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

Your good intention during intercourse might be to give your partner an intense orgasm, but orgasms aren t something one can  give . All you can do is make the conditions more favorable for the other person to have them by manipulating your moves. 

Here are six ways in which you can orgasm better: 

Don t skip the foreplay: Just like it is not a good idea to run a marathon without sufficient warm up, it isn t advisable to skip or shorten the foreplay. Explore and find out and choose the right kinds of foreplay that take the arousal to great heights. Oral sex, clitoral stimulation and self-stimulation during sex are incredible in achieving a better climax. 
Experiment with edging: Try what we call 'edging'. That is, bring yourself close to climax, then stop short of reaching climax, and after a pause a few seconds, rebuild your arousal   again just close to climax. Repeat this until you can't hold any more and then come! The resulting orgasm is very intense and worth the effort. 
Try sex toys: Once in a while let a sex toy join the fun. Sex toys are useful in maximizing the pleasure levels during intercourse or solo. 
Use a lubricant: Don t think that a lube just addresses the vaginal dryness and painful intercourse. Research shows that as many as 50% women get better orgasms when they use lubricants. The lubrication adds sensitivity to the genitals and helps get good orgasms. 
Target the C-spot: A lot of women have problems in getting orgasms during intercourse as the clitoris isn t stimulated enough. The clitoris has the maximum number of nerve endings and during intercourse, clitoral contact is needed for most women to reach orgasm. Tip: Try out woman-on top, side-to-side and doggy style positions for clitoral stimulation. There are many more options too. 
Do not overlook the testes: Stroking your sack upwards right before getting an orgasm adds more power to the orgasms in men. The testes are tremendous pleasure points for a man and gently stroking them is useful in heightening the arousal which leads to a stronger orgasm.

6 Ways To Orgasm Better

Oral sex is a form of sexual activity, which involves the arousal of one's genitalia by his/her partner using the mouth (tongue, lips and throat). It is also called Cunnilingus (performed on a female) and fellatio (performed on a male). It is done before intercourse and during foreplay for sexual arousal. It is safe as compared to vaginal or anal sex, the rate of getting a sexually transmitted disease or HIV is comparatively lower. 

Oral sex can spice up your life and can also make your partner reach orgasm. It is also a safe way of getting sexual pleasure without getting pregnant. But necessary precautions must be taken in order to have safe oral sex.

Some of these necessary precautions are:

1. You can get throat cancer from oral sex: Human papillomavirus (HPV) is a cancerous virus found in the body of infected people. This virus can be transmitted to the person with whom you are engaging in oral sex. Studies show that people who engage with more than 6 sexual partners at once are more prone to get oral cancer. It is advisable to get your partner tested for HPV virus before engaging in oral sex.

2. Oral sex also causes stress: Oral sex is generally related to hygiene, therefore the partner can be self conscious and worried about his/her genital hygiene. If oral sex is performed on a daily basis, some people prefer to wax their pubic hair often. This is harmful because it can cause red bumps and burning sensation occurs. It is advisable to trim your pubic hair and wash it properly before engaging in oral sex.

3. A condom should be worn by the male during oral sex so that there is no risk of male fluid entering the woman's body.

4. A latex, which is made into a thin sheet called dental dam can be used on the vagina or anus. This creates a thin barrier between the mouth and the genitalia. Hence, chances of getting infected by sexually transmitted diseases are greatly reduced.

Oral sex can be pleasurable and fun, but the risks of getting sexually transmitted diseases like herpes, gonorrhea and crabs is not altogether misplaced. So it is advisable to use proper protection and to maintain hygiene before engaging in oral sex.

4 Ways to Have Safe Oral Sex - Necessary Precautions

8 Steps to a Happier Sex Life - Sex is probably the most important part of a relationship along with compatibility, trust and comfort. To make your relationship stronger and deeper, happiness in sex life is crucial. It must be the part of your life that you always look forward to and that brings the two of you together irrespective of the way your days go.

Follow these simple protocol to make for a happy sex life and therefore a happy life.

1) Believe you are sexy - Stop undermining yourself. You are sexy, accept it. And believe that your partner gets turned on by you. When you believe that your partner finds you sexy, you will be more interested in sex and so will your partner be.

2) Believe in the little gestures - Sex is not always awesome while you are in the act. The build up through the day can be made with the simplest of actions. A meaningful touch on the breakfast table, a mid-day text saying you miss him and an intimate evening message, or simply holding hands while shopping for grocery, all add up to build the connection between both of you.

3) Focus on the positive - Tell your partner what he does that you like. The kiss on the nape or how their breathe on your skin makes your senses tingle ? tell that. When your partner knows what you like, your bedroom experiments can take interesting turns. Always help your partner focus gently to what gives you pleasure.

4) Make time for sex - When new in a relationship, couples tend to have more sex and the frequency diminishes once they are comfortable in the situation. Avoid this; sex should be in your priority list at all times. Sex indeed should be a natural event. However, our lifestyles don't permit it. Also, there are too many distractions. If you need to schedule sex, it's okay. The idea is to indulge in it. You both have your needs and they should be fulfilled, right?

5) Fantasize - One great way to keep the passion alive is to share your fantasies. Doesn't matter how dirty it is, don't worry about what your partner will think. Far from judging, you yourself might realize something new about your partner. Chances are, that you might love the fantasies you both talk about.

6) Take it easy -  In real life, it is okay to not be perfect, to stop to catch breath and be real. To be happy with your sex life doesn't mean having spectacular sex every time. More than how you perform, it is how the experience was for both of you. Enjoy the process, it is for real.

7) Be responsive - Respond, even if you are not in the mood. Don't shun your partner because you are not in the mood. But if one of you wants to have sex, pushing them away is not a good idea. And if you still don't want to go ahead, explain that it's not them, but the time and plan to connect some time in near future.

8) Be willing to have sex - If you would rather watch tv all day rather than have sex and then do it nevertheless just because your partner initiated it, they would know. Never make your partner feel that you are having sex out of obligation. This is a mood killer and a guarantee for low satisfaction derived. Make sex an enjoyable affair, think what all you like and show them to your partner. 

If you have any further questions on sexual health, ask me by clicking on 'Consult'.

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Having Better Sex - 8 Steps to a Happier Sex Life

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

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)

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