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

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)

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 Common Causes Of Male Infertility

Till some time ago, male fertility wasn't paid much attention to, in our country. But, with changing times and increasing awareness, much is being discussed about male fertility. For couples trying to go family way, it is important to know how male fertility works. For a woman to get pregnant (assuming everything is fine within her body), the following things must occur in the male partner’s body: 
a. Healthy sperms
b. Sperm must get carried in delicate tubes to mix with the semen right before ejaculation.
c. Good sperm count
d. Movement and function of the sperm should be normal.
If any of the above are not happening as should be, it could indicate male infertility. Some of the reasons for male infertility could be:
1) Infections - Infections can interfere with the sperm health of an individual.
2) Varicocele - This happens when the veins which drain the testicles develop a swelling in them. This leads to reduced sperm count and fewer moving sperm. This can be treated and it is possible to improve the result with the help of assisted reproductive techniques like vitro fertilization.
3) Inflamed Testicles - Certain infections are known to interfere with the sperm health and production. These infections include STDs, prostatitis and inflamed testicles due to mumps. Few infections can lead to permanent testicular damage.
4) Inherited Disorder - Infertility can result from inherited disorders like Klinefelter’s syndrome where instead of being born with one X and one Y chromosomes, some males are born with two X and one Y chromosomes. Disorders in the testicles can also be the cause of male infertility.
5) Sexual Issues - Erectile Dysfunction pain during intercourse, premature ejaculation and such can also be the reasons for male infertility.
It is best to consult a doctor to understand the exact cause behind your problem.



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5 Common Causes Of Male Infertility

6 Symptoms of Low Testosterone

Testosterone is an important hormone for men and is responsible for male sexual and reproductive health. It begins to spike during the years of puberty, helping in development of primary and secondary sexual characters. In boys, it helps to build muscles, deepens his voice, and boosts the size of their penis and testes. It plays an important role during later years as well, by maintaining mood, libido, emotional and physical health. That’s why low testosterone can cause a variety of problems in men. 

Here is a list of symptoms that will help you understand if you may have lower testosterone levels.

1. Drop in Energy: Sometimes, we all feel full of energy, but sometimes those energy levels are quite low. And then, there are occasions when we feel low on energy, you may feel that you are getting tired easily and frequently. Fatigue is one of the common effects of low testosterone. If this happens with you regularly, if you are tired all the time despite sleeping for 6-8 hours, consider getting yourself checked by a consultant.

2. Changes in Sex Life: A sudden drop in your sex drive or facing problems in erection (erectile dysfunction) can be another  common symptom of low testosterone. But you should get yourself tested for other conditions as well, including heart disease or diabetes, especially if you are over 35 years of age. Ask for online consultation if you want everything to be private and discreet.
 
 3. Fuzzy Thinking: Do you sometimes think that your thoughts are a blur? Low testosterone can also impact your memory. It can make you feel stressed, sad and even depressed, resulting in concentration problems. These  can be a result of low testosterone

4. Mood Changes: Testosterone directly impacts your mood, even leading to extreme sadness or psychological depression. If nothing seems to make you happy, if you are not what you used to be, then visit a doctor.

5. Muscle Changes: Muscle mass and strength reduces over the years. As testosterone helps build muscle, low levels may be the cause if you witness sudden drop in muscle mass. In such a case you should consult a doctor. It can be because of low hormone function.

6. More Body Fat: If you have been enjoying a more fit or healthier weight most of your life but suddenly start gaining weight, it might point towards low testosterone in the body. Also, if you are unable to lose weight even on a healthy diet, consider consulting a doctor.



6 Symptoms of Lower Testosterone - Most Important Male Sex Hormone

5 mind reasons you might not be getting an orgasm

Sex is not only a physical need, sex is a great way to emotionally bond and get closer to your partner as well. Any dissatisfaction in the bedroom can affect other aspects of your life, and can lead to fights, squabbles and general unhappiness. The inability to orgasm can become a major bone of contention. There can be various reasons behind the inability to climax. Some of the common ones are detailed below:

1. Lack of stimulation

Studies show that only 25% of women reach climax during sexual intercourse. The remaining 75% of women require more stimulation, like fingers or even toys and tongues to reach orgasm. Amongst this is a subset of 10-15% of women who never reach orgasm. Thus, a large number of women require extra stimulation to achieve climax during sex. You must talk to your partner about putting in some extra effort and providing the extra stimulation you need to achieve climax.

2. Over-thinking

Many men and women over-think their actions in bed. From their expressions to how they are reacting and how they are making their partner feel - everything is under constant scrutiny and revision. This leads to a lot of stress, which can hinder your ability to reach orgasm. You need to relax in the bedroom, because whatever you do will feel good in some way or another. Your anxieties can also distract you from what is going on, which means you don't get the chance to fully experience the pleasures of sex. If it helps, speak to your partner about your anxieties and tell them what you are stressing about during sex.

3. Differences between men and women 

Men are visual creatures. This means that what they see turns them on. A woman's orgasm, on the other hand, happens in her head. Thus, men and women have different roots to their stimulation. Lack of an orgasm might mean either of these needs isn't being fulfilled. A great way to work around this and make sex more fun is to include a lot of foreplay in your love-making session. You can do this by trying out role-playing or using sex toys. Make sure to take it slow for a great build-up to your orgasm.

4. Performance issues

Porn has an impact on your sex life. It can increase your expectations to a considerable extent, which may not be fulfilled, thus hampering your experience in the bedroom. A lot of people become so focused on reproducing that experience that they forget that its real life. The focus on performance overwhelms their actual experience of sex, which results in an inability to reach orgasm. Try to accept the fact that you don't really have to perform for your partner. Your partner appreciates you for what you are, despite everything.

5. Mental blocks

A problem in the relationship, certain health conditions like depression, past trauma and negative social conditioning can all have negative impacts on your ability to orgasm. Talk to your partner about past trauma if you have any, and what your triggers are. Consider speaking to a sex therapist as mental health issues should never be neglected. Depression hits the libido hard, and the problem is only compounded by antidepressants. Negative social conditioning can only be helped by therapy, so try to reach out to a mental health professional.

If you would like to consult with me privately, please click on 'consult'.
Related Tip: Why You Must Try Kegel Exercises for a Happier Sex Life

5 Mind Reasons You Might Not Be Getting an Orgasm

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