Knowing Premature Ejaculation - PART 2: Diagnosis, Types & Causes

As many as 30-40 % men across the world including India experience problem of PE at some time of life. In Part 1, we learnt about the condition called Premature Ejaculation (PE). In this 2nd part, let’s understand about it’s diagnosis & types of PE - why and how it happens.

How to Diagnose PE:

The specific criteria for premature (early) ejaculation are as follows:
- In almost 75-100% sexual activity, the experience of ejaculation occurring during sexual intercourse within 1 minute after vaginal penetration and before the individual wishes it.
- The problem has persisted for at least 6 months and is a cause of mental stress to the person.
- The dysfunction cannot be better explained by any other nonsexual mental disorder, any medical disease, the effects of a drug or medication, etc
 
Severity of PE:
 
The severity of premature (early) ejaculation is broadly defined as follows:
1. Mild (occurring within approximately 30 seconds to 1 minute of vaginal penetration)
2. Moderate (occurring within approximately 15-30 seconds of vaginal penetration)
3. Severe (occurring even before sexual activity, at the start of sexual activity, or within approximately 15 seconds of vaginal penetration). In such cases conception will not be possible unless artificial insemination is used.
 
TYPES and Characteristics of P.E. :
Premature ejaculation can be Chronic (lifelong) or Acquired (recent).
Chronic PE:
With chronic (lifelong) premature ejaculation, the person has been experiencing premature ejaculation since he became sexually active (ie, post puberty). 
Acquired PE:
Acquired (recent) premature ejaculation means that the condition began in an individual who previously experienced an acceptable level of ejaculatory control and only recently has developed PE.

What are the Causes?
The causes of PE can be divided into two broad sub-heads, which are psychological or biological cause:
 
 
1. Psychological Causes:
Premature ejaculation is believed to be a psychological problem and does not represent any known organic / physical disease involving the male reproductive organs or any known defect in the brain or nervous system. It is usually due to a pattern that is hard to change and is a result of your previous sexual experiences.
 
One of the most common reason is childhood habit of reaching climax/ ejaculation quickly because of fear of discovery when masturbating or during early sexual experiences with a female partner. This pattern of rapid attainment of sexual release is difficult to change in later stage of life (in marriage or long-term relationships).
 
Other reasons are situations in which one may have hurried climax/ ejaculation in order to hide any problem or feelings of guilt that make you rush through sexual encounters. Also, psychological causes include anxiety and relationship issues which can also result from deep anxiety about sex that relates to bad experiences encountered by the patient during development (eg: incest, sexual assault, conflict with parents, etc ).
 
2. Biological Causes
 
A number of researchers have found differences in nervous stimulations and hormonal differences in men who experience premature ejaculation compared with individuals who do not.
 
Some believe that some men have hyper-excitability or oversensitivity of their genitalia.
 
Abnormal functioning of the ejaculatory system can be attributed to:
- Thyroid problems; infection or inflammation of the urethra or prostate.
- Nerve damage occurring due to trauma or surgery (a very rare cause).
- Abnormal levels of hormones and/or neurotransmitters (chemicals present in the brain)
- Higher free and total testosterone levels or varied other biochemical markers
*The research however has been non-conclusive.

In Part 3 and 4, we will discuss the right approach and therapy for the men / couple suffering due to PE.



Knowing Premature Ejaculation - PART 2: Diagnosis, Types & Causes

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

5 reasons your partner doesn't want to have sex anymore

There are innumerable explanations as to why couples in long-term relationships find themselves in situations when either one of the partner's starts avoiding sex for a reason the other cannot comprehend.

The explanation for your partner's behaviour may be due to an underlying medical issue or various emotional or psychological factors. Following are a few reasons why your partner does not want to have sex anymore:

1. Physical factors: your partner might be experiencing a loss of libido due to physical ailments, particularly ones pertaining to the endocrine and circulatory systems. Disorders such as diabetes, hypothyroidism, heart complications to name a few, affect the hormone levels in the body, which leads to the lack of sexual drive.

2. Psychological factors: Many mental and emotional factors also affect libido in both men and women. Stress and depression, which often cause sleep deprivation, are two of the biggest causes of unwillingness to have sex. Talk to your partner about what the root of the problem is and ascertain what is creating stress and triggering depression. Communication and counselling are the main ways of dealing with such a situation.

3. Excessive masturbation: If a person watches too much pornography and consequently indulges in masturbation frequently, sexual function is automatically lowered when it comes to performing during intercourse. If your partner masturbates too much, simply ask that the practice needs to be put an end to.

4. Lack of affection: When there is a lack of warmth and affection between partners, the desire to engage in sexual intercourse is automatically diminished. Communicate with your companion to determine ways in which you can rekindle love and passion in the relationship.

5. Addiction to narcotics: If your partner has developed an addiction to certain narcotics, such as nicotine, morphine and various anti-depressants that reduce sex drive, it could be the reason for not wanting to have sex.

The reasons for developing an aversion to sex are often extremely subjective and complex. Open and honest communications between partners may unravel the problem but in many cases, therapy and medical assistance provides the solution.



5 Reasons Your Partner Doesn't Want to Have Sex Anymore

People who have healthy sex life are not only happier but also healthier than those who don't. Here are 9 health benefits you never knew sex can provide -

1) Rocking Immune System: Regular sex ensures higher levels of what defends your body against germs, viruses, and other intruders.

2) Lowers Blood Pressure: One landmark study found that sexual intercourse specifically (not masturbation) lowered systolic blood pressure.

3) Great Exercise: Sex is a really great form of exercise. It is a muscular exercise that burns calories and increases your heart rate.

4) Lowers Heart Attack Risk: Great sex life is good for your heart. It not just raises your heart rate, sex helps keep your estrogen and testosterone levels in balance.

5) Reduces Pain: Getting an orgasm can block pain. Vaginal stimulation can block chronic back and leg pain, and can reduce menstrual cramps, arthritic pain, and in some cases even headache.

6) Improves Sleep:  People usually dose of quickly after sex and tend to get a sound sleep.

7) Relieves Stress: Sexual arousal releases a brain chemical that revs up your brain's pleasure and reward system. Sex and intimacy relieve you of stress and boost your self-esteem and happiness too.

8)  Reduces Risk Of Prostate Cancer: A study, published in the Journal of the American Medical Association revealed that men who ejaculated frequently (at least 21 times a month) were less likely to get prostate cancer.

9) Helps Women's Bladder Control: Incontinence, a problem that affects about 30% of women at some point in their lives is helped with a regular sex. Good sex is like a workout for their pelvic floor muscles. An orgasm causes contractions in those muscles thus strengthening them

Click on consult privately to ask me any follow-up questions on this.

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Having Sex - 9 Health Benefits

Knowing premature ejaculation - part 3: management and techniques (non-medical methods)

As shared in part 1and 2 of this series, because of premature ejaculation (pe), both the partners may end up experiencing highly unsatisfactory sex. In fact, it can increase anxiety, which may deteriorate the problem. 
Remember there is not a single magical drug or medicine in the chemist shop which can solve your problem overnight especially if you have chronic pe. Before seeking any medical treatment for pe, it is appropriate to consider the varied options for solving this issue. These include counseling with a sexual therapist, non- medical treatments like various exercises/ techniques and medical treatments including both modern and alternative medicine.

A. Counseling from an expert - sexual therapist or sexual medicine practitioner:
It is well understood that sex is in the mind. However, repeated pe/ failures can lead to lot of stress and disappointments. Anxiety due to pe itself is a big issue and can lead to recurrence of pe.
Reassurance from sexual therapist / counselor that pe is not a disease and can be easily treatable is relaxing for men who are facing this problem. So please share your detailed history and sexual habits with the expert. This may help the expert to guide you well.

B. Behavioral changes:

Some basic things may also help you to deal with the problem. 

1. Some men attempt to treat themselves for premature ejaculation by distracting themselves by thinking nonsexual thoughts (such as naming cricket players and records) to avoid getting excited too fast when approaching their partners. This helps them to focus their attention away from the sexual stimulation.

2. It is also suggested to men that they should relieve themselves of the sexual tension by ejaculating with self masturbation 1-2 hours before attempting sexual intercourse with their partner.

3. Using condoms is known to help in premature ejaculation in some men by decreasing sensation.

4. Women on top position usually helps to delay orgasm in men

 
C. Exercises &amp; techniques:

There are several exercise and techniques you can try sitting in your home.

1. The" stop and start" method:
This technique involves sexually stimulating the man by self until he feels like he is about to reach orgasm. Then he needs to stop the stimulation for about 20-30 seconds and then start it again. Repeat this pattern until the man wants to ejaculate. This can be continued for 10-15 minutes. At the end of say, 10th or 15th minute, continue stimulation until the man reaches orgasm and ejaculates.
2. The" squeeze" method:
 This technique involves sexually stimulating the man by self or by his partner until he recognizes that he is about to ejaculate. At that point, the man or his partner gently squeezes the end of the penis (where the glans penis meets the shaft) for at least 15 seconds. Stop sexual stimulation for about 60 seconds, and then start it again. The person or couple may repeat this pattern for at least 10-15 minutes. At the end of say, 10th or 15th minute, continue stimulation until the man reaches orgasm and ejaculates.
3. Practice breathing exercises 

Deep breathing can greatly help in controlling the arousal and tension that cause early ejaculation. Men must avoid shallow breathing as it can trigger premature ejaculation. Instead, what you should do is spend 5 seconds taking in a long deep breath; then hold it for 3 seconds and then exhale for the next 5 seconds. If you can do this for 5 minutes in the bedroom without pause then you can control premature ejaculation.

If you would like to consult with me privately, please click on'consult.

Knowing Premature Ejaculation - PART 3: Management and Techniques (Non-medical methods)

Did you know keeping your private parts clean can avoid major health issues?

Private parts not only make or break intimacy but also also affect your overall health. Men and women - both need to keep them clean. Here are 5 things that you need to religiously follow.

1) Wash them everyday - In case you are not washing your private parts every day, let me share with you that it is a must-do! Your private parts are moist and house many bacteria. You can use soap to wash but an unscented or mild one. Wash them with lukewarm and clean water.

2) Clean them up before and after sex - Cleaning your private parts before and after sex is of great importance. Before sex because of etiquette. And, after sex for a healthy sexual life ahead! The body fluids or semen which gather on and near your reproductive organs, if not washed can harbour the growth of bad bacteria and set a stage for infections.

3) Groom them well - Untrimmed hair around the private parts is highly unhygienic. It can lead to too much of itching, increasing the chances of infection.

4) Wear fresh undergarments everyday - Unwashed shirts can do but unwashed boxer or briefs is a big no-no. You need to keep your underwears clean &amp; dry. Wear a fresh and clean undergarment every day. Changing your briefs after masturbation, sex, work-outs in gym is also highly recommended.

5) Don't delay visit to a doctor - If you are experiencing any sort of irritation, itching, redness, odour, swelling or other form of discomfort please do not delay in consulting a doctor. It can be a sign of a serious health problem or a severe infection.

5 Sexual Hygiene Musts For Men And Women

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