation.
    Surgery: The last option for treating a very severe form of this condition is to put the patient through surgery which will seek to remove endometriosis, as these growths in the womb's lining can cause a lot of pain during intercourse. Also, vaginal enlargement surgery can be carried out with the help of episiotomy. 

This kind of procedure usually helps in fixing the scar tissue that may have been left from a previous procedure, which can restrict or block the vaginal path. Getting help at the right time for this condition is of great importance so as to have a normal sex life.

How to Treat Vaginismus

One of the most important decisions a couple takes is to start a family. It fills them with hope and joy of new future, but if the attempts have been unsuccessful for more than six months, it can take a toll on the relationship and the mental health of the couple. This is the time to seek fertility specialist who will be appropriate to analyze the situation and provide proper guidance. Read on to find out the exact indications to see a fertility specialist:

1. If a woman who is under the age of 35 is unable to get pregnant even after a year of having regular unprotected sex
2. A woman who has had more than three miscarriages
3. Someone who has suffered from blocked fallopian tubes and is in need of surgery
4. One who experiences irregular ovulation
5. A couple who has suffered from genital infections
6. A pregnant woman who has consumed an estrogen derivative
7. A man who has been diagnosed with low semen count, also known as poor motility
8. A couple who has not been diagnosed with any irregularity but is infertile

Which specialist should you visit?

If you or your partner or both have shown signs of infertility, then visiting the following specialists can be helpful:

Specialists for men

Urologists and Andrologists are specialists who treat men for infertility. Urologists conduct an analysis of semen quality, semen count, hormone levels, reproductive organs and abnormalities in bladder and kidneys. Andrologists are medical professionals who specialize in hormonal conditions and physiology of male infertility.

Specialists for women

Hormonal imbalance is one of the potent obstacles to pregnancy. If a general obstetrician/gynecologist has not been able to successfully treat a woman then she can visit a reproductive endocrinologist who specializes in hormonal disorders. Depending upon the nature of the problem, she can also visit a reproductive surgeon who deals with uterine abnormalities, endometriosis, and reproductive organ surgery.

When Should a Couple See a Fertility Specialist?


- hiv testing in pregnancy should be done early so as standard care can be taken for the pregnant women.


- this hiv testing must be repeated in the third trimester, usually before 36 weeks of gestation. This should be done in women with hiv-seronegative and also in pregnant women who are at a high risk of developing hiv infection.


- expedited hiv tests should be performed at the time of delivery and labor and this is a must in women who have not been documented for hiv. The results of the test should be available in one hour of the test and the testing should be available 24 hours. In case the results are positive then, infant postnatal antiretroviral and intrapartum drug prophylaxis should be started immediately.


- women who have not been able to be tested for hiv at the time of labor and delivery are suggested expedited screening for hiv. Their screening can be done immediately postpartum or their babies should undergo screening. In case the infant and mother, both are positive, then infant antiretroviral drug prophylaxis should be started immediately. These mothers should avoid breastfeeding their babies, until the supplemental hiv tests are negative. In infants with positive hiv, prophylaxis should be discontinued and antiretroviral drug therapy should be started.


- in case of acute hiv infection during pregnancy, that is in the intrapartum period, or during breast feeding, initial testing can be performed with an antigen/antibody combination immunoassay. If the supplemental test is negative, then an additional test which is the virologic test (dna, rna) are necessary for the diagnosis of the hiv infection.
- if the mother is hiv positive then this information must be documented in the infant's medical record and also communicated to the infants care provider.
The knowledge of an antenatal maternal hiv infection allows the:
- women with hiv infection to get the correct antiretroviral therapy along with prophylaxis for the infections which might occur due to the immunocompromised state of the body. This also prevents and decreases the risk of transmission to their partners.
- when there is provision for antiretroviral therapy for the mother during pregnancy and labor along with antiretroviral drug prophylaxis for the baby there is less risk of perinatal transmission of the hiv.
- the hiv infected women should be counseled for a cesarean delivery. The option of an elective cesarean reduces the perinatal transmission of the hiv.
- the hiv women should be counseled about the risk of breastfeeding.

Identification and Management of Perinatal HIV Treatment

4 Things that Cause Vaginal Dryness

Vaginal dryness is an uncomfortable and painful condition that usually occurs during or after menopause. The estrogen level in your body gets reduced during this time which eventually leads to vaginal dryness. However, there are other factors that can trigger this condition including certain medications and immune disorders. This is a problem that can affect women at any age but it is visible more frequently in older women.

Here are some common factors that may lead to vaginal dryness:

1. Hormonal changes - A decrease in estrogen level that occurs during menopause is one of the most common causes of vaginal dryness. The decrease in estrogen may also occur during perimenopause, during breastfeeding or after childbirth. Radiation and chemotherapy for cancer treatment may also result in a decrease in vaginal lubrication.

