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

A number of factors, such as physical ailments, stress, anxiety and even relationship problems can cause sexual problems. Relationship concerns where intimacy and the culmination of the various phases of sexual activity from stimulation to excitement and peak, cannot be possible in a satisfactory manner. So what are the routine sexual problems recognised and treated as per ayurveda? read on to know more.

1. Erectile dysfunction: this condition is also known as impotence and it usually occurs when male patients cannot muster up and retain an erection for long enough to enjoy sexual intercourse. This problem can be fixed with various herbs and condiments including sanda oil massage on the testicles and nearby areas in order to increase the blood flow. Also, one can have ginger, honey, drumsticks, milk and other such ingredients for better achievement and retention of an erection for a prolonged period of time during sexual intercourse.

Sanda oil is not available in its pure form and simple branding of this name is not useful. Sanda is a wild reptile, which was boiled in ancient times and fats taken out to make sanda oil. This is not possible now a days. Instead various'tilas' (penis massage oils) prepared by valuable herbs and vegetable oils such as sesame oil should be used. Tila using mall (purified arsenic) and egg are also effective. Preparation and use should be as per instructions in classic ayurveda. Tila is selected as per history, present condition and duration of specific problem

Otc or advertisement products are general products, which do not benefit all. Post application directions are also important otherwise there may be adverse effect of tila application

2. Premature ejaculation: premature ejaculation is a condition when the male patient may face ejaculation as soon as the intercourse begins, or upon insertion. This happens in an unplanned way and is a sudden occurrence that usually puts a damper on the sexual mood and activity. In ayurveda, there are various herbs including ashwagandha and a variety of oil massages that can help in treating this problem.

3. Sexual weakness: sexual weakness is a condition when the female or male patient may not have the energy to go through with sexual intercourse and may even complain of pain during intercourse. This problem is especially common among women, and may be caused due to fatigue, stress or even low pelvic strength following childbirth or miscarriage. The best way to treat this issue is with the help of proper counselling and therapy that will help in introducing yogic poses that can strengthen the pelvic area so as to have better sexual strength.

4. Infertility: this problem may be found in both men and women. Ashwagandha, vasant kusumakar ras, shilajit and labub kabir are some of the herbs and concoctions that can help in increasing virility and the chances of conception by creating better sperm quality and quantity, as well as more effective ovulation.

Most of the sexual problems in ayurveda are recognised as factors that arise from stress and anxiety. These are recognised as temporary issues that can be fixed with the help of a proper routine of eating, resting and exercising, as well as a healthy diet where the patient stays away from smoking, excessive drinking as well as drug abuse. Before taking any herbal medicines, one will have to consult the doctor and find out about side effects for patients suffering from chronic ailments like diabetes, cardiovascular diseases and others.

Solving Routine Sexual Problems Through Ayurveda

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

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

Almost 60% men are suffering from erectile dysfunction (ED), and these troubles are getting prominent day by day due to unhealthy lifestyle. Now, you will find various options for treating erectile dysfunction, and you got to get a fair idea about them. Not all medicines are suitable for you, and this is the reason doctors conduct a clinical examination before prescribing medicines.

Best drug options for treating erectile dysfunction

1. Topical administration: Macrochem and Nexmed are the two most popular options, and they are available in a gel form. This gel can be applied with ease over your weak or curved penis so that unwanted erections can be prevented. In this case, needles are not inserted, and thus you will face no adverse reactions. But proper medications are also required along with these medicated gels.

2. Penile injections: Brindley and Virag are the two popular penile injections that can be easily injected so that you can get rid of erectile dysfunction. These injections are to be injected only under proper medical supervision otherwise you might face dreadful consequences. Alprostadil, phentolamine and papaverine deserve a special mention, and they are the safest options as per medical experts. Trial dosage can be easily administered, and on the other hand, combination medications need to be tried out for getting beneficial results.

3. Intraurethral agents: There are many medical programs where these agents have been referred by experts. Though these agents are treated as alternative options, but you can still try them out in order to get some positive effects. In fact, the recovery process can be accelerated to a great extent by means of using these kinds of agents. You can get smoother and highly satisfactory penetration experienced with the use of these agents along with other prescribed medications for erectile dysfunction.

4. Oral agents: though there are innumerable oral agents that can treat Ed trouble, but you have to choose quite carefully with the help of an experienced doctor. Some popular options in this regard are Cialis, Levitra, Staxyn, Stendra, Viagra and others. Only prescribed dosage needs to be taken, and thus you should take only those medicines that are only being prescribed by your doctor.

Do not choose medications as per your preference and never collect ED medicines over-the-counter. Before prescribing any ED medicine, doctor usually conducts a thorough examination in order to know the actual health condition of the patients and this clinical examination is important for referring the right ED medicines.

Most Common Drugs that Successfully Treat Erectile Dysfunction

Peyronie's disease is a problem predominantly found in 3-9% of adult men, especially after 40 years of age. In the disease, a scar tissue is formed in the outer layer of the penis called tunica albuginea. Scar tissue is a just plaque inside the penis.

Peyronie's disease causes the penis to bend sideways or upwards and can make sex become difficult due to deformity and erection may be a painful process. It is usually associated with erectile dysfunctions, severe anxiety and reduced testosterone levels. It is worth noting that there are treatments for peyronie's disease, however, the pain often goes away on its own, generally, in 6-18 months of onset, but the deformity stays.

Here is everything you need to know about this disease:

Causes
It is not known exactly what causes peyronie's disease, however, there are some factors, which make it more likely than others. Here are those factors:

1. Trauma: this is the most common factor which causes peyronie's disease. It is believed that when someone suffers from tiny bleeding of the penis, which is very common in patients of diabetes, the plaque starts to build up. The injury or trauma, which causes the bleeding may go unnoticed as well.
2. Genes: genes are also a possible cause of peyronie's disease.

Symptoms
The symptoms of peyronie's disease vary, such as:
1. Pain on erection: there is usually pain in erection during the initial phase.
2. Bent penis: when the penis becomes hard before sex, it may bend downwards or sideways by more than 15 degree, so the vaginal entry becomes impossible or is painful for the partner.
3. Scars: tissue may form on other parts of the body, as well including the hand and feet. In fact, it has been said that men who have scarring in the hand, which affect the fingers are more likely to contract the disease as well.
One may see extensive scarring in hands in a disease called dupuytren's contracture. 

Treatment
1. Wait &amp; watch: it is worth noting the acute phase with pain is treated by wait and watch, controlling contributory factors like diabetes, low testosterone and psychogenic factors. Antioxidants are useful. Large number of cases are relieved of the pain in 1 to 1.5 years.
2. Intralesional injection: if the bend is significant enough to interfere in sexual functioning, it can be treated by injecting medicines in the plaque. The medicine, xiaflex is currently not available in india and other medicines given are not very effective.
3. Surgery: this is a last option when peyronie's disease has not gone on it's own and medicines are not helping either. The two most common procedures performed are removing the plaque and putting a tissue graft in its place and also removing the tissue opposite the plaque to counter the bending effect. The results are fairly good.

Going for a penile implant is the last option, which is a permanent solution and is commonly done in india. And, the success rate for penile implant is also very high.

Peyronie's Disease: About Bent Penis

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