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My last article gave insight on the non-medical methods of controlling premature ejaculation.  Now, as a wrap up on this topic, I will highlight the options of medical treatments available for managing P.E. However, take it as a warning that you must consult your doctor before trying out any of these methods and medicines, because more often than not, such drugs and medicines have their side effects that can adversely bother your health.

By now we know that Premature ejaculation (PE) occurs when a man reaches peak of sexual excitement and ejaculates before he actually wants it to happen, thus, leaving his partner deprived of the sexual pleasure that she deserves. Even the most empathetic female partner would not like his man to leave her unsatisfied in bed.  Sooner or later this problem becomes a medical problem, reduces the warmth in their relationship.

Several factors including psychological problems such as anxiety; biological problem like penile hypersensitivity, hormonal imbalance (e.g. thyroid problem); behavioural problem like, habituation of quick sex/masturbation, etc may be held responsible for causing PE.

Medical (Allopathic) therapy for PE treatment:

Drugs used for managing premature ejaculation reduce sensitivity and anxiety, improve blood flow and even affect some chemical mediators present in the brain. These class of drugs include local anaesthetics, antidepressants and phosphodiesterase-5 inhibitors.

Anaesthetic compounds were the first medical treatment proposed for PE management. They were applied topically to the surface of skin. Lidocaine-prilocaine sprays or creams decrease the sensation of the penis and increase the time taken to ejaculate during vaginal penetration. These sprays/ creams are applied 10 to 20 minutes prior to sexual activity. Side effects of topical agents include partial loss of sensation of penis, absorption in vagina resulting in vaginal numbness and irritation.

Earlier agents like Alpha Amino Benzoate and Phenoxybenzamine were used to prolong duration of intercourse, but they were associated with severe side effects.

It has been found that Serotonin (a chemical in brain) levels were deficient in PE patients. Treatment medications include Selective Serotonin Reuptake Inhibitors (SSRIs), which interact with a receptor (5-HT2C) present in brain and increases the production of Serotonin. They also help in reducing anxiety and depression associated with PE. Through this mechanism, they prolong the time to reach ejaculation. Several SSRIs have increasingly become used as 'off-label' for PE.

Among the available SSRIs, Paroxetine-Dapoxetine is more beneficial with lesser side effects as compared to other SSRIs. These medications are associated with sexual side effects including decreased fertility and erectile dysfunction. Dapoxetine is a recent SSRI which acts quickly and cleared rapidly from the body. Adverse effects with SSRIs are usually minor and include fatigue, mild nausea, loose stools and sweating. Other side effects may include decreased sexual urge and increased tendency to suicide, especially with long-term use of Paroxetine.

Another potential medical treatment option for PE are class of medications which increase the blood flow by dilating the blood vessels of penile region and prolong the PE. But headache, dizziness, flushing, body-ache associated with them have limited their use in PE.

At present, clinicians need to consider all treatment modalities when evaluating a man with PE, as each patient may respond differently and experience variable side effects. Additional and more effective therapies need to be developed having least side effects.

Ayurvedic therapy for PE treatment:

Vajikaran in Ayurveda is an important treatment modality which increases sexual capacity and improves health. In Sanskrit, Vaji means horse, the symbol of sexual potency and performance thus Vajikaran means producing a horse's vigour, particularly the animal's great capacity for sexual activity in the individual. Vajikaran therapy reenergizes all the seven dhatus (body elements), and restores equilibrium and health. It also offers a solution to minimize the shukra (sperm and ovum) defects.

There are many formulations which are used in Vajikaran. Some of the commonly used formulations include Vrihani Gutika, Vrishya Gutika, Vajikaranam Ghritam and Upatyakari Shashtikadi Gutika.

Vrihani Gutika is one of the potent formulations while Vrishya Gutika is highly potent aphrodisiac used in treatment of PE. Vajikaranam Ghritam enhances the strength of penis. Upatyakari Shashtikadi Gutika is useful for the enhancement of the fertility.