2. Irritants - Chemicals present in soaps, dyes, hygiene products and perfumes may cause allergy in some women. Irritants present in underwear or towels and other allergens like objects and lubricants that are placed in the vagina may also cause vaginal dryness.

3. Insufficient arousal - Low libido or other sexual problems may also lead to vaginal dryness. Poor sexual performance and early ejaculation may also contribute to it.

4. Anxiety - Sexual desire can be affected by emotional and psychological factors such as anxiety and stress that may eventually lead to vaginal dryness. High anxiety level in women results in insufficient flow of blood, causing vaginal dryness.

How can vaginal dryness be treated?

Topical estrogen therapy is a common method of treating vaginal dryness caused by low estrogen level. Topical estrogen helps in inserting some hormone that your body is no longer producing. This controls the vaginal symptoms to a certain extent but it does not replace as much estrogen as oral hormone therapy, in your blood stream. Lubricants and moisturizers may also be applied to reduce vaginal dryness and make sex less painful and uncomfortable.

Word of Caution

Please get a PAP Smear done before starting local estrogen and keep a follow up with your doctor.



4 Things that Cause Vaginal Dryness

Fertility is a potential for reproduction. In other words, fertility is an ability to have babies or to reproduce. When fertility rate in a community, increases more babies are born. To produce an offspring it depends on age, health and other factors of the woman. When we talk about fertility rates it means the number of births that happen during a certain time period in a specific location. On the other end, lack of ability to reproduce is termed as infertility. There are various treatments to deal with fertility issues and one of the ancient and natural as well as a trusted treatment is Ayurveda.

Causes
Female infertility is caused due to structural problems like blocked fallopian tubes, a defect in cervical canal, uterine fibroids or polyps. Hormonal imbalance leading to ovulation problems too can cause infertility. In males. infertility may have anatomical, psychological, hormonal or lifestyle related causes. The cause of infertility in approximately 20% of couples can't be determined using the currently available methods of investigation. From Ayurvedic perspectives, shukra dhatu can get affected by various physical, mental causes and even by serious diseases. Poor quality shukra dhatu can cause infertility in males & females.

Symptoms

Failure to reproduce

Ayurveda For Infertility

Ayurveda is one of the world's oldest holistic healing systems. It is based on the belief that health and wellness depend on a delicate balance between the mind, body and Spirit. The primary focus of Ayurvedic medicine is to promote good health, rather than fight disease. Fertility problems are increasing these days for many young couples. There are many factors which account for this like Lifestyle, delayed marriages, diet, etc. But Ayurveda not only does explain how to increase fertility with herbal supplements, but it also focuses on how to have healthy children.

For a pregnancy to be healthy and successful, a couple needs to take care of the following four essential factors:

Sperm/Ovum (Seeds)
Uterus (Soil)
Nourishment (Water)
Time for Conception (Timing of Sowing)
Reproductive health, in both men and women, depends on the health of the reproductive tissue or shukra dhatu. In women, shukra creates the ovum as part of the monthly cycle, and in men, the semen is formed due to sexual stimulation. The shukra is created as part of a long chain of metabolic transformations. It starts with the digestion of food, then goes on to the transformation of food to nutrient fluid, blood, muscle, fat, bone, bone marrow, and finally, to shukra tissue. Healthy shukra tissue, then, according to Ayurveda, depends on the health of all the other tissues in the body.

Foods to Nourish All Seven Dhatus (Bringhana)

Fresh, organic fruits and vegetables
Dairy proteins, including milk, lassi, and panir (a fresh cheese made of milk)
Whole grains
Mung dhal
Soaked almonds or soaked walnuts
Dried fruits such as dates, figs, and raisins
Sweet, juicy fruits such as mangoes, peaches, plums, and pears
If your digestion is strong, eat urad dhal (available at Indian grocery stores) cooked with equal parts turmeric, cumin, coriander, and fennel.
A banana cooked in ghee, cinnamon and cardamom is a tasty and wholesome dessert for people with strong digestion.
Foods to Enhance the Reproductive Tissue (Vrishya)

Asparagus
Broccoli
Milk
Date-milk shake
Mango milkshake
Rice pudding
Spices such as ajwain powder, cumin (which purifies the uterus in women and the genitourinary tract in men), turmeric (to improve the interaction between hormones and targeted tissues), and black cumin.
In general, it's important to eat a wide variety of foods in order to receive all the essential nutrients. Keep trying new vegetables and fruits, and rotate your menus to make sure you're not eating the same thing day after day.

Infertility - Ayurvedic Remedies are the Solution!

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