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

High blood pressure and sex

High blood pressure is a condition in which the pressure of the blood against the artery wall is high enough to cause health problems, including heart disease. No symptoms may be noticed in a person for years but the damage to the blood vessels and to your heart continues. High blood pressure can have an impact on your sex life. Although sexual activity does not lead to any possible threats to your health but high blood pressure can affect the pleasure you would have otherwise derived from sex.

In Men

High blood pressure leads to the wearing out of the lining of blood vessels and causes arteries to narrow and harden that decreases the blood flow. This results in decreased blood flow to the penis. In case of some men, this decreased blood flow makes it difficult for them to achieve and maintain an erection. This problem is called erectile dysfunction.

High blood pressure may also interfere with ejaculation and be a cause for low libido. The medications that are prescribed for treating high blood pressure may lead to this condition.

In Women

Just as in the case of men, high blood pressure results in the decreased flow of blood to the vagina in case of women. This may cause problems like low libido, vaginal dryness, or complexities in achieving orgasm. Sexual dysfunction in women results in stress, anxiety and even relationship issues.



High Blood Pressure and Sex

Many people suffer from a low libido problem. This can be a problem for their partners as well as for themselves. A low sex drive can also reduce one's self esteem and confidence. In severe cases it also leads to depression.

Factors which cause low sex drive:
1. Sexual problems: Many sexual problems also lead to a low sex drive. An inability to experience orgasm even after a lot of attempts can make one indifferent to sex. Some people also experience pain because of a tight vagina. In such cases their desire to have sex reduces greatly.

2. Medical diseases: Many medical conditions also affects your libido, such as cancer, arthritis, blood sugar (diabetes), artery diseases, high blood pressure and neurological diseases.

3. Medications: Some people suffer from depression and anxiety disorders. To get over these disorders most doctors prescribe them antidepressants and anti-anxiety pills, these medications create a very low libido.

4. Habits: Many lifestyle habits such as over-consumption of alcohol can make your sex drive reduce a lot. Smoking also decreases the blood flow in your body which may make your libido fall.

5. Surgery: Reconstructive surgeries such as breast reconstruction surgery and genital tract surgery can also affect sexual desire and give your body signals to not engage in an intercourse.

6. Fatigue: Tiredness because of physical activities or caring for your old parents or young children can also make you uninterested in sex. Your body and brain might not have the energy to engage in an intercourse due to fatigue.

7. Menopause: The levels of estrogen reduce greatly during menopause. Low estrogen levels make your vagina dry hence sex can be uncomfortable and painful. Women also go through hormonal changes which make them suffer from a low libido.

8. Pregnancy: After pregnancy, breastfeeding your baby becomes an everyday activity. This can reduce sexual desire because of the pressure of caring for a new born baby.

Regular exercising complemented with enough sleep is known to reduce stress thus giving you a high sex drive. Avoid consuming alcohol. Testosterone replacement therapy (a therapy used for treating erectile dysfunction) also treats low desire.

Worrying Factors That Lead to a Low Sex Drive

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

When Should You Use Viagra?

Viagra is a very common drug prescribed for treating erectile dysfunction. It works by enhancing the flow of blood to the penis during sexual intercourse to bring about erection. Viagra actually contains the active ingredient Sildenafil Citrate which is a selective inhibitor of Cyclic Guanosine Monophosphate (cGMP)-specific phosphodiesterase type 5 (PDE5).

This drug works efficiently with sexual stimulation. Erectile dysfunction is very common among older men whose sexual function tends to fall after they reach their 50s. But these days even younger men in their 30's and 40's are experiencing an increased incidence of erectile dysfunction.

Doctors can even recommend the drug to both younger and elder men who suffer from erection problems.

Solidification of the arteries, the blood vessels that supply blood to the penis, can occur during the teen years. The problem then develops by the time they reach the age of 20-30 years and more, hindering their ability to get and maintain an erection. Men suffering from diabetes and facing the problem of Erectile dysfunction can be assisted by this drug.

The drug should be ideally taken an hour before the sexual intercourse.

On the other hand, you can also take Viagra half an hour to 4 hours before the sexual intercourse. You don't require having food in order to take the drug. But you need to keep in mind that if you take it after a meal high in fats, it can take a little bit longer for you to experience its effects.

Most importantly, the misuse of Viagra should be avoided. It should be taken only under medical supervision. The drug doesn't have the power to help you ejaculate easily if you suffer from problems related to orgasm or even enhance your sexual appetite. It does not enhance sexual timing, so should not be used to treat premature ejaculation. Men also shouldn't expect the drug to take the erections to unexpected heights.

Word of Caution:

One should never take the drug for recreational purposes. One can end up suffering from minor erectile dysfunction due such abuse.



When Should You Use Viagra?

Sex tips every woman needs to know by the time she is 30
 
Thirty is more or less the age by which you can consider yourself a woman of the world. You have toiled hard to get into a comfortable space at work and are into a stable relationship as well. An important aspect to not ignore is your sexual life. Be equipped with the right ideas and ways to enjoy that aspect of your life.

Some facts and tips for the women of today.

1. Safety is foremost: meaningless hookups or otherwise - you cannot be careless; safety must be your priority. 

2. Express yourself: men are bad at guessing. They will not be able to guess what you like and how you like it. Tell the man exactly what you expect.

3. Live in the moment: a quickie is never a bad idea. Having frequent sex has its perks for your mood as well as overall health. An impromptu quickie will only put a spring to your steps.

4. Watch each other pleasuring self: it is not just for visual appeal, it is in fact educative - you get to study exactly what type of touch, speed, grip, etc gives him the most pleasure. He gets to know the same about you.

5. Take the initiative: most men like being shown that they are desired too. Why should he always initiate sex. Take the lead.

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


Sex Facts Every Woman Needs To Know By The Time She Is 30

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