Also, Chapdraprabha Vati and Kaunch Pak are known to increase sexual vigour and semen consistency helping in increase in sexual timing.

So, with this concluding article, I wrap up my knowledge and experience in treating patients suffering from premature ejaculation. Take care, and stay healthy!

In case you have a concern or query you can always consult an expert & get answers to your questions!

Memory slips are aggravating, frustrating, and sometimes worrisome. When they happen more than they should, they can trigger fears of looming dementia or Alzheimer’s disease. there are many mundane—and treatable—causes of forgetfulness. Here are seven common ones and how can homeopathic treatment can help you.To know more about homeopathy and homeopathic treatment read more.....

Lack of sleep.

Not getting enough sleep is perhaps the greatest unappreciated cause of memory slips. Too little restful sleep can also lead to mood changes and anxiety, which in turn contribute to problems with memory.

Medications.

Tranquilizers, antidepressants, some blood pressure drugs, and other medications can affect memory, usually by causing sedation or confusion. That can make it difficult to pay close attention to new things. Talk to your doctor or pharmacist if you suspect that a new medication is taking the edge off your memory. As shown in the table below, alternatives are usually available.

*Medications* that may affect memory and possible substitutes
If you take these drug, ask about switching to one of these drugs:
1.paroxetine (Paxil) another antidepressant such as fluoxetine (Prozac) or sertraline (Zoloft), or a different type of antidepressant such as duloxetine (Cymbalta) or venlafaxine (Effexor)
2.cimetidine (Tagamet) a different type of heartburn drug, such as lansoprazole (Prevacid), omeprazole (Prilosec), or esomeprazole (Nexium)
3.oxybutynin (Ditropan) or tolterodine (Detrol, Detrusitol) other medications for an overactive bladder, such as trospium (Sanctura), solifenacin (Vesicare), or darifenacin (Enablex)
4.amitriptyline (Elavil), desipramine (Norpramin), or nortriptyline (Aventyl, Pamelor) another type of medication, depending on why your doctor has prescribed a tricyclic antidepressant (neuropathic pain, depression, etc.)

5.*captopril (Capoten)* a different type of ACE inhibitor, such as enalapril, lisinopril, or ramipril
cold or allergy medication containing brompheniramine, chlorpheniramine, or diphenhydramine loratadine (Claritin) or other non-sedating antihistamine
(Adapted from Improving Memory: Understanding age-related memory loss, a Harvard Medical School Special Health Report)

Underactive thyroid

A faltering thyroid can affect memory (as well as disturb sleep and cause depression, both of which contribute to memory slips). A simple blood test can tell if your thyroid is doing its job properly.

Alcohol.

Drinking too much alcohol can interfere with short-term memory, even after the effects of alcohol have worn off. Although “too much” varies from person to person, it’s best to stick with the recommendation of no more than two drinks per day for men and no more than one a day for women. One drink is generally defined as 1.5 ounces (1 shot glass) of 80-proof spirits, 5 ounces of wine, or 12 ounces of beer.

Stress and anxiety.

Anything that makes it harder to concentrate and lock in new information and skills can lead to memory problems. Stress and anxiety fill the bill. Both can interfere with attention and block the formation of new memories or the retrieval of old ones.

Depression.

Common signs of depression include a stifling sadness, lack of drive, and lessening of pleasure in things you ordinarily enjoy. Forgetfulness can also be a sign of depression—or a consequence of it.

If memory lapses are bugging you, it’s worth a conversation with your doctor to see if any reversible causes are at the root of the problem. Something like getting more sleep, switching a medication, or a stress reduction program could get your memory back on track.

TREATMENT PROTOCOLS FOR POOR MEMORY

Spleen Kidney and heart are the 3 organs which provides memory

●Following are the three patterns of poor memory :

1) spleen deficiency causes poor memory, inability to concentrate and study.

2) deficiency of kidney essence causes poor everyday memory.

3) heart deficiency causes poor memory of past events , forgetting names.

1) Spleen deficiency causes
poor memory inability to concentrate
and study:
Main symptoms :
1) poor memory
2) tiredness
3) poor appetite
4) *pale tongue*
5) *weak pulse*

Treatment principle :
1) tone the spleen
2) strengthen intellect. Spleen houses intellect , which controls memorisation, study and concentration.

2) Kidney essence deficiency
causes poor memory everyday.
Main symptoms :
1) poor everyday memory
2) can not remember names , faces, roads etc.
3) dizziness
4) tinnitus
5) weakness
6) if kidney yang is deficient , tongue will be
pale
7) if kidney yin is deficient the tongue will be
red

Treatment principles :
1) tone the kidney
2) nourish essence and marrow

3) Heart deficiency causes

• Poor memory of past events 
• Forgetting names 

Main symptoms :

1) poor memory of past events
2) forgetting names
3) absent mindedness
4) tiredness
5) slight breathlessness
6) if there is heart yang deficiency the tongue will be pale with heart cracking
7) if there is heart yin deficiency the tongue will be red with heart crack

Treatment principle :
1) *tone the heart*
2) strengthen the mind and memory

Homeopathic treatment

There are many remedies in homeopathy to treat this condition. It requires a detailed study of the patient to know his/her lifestyle and life circumstances to be able to diagnose at the correct cause/causes so as to administer the right remedy. Since homeopathic medicines do not have sideeffects this is a very great advantage.

A woman's sexual desire naturally fluctuates over the years. Highs and lows commonly coincide with the beginning or end of a relationship or with major life changes, such as pregnancy, menopause or illness. Some antidepressants and anti-seizure medications also can cause low sex drive in women.

If you have a persistent or recurrent lack of interest in sex that causes you personal distress, you may have hypoactive sexual desire disorder — also referred to as female sexual interest/arousal disorder.
But you don't have to meet this medical definition to seek help. If you are bothered by a low sex drive or decreased sexual desire, there are lifestyle changes and sex techniques that may put you in the mood more often. Some medications may offer promise as well. 
If you want to have sex less often than your partner does, neither one of you is necessarily outside the norm for people at your stage in life — although your differences, also known as desire discrepancy, may cause distress.
Similarly, even if your sex drive is weaker than it once was, your relationship may be stronger than ever. Bottom line: There is no magic number to define low sex drive. It varies from woman to woman.

Some signs and symptoms that may indicate a low sex drive include a woman who:
* Has no interest in any type of sexual activity, including self-stimulation
* Doesn't have sexual fantasies or thoughts, or only seldom has them
* Is bothered by her lack of sexual activity or fantasies
When to see a Doctor specializing in sexual health.
If you're bothered by your low desire for sex, talk to your doctor. The solution could be as simple as changing the type of antidepressant you take.

Causes

A woman's desire for sex is based on a complex interaction of many components affecting intimacy, including physical well-being, emotional well-being, experiences, beliefs, lifestyle and current relationship. If you're experiencing a problem in any of these areas, it can affect your sexual desire.

Physical causes
A wide range of illnesses, physical changes and medications can cause a low sex drive, including:
* Sexual problems. If you experience pain during sex or an inability to orgasm, it can hamper your desire for sex.
* Medical diseases. Numerous nonsexual diseases can also affect desire for sex, including arthritis, cancer, diabetes, high blood pressure, coronary artery disease and neurological diseases.
* Medications. Many prescription medications — including some antidepressants and anti-seizure medications — are notorious libido killers.
* Lifestyle habits. A glass of wine may make you feel amorous, but too much alcohol can spoil your sex drive; the same is true of street drugs. And smoking decreases blood flow, which may dampen arousal.
* Surgery. Any surgery, especially one related to your breasts or your genital tract, can affect your body image, sexual function and desire for sex.
* Fatigue. Exhaustion from caring for young children or aging parents can contribute to low sex drive. Fatigue from illness or surgery also can play a role in a low sex drive.

Hormone changes
Changes in your hormone levels may alter your desire for sex. This can occur during:
* Menopause. Estrogen levels drop during the transition to menopause. This can cause decreased interest in sex and dryer vaginal tissues, resulting in painful or uncomfortable sex. Although many women continue to have satisfying sex during menopause and beyond, some women experience a lagging libido during this hormonal change.
* Pregnancy and breast-feeding. Hormone changes during pregnancy, just after having a baby and during breast-feeding can put a damper on sexual desire. Of course, hormones aren't the only factor affecting intimacy during these times. Fatigue, changes in body image, and the pressures of pregnancy or caring for a new baby can all contribute to changes in your sexual desire.

Psychological causes
Your problems don't have to be physical or biological to be real. There are many psychological causes of low sex drive, including:
* Mental health problems, such as anxiety or depression
* Stress, such as financial stress or work stress

Relationship issues
For many women, emotional closeness is an essential prelude to sexual intimacy. So problems in your relationship can be a major factor in low sex drive. Decreased interest in sex is often a result of ongoing issues, such as:
* Lack of connection with your partner
* Unresolved conflicts or fights
* Poor communication of sexual needs and preferences
* Infidelity or breach of trust

Treatments and drugs
Most women benefit from a treatment approach aimed at the many causes behind this condition. Recommendations may include sex education, counseling and sometimes medication.
Counseling
Talking with a sex therapist or counselor skilled in addressing sexual concerns can help with low sexual desire. Therapy often includes education about sexual response and techniques and recommendations for reading materials or couples' exercises. Couples counseling that addresses relationship issues may also help increase feelings of intimacy and desire.

Medication review
Your doctor will want to evaluate the medications you're already taking, to see if any of them tend to cause sexual side effects. For example, antidepressants such as paroxetine (Paxil, Pexeva) and fluoxetine (Prozac, Sarafem) may lower sex drive. Adding or switching to bupropion (Aplenzin, Wellbutrin) — a different type of antidepressant — usually improves sex drive.
Hormone therapy
Estrogen delivered throughout your whole body (systemic) by pill, patch, spray or gel can have a positive effect on brain function and mood factors that affect sexual response. But systemic estrogen therapy may have risks for certain women.
Smaller doses of estrogen — in the form of a vaginal cream or a slow-releasing suppository or ring that you place in your vagina — can increase blood flow to the vagina and help improve desire without the risks associated with systemic estrogen. In some cases, your doctor may prescribe a combination of estrogen and progesterone.
Male hormones, such as testosterone, play an important role in female sexual function, even though testosterone occurs in much lower amounts in women. However, replacing testosterone in women is controversial and it's not approved by the Food and Drug Administration for sexual dysfunction in women. Plus it can cause acne, excess body hair, and mood or personality changes.

Lifestyle and home remedies

Healthy lifestyle changes can make a big difference in your desire for sex:
* Exercise. Regular aerobic exercise and strength training can increase your stamina, improve your body image, elevate your mood and boost your libido.
* Stress less. Finding a better way to cope with work stress, financial stress and daily hassles can enhance your sex drive.
* Communicate with your partner. Couples who learn to communicate in an open, honest way usually maintain a stronger emotional connection, which can lead to better sex. Communicating about sex also is important. Talking about your likes and dislikes can set the stage for greater sexual intimacy.
* Set aside time for intimacy. Scheduling sex into your calendar may seem contrived and boring. But making intimacy a priority can help put your sex drive back on track.
* Add a little spice to your sex life. Try a different sexual position, a different time of day or a different location for sex. Ask your partner to spend more time on foreplay. If you and your partner are open to experimentation, sex toys and fantasy can help rekindle your sexual sizzle.
* Ditch bad habits. Smoking, illegal drugs and excess alcohol can all dampen sexual desire. Ditching these bad habits may help rev up your sexual desire as well as improve your overall health.    

Low sexual desire can be very difficult for you and your partner. It's natural to feel frustrated or sad if you aren't able to be as sexy and romantic as you want — or you used to be.
At the same time, low sexual desire can make your partner feel rejected, which can lead to conflicts and strife. And this type of relationship turmoil can further reduce desire for sex.

It may help to remember that fluctuations in your sexual desire are a normal part of every relationship and every stage of life. Try not to focus all of your attention on sex. Instead, spend some time nurturing yourself and your relationship.
Go for a long walk. Get a little extra sleep. Kiss your partner goodbye before you head out the door. Make a date night at your favorite restaurant. Feeling good about yourself and your partner can actually be the best foreplay.

The condition of premature ejaculation (PE) is a far more common male sexual dysfunction of middle age people. Generally, premature ejaculation is a male orgasmic disorder that causes an orgasm or "climaxing" faster than both partners' desire. The most couple found this condition irritating and undesirable while some considered it pleasing to them. If the problem of (PE) persists, it can have an adverse effect on the sexual satisfaction of the couple and disrupt the peace in their marital life.

It's difficult to define specific time duration for PE because the length of ejaculation varies from one individual to another. Researchers have revealed that individuals who complain of (PE) reach their climax and ejaculate within 1-2 minutes of penile penetration compare to 7-10 minutes of other individuals who don't complain of the same condition. We can conclude that if a man comes in less than 90 seconds of penile penetration, it's likely that he's suffering from premature ejaculation.

Causes of premature ejaculation:

Several factors contribute to the condition of PE ranging from biological, psychological to social and cultural contributions. Although the exact cause of (PE) is not well known the latest researches have shown that factors that cause sexual dysfunction will cause premature ejaculation.

Some physicians argued that serotonin, a neurotransmitter found in the gastrointestinal tract, central nervous system and platelet is very important in monitoring premature ejaculation. Other biological factors such as infection of the prostate, abnormal level of hormone, diabetes, drug abuse, inheritance can contribute to PE.

Psychological factors that can affect PE include anxiety, depression, stress, sexual abuse, nervousness, early sexual experience and poor body image.

Symptom of premature ejaculation:

The major premature ejaculation symptom is the inability to delay ejaculation. When an individual sees that he cannot control or delay his ejaculation, it's likely to be suffering from PE.

Remedies for premature ejaculation:

A number of treatments have been described to counter premature ejaculation. These are psychological therapies, behavioral therapies, and medical therapies.

In psychological therapies, the clinical psychologist tries to use psychological procedures to evaluate the cause of the man's (PE) problem and proffers a reasonable psychological advice or solution based on the identified cause of the PE. To carry out psychological therapy, a man with premature ejaculation is advised to be confident about his sexual performances and to be less anxious about it. This treatment is usually coupled with medical therapies in order to provide a lasting solution to the problem.

Some of the questions which are often asked by the clinical psychologist from a sufferer include:

What can you say about your present interest in sex?

Do you experience pain during sexual intercourse?

Do you usually engage in mutual romance before intercourse?

Have you ever had a problem reaching climax?

In behavioral therapies, the mutual cooperation of the partners is very important. There's a popular method of "squeezing". In this method, the wife stimulates her man by holding his penis until he's in the state of climax or orgasm. Prior to ejaculation, the wife squeezes the penis hard until he partially loses an erection. This purpose of this is to allow the man to be aware of when he's about to come in each sexual intercourse and begins to delay his ejaculation.

In medical therapy, some pills used as depressant and anesthetic creams have been proved to be effective in slowing down ejaculation time in men although those pills are never approved for use by US Food and Drug Administration (FDA). These drugs include Prozac, Sarafen, Paroxetine, Clomipramine (Anafranil), Sertraline (Zoloft), and some other drugs capable of increasing the level of serotonin production. It's important to note that these drugs might have side effects if used as a treatment for (PE).

Ayurveda treatment for premature ejaculation

The cause of premature ejaculation with respect to ayurvedic perspective is the provocation of Vata (air) and Pitta Dosha at the commencement of the sexual intercourse. Dosha is known to be aggravated by anxiety and nervousness while Vata is known for its quality of swiftness and heightened sensitivity to the sense of touch.

What is ejaculation?

It is the release of semen from the penis at orgasm. Semen is made up of sperm and fluid from testes (singular testis), seminal vesicles and prostate gland.

When a man is sexually stimulated, the brain sends signals to the genital area through nerves in spinal cord that causes contraction of pelvic muscles. Waves of pelvic muscle contractions transport the semen from the testes to tip of penis through vas deferens. This is called ejaculation or orgasm (colloquially to cum, shoot, blast or bust).

What is premature ejaculation (PE)?

PE means 'cumming too soon', that is, a man ejaculates before he is ready for it and he has no control over it.

Studies have shown that most men ejaculate between 2-5 minutes after penetration. This time frame is again arbitrary since it can differ from men to men, couple to couple, between cultures and other factors. So, for practical reason, if ejaculation occurs within 1 minute of penis entering into a vagina, it is called premature ejaculation. It is the commonest sexual problem in men and affects all ages.

What are the causes?

• Premature ejaculation can be primary or secondary.
• Primary or lifelong PE is when a man has not had control of ejaculation from the time of his first sexual experience. It can be caused by a chemical imbalance in brain centres that lowers the threshold for ejaculation.
• Secondary or acquired PE is usually when there has been a period of normal functioning before premature ejaculation began. Secondary premature PE is often linked to psychological factors like stress, performance anxiety, relationship issues and impotence.

How is it diagnosed?

There are no tests or scans to diagnose PE. If you have premature ejaculation, you need to see your local doctor and a diagnosis is made based on your history.

What treatments are there for premature ejaculation?

Treatment for PE may involve sex therapy, behavioural techniques, medications, local gels and creams, and treatment of other conditions like erectile dysfunction.

Sex therapy is administered by a person called sex therapist. This is particularly important if the cause of premature ejaculation is psychological like relationship issues and anxiety. Sex therapist provides counselling to address these issues.

There are mainly two behavioural techniques that can be used for treating premature ejaculation:

Seman's 'stop start' technique and Masters and Johnson's 'squeeze' technique.

How to perform Seman's 'stop start' technique

• Arouse yourself sexually by playing with your penis or ask your partner to stimulate it for you
• Once you are fully aroused and feel you are close to ejaculation, stop playing
• Wait for some time until the feeling of ejaculation passes away
• Once the feeling has passed, you can restart stimulating your penis
• Repeat this cycle 5-6 times until you finally ejaculate
• Once you feel more confident with this technique, you can actually practice this after entering your partner. Start thrusting your partner until you feel you are close to ejaculation, stop thrusting and divert your attention to something else. Once the ejaculation feeling passes away, resume thrusting and stopping until you finally ejaculate.
• How to perform Masters and Johnson's 'squeeze' technique

Once you are fully aroused and feel you are close to ejaculation, squeeze the tip of the penis between your thumb and index finger (or your partner can squeeze it for you) for several seconds until the feeling of ejaculation passes away. Repeat this squeeze and release technique for as long as you can until you finally ejaculate.

What medications are used to treat PE?

• You need to see your local doctor to get medications prescribed for PE.
• Dapoxetine (Priligy) is the only medication that is specific to the treatment of premature ejaculation. It is taken 'on-demand' only, one to three hours before sexual intercourse.
• Some antidepressants have the side effect of delayed ejaculation and used for premature ejaculation. They include SSRIs like fluoxetine, paroxetine and sertraline and tricyclic antidepressant called clomipramine.
• If PE is associated with erectile dysfunction, Viagra, Cialis or Levitra may be prescribed by your doctor.
• Local anaesthetic creams and gels can reduce penile sensation and help premature ejaculation. They should be applied up to 30 minutes before sexual intercourse.
• Using two condoms can reduce penile sensation and help a man take longer to ejaculate.

Just remember

Premature ejaculation is a very common sexual problem in men and affects all ages. It can cause embarrassment and anxiety and affects a man's self-esteem. It can affect both partners emotionally and sexually. There are many treatments available including sex therapy, behavioural techniques and medications but you need to seek help early. It is very important for partners to discuss this openly and get help from a doctor or other health care professionals.