Introduction
Premature ejaculation occurs when a man ejaculates sooner during sexual intercourse than he or his partner would like. Premature ejaculation is a very common complaint. Estimates vary, but as many as 1 out of 3 men say they experience this problem at some time in his life.
As long as it happens infrequently, it’s not cause for concern. However, it is diagnosed with premature ejaculation if:
Always or nearly always ejaculate within one minute of penetration
Are unable to delay ejaculation during intercourse all or nearly all of the time
Feel distressed and frustrated, and tend to avoid sexual intimacy as a result
Both psychological and biological factors play a role in premature ejaculation. Although most of men are ashamed of talking about it, premature ejaculation is a common and treatable condition. Medications, counselling and sexual techniques that delay ejaculation — or a combination of these — can help improve the person’s sexual life.
Signs & symptoms
The key symptoms of premature ejaculation include:
- Ejaculation that routinely occurs with little sexual stimulation and with little control.
- Decreased sexual pleasure because of poor control over ejaculation.
- Feelings of guilt, embarrassment or frustration.
Basically, premature ejaculation can be classified as:
- Lifelong or primary where the premature ejaculation happens in all or nearly all of the time beginning with first sexual activity.
- Acquired or secondary where the problem develops after a period of normal sexual experiences without ejaculatory problems.
Causes
- Depression or anxiety, particularly about performance.
- Feeling anxious about rejection by a sexual partner.
- Expecting failure.
- Negative sexual experiences in childhood.
- Religious beliefs.
- Problems within the relationship
Sometimes biological factors might be the reason behind premature ejaculation, including:
- Abnormal hormone levels
- Abnormal levels of brain chemicals called neurotransmitters
- Inflammation and infection of the prostate or urethra
- Inherited traits
- Erectile dysfunction
Pathophysiology
Premature ejaculation is believed to be a psychological problem and does not represent any known organic disease involving the male reproductive tract or any known lesions in the brain or nervous system. The organ systems directly affected by premature ejaculation include the following:
- Male reproductive tract (penis, prostate, seminal vesicles, testicles, and their appendages)
- Portions of the central and peripheral nervous system controlling the male reproductive tract
- Reproductive organ systems of the sexual partner (if female) that may not be stimulated sufficiently to achieve orgasm
Perhaps the most pronounced effect of premature ejaculation, however, is psychological: Both partners are likely to be dissatisfied emotionally and physically by this problem. Attempted pregnancy is a particular concern. If the premature ejaculation is so severe that it happens before commencement of sexual intercourse, conception will not be possible unless artificial insemination is used.
Differences in nerve conduction/latency times and hormonal differences in men who experience premature ejaculation compared with individuals who do not are observed. The theory is that some men have hyperexcitability or oversensitivity of their genitalia, which prevents downregulation of their sympathetic pