Many of the issues, which hamper your intimate life are primarily not big problems, but because of the taboos and social beliefs they are not discussed openly. Hence, they failed to get resolved and become big because of continuous worry they give. In fact, most of them are not even symptoms of any organic disease process or functional problem. Many of them are very basic issues because of ignorance, myths, and social taboos leading to development of anxieties, distress and further worsening of the problem in question.
Generally, men are concerned about their performance in bed with their partners (wife or girlfriend), like how best then can do, how long they will last, concerns about their masturbation habits, size of penis, sperm quality and many more.
Premature Ejaculation (PE) is one of them. Not a disease; Not at all..!!
The person even if he is sexually fit, having normal erections, but due to anxiety, just fails to hold back the orgasm/discharge for reasonable time, and becomes worried. We need to reassure, it is not a disease and it can be easily manageable.
We will discuss this topic in Four parts a) what is it , b) how it happens, and c) how to approach to resolve this problem with behavioral methods, exercises, techniques and d) Medical Treatment – both modern as well as alternative medicine.
What is Premature Ejaculation (PE)? Definitions and how commonly it occurs.
PE is also referred to as early or rapid ejaculation or discharge is a sexual dysfunction, most common in men under 40 years. In elderly men above 60 years, though erectile dysfunction is more common, but they do suffer from PE as well. 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 ) either before or shortly after sexual penetration (usually within 1-2 minutes of penetration), he may be suffering from premature ejaculation. Mayo clinic in USA defines PE as, when a man “always or nearly always ejaculates within one minute of penetration”.
An occasional instance of premature ejaculation might not be a cause of concern, but, an abnormal pattern usually exists if the problem occurs in more than 50% of attempted sexual encounters, for which treatment may be required.
Premature ejaculation happens with negligible sexual stimulation or before you wish to ejaculate. As a consequence, both you and your partner may end up experiencing highly unsatisfactory sex. In fact, it can dramatically increase anxiety, which may worsen the problem.
Many therapists or clinicians who treat PE describe it as 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 varies and depends on many 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 most of the times in 5 minutes and both are satisfied with this timing, then this is not PE.
Alternatively, a male might delay his ejaculation for up to 15- 20 minutes, 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 we do not like to call this kind of situation as PE.
So every individual is unique. Every couple is unique. Same individual may have different sexual behavior with different partner and different times. Varied situations and varied places of performing the act have a role to play in determining the outcomes of individual sexual performance/s.
Statistics of PE:
You are not alone! PE is a common sexual complaint. As many as 30-40% men across the world including India experience problem of PE at some time in life.
Approximately 30%-70% of American males experience premature ejaculation. The National Health and Social Life Survey (NHSLS) indicate a prevalence of 30%, which is spread across all adult age groups. Estimates of PE rates in India and many European countries are similar to those of the United States.
Diagnosis of PE:
- As per DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition), the specific criteria for PE are as follows:
– In almost 75-100% sexual activities, the experience of ejaculation occurs within one minute of vaginal penetration.
– The problem of PE has persisted for at least six months
– The symptoms cause significant mental stress to the person
– It occurred due to a nonsexual mental disorder, a medical disease, effects of a drug or medication, etc.
Severity of PE:
The severity of PE or early ejaculation is broadly defined as follows:
- Mild: occurring within 30 seconds to one minute
- Moderate: occurring within 15-30 seconds
- Severe: occurring even before sexual activity, at the start of it, or within 15 seconds of vaginal penetration
Even the severe form is not uncommon. Many times men approach the doctors with complaint that they are not able to penetrate the vagina. They ejaculate on minor physical stimulation and it occurs again and again. In such case, pregnancy will not be possible unless artificial insemination is used.
TYPES and characteristics of P.E.:
PE can be Chronic or Acquired.
Chronic (lifelong) PE is when the person has been experiencing it since he became sexually active (i.e., post puberty). Usually it is seen that PE starts occurring from the beginning of sexual activity, probably the first sexual intercourse or even on masturbation, when the discharge occurs early.
Acquired (recent) PE means that the condition began in an individual who previously experienced an acceptable level of ejaculatory control and had successful sexual escapades but only recently (couple of weeks to months) has developed the tendency to ejaculate early.
WHAT CAUSES P.E?
Not a particular cause is responsible for causing PE. However, the causes of PE can be divided into two broad sub-heads, which are psychological and biological cause:
PE is believed to be a psychological problem and does not represent any known defect in the brain or nervous system. Psychological causes behind PE may include a certain pattern that is hard to change as result of your previous sexual experiences. They may arise from following:
- Atmosphere at Work or school
- Relationships with peer groups
- General attitude toward sex
- Any bad feelings about sex that relates to one or more bad experiences encountered
- Erectile dysfunction
- Performance anxiety, where men want to show a good performance of sexual act with the female partner.
- Type of the relationship/sexual engagement (e.g., married/unmarried/live in relationship)
- Sexual attitude or interest of the female partner
- Early sexual experiences, like development of habit of reaching climax soon for pleasure or ejaculating quickly because of fear of being discovered by others when masturbating as teenagers or during early sexual experiences with female partner. This pattern of rapid attainment of sexual release is difficult to change in later stage of life during marriage or long-term relationships.
- Last but not least, a situation in which you may have hurried climax/ejaculation in order to hide your problem from your female partner; or feelings of guilt that make you rush through sexual encounters.
Biological causes of PE:
Many scientists have questioned whether PE is purely psychological. A number of investigators have found differences in nervous stimulations and hormonal differences in men who experience PE as compared to individuals who do not. Some believe that some men have hyper-excitability or oversensitivity in their genitalia, which is again not proven. So, among the biological causes of PE, the most common are:
- Abnormal functioning of the ejaculatory system
- 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 (which are chemicals present in the brain)
- Higher, free and total testosterone levels have been demonstrated in men with PE than in men without premature ejaculation. Recent article in a Chinese andrology journal showed that semen from men with PE contained significantly less acid phosphatase and alpha-glucosidase than the counterparts
- Another study found that many men with PE have low serum prolactin levels
Somehow these biochemical markers play only a partial role in contributing to PE. Further research is needed.
Treatment of P.E. by non-Medical methods:
Due to PE both partners often end up experiencing highly unsatisfactory sex. In fact, it can increase anxiety, reduce self-confidence and escalate relationship issues. Remember, there is no magical drug or medicine which can solve your problem overnight especially if you have chronic PE.
So, before seeking any medical treatment for PE, it is appropriate to consider the varied options available for solving this issue. These include counseling with a sexual therapist, medical treatments including both modern and alternative medicine, and non-medical methods like exercises/techniques of controlling early ejaculation as discussed below:
Counselling by an expert – Sexual therapist or sexual medicine practitioner:
It is an accepted fact that sex is in the mind. Mind controls your sexual behaviour. However, repeated early ejaculations can lead to lot of stress and disappointment. Anxiety due to inability to satisfy your partner itself is a big issue and can lead to reoccurrence of PE. So, the stress/anxiety that is linked to your problem needs foremost attention.
Many a times, if your family physician is not able to help you overcome the stress that you are facing with your problem of prematureejaculation, then you must seek advice from an expert.
Reassurance, from a sexual therapist/counsellor, that PE is not a disease and can be easily treated is very soothing and relaxing for the men who are facing this problem. So, you may please share your detailed history and sexual habits with the expert that will help him to guide you well.
Some basic behavioural changes may also help you to deal with the problem of early ejaculation. For example, 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 and reaching climax too soon while making love to their partners. This helps them to focus their attention away from the sexual stimulation.
Another technique suggested to men is that they should relieve themselves of the sexual tension by ejaculating with self masturbation 1-2 hours before attempting sexual intercourse with their partner.
Condom decreases sensation. So, using condoms is also useful in preventing ejaculation for some time.
For some, “women-on-top” position also helps in delaying orgasm in men.
Exercises & Techniques:
There are several Exercise and techniques that one can try sitting in his home. Let’s have a look at some of them.
The “Stop and Start” method:
In this technique, the person sexually stimulates himself till the point he feels like he is about to reach orgasm. Then he needs to stop the stimulation for about 20-30 seconds and then start the stimulation again, repeating this pattern until the man finally wants to ejaculate. This can be continued for 10-15 minutes. At the end of, say 10th or 15th minute, one can continue stimulation until he reaches orgasm and ejaculates.
The “Squeeze” method:
This technique requires the man to sexually stimulate himself or be stimulated by his partner until the point 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, both can continue stimulation until the man finally reaches orgasm and ejaculates.
Deep breathing method:
Deep breathing can greatly help in controlling the arousal and tension that cause early ejaculation. Men must avoid taking shallow breaths as it can trigger premature ejaculation. Instead, what one should do is spend 5 seconds inhaling a long deep breath; then hold it for three 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.
Treatment of P.E. by Medical methods:
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, alcohol abuse; and even some genetic problems 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 classes 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 classes 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, I wrap up my knowledge and experience in treating patients suffering from premature ejaculation. See you again next time with another interesting and knowledge-packed write-up. Take care, and stay healthy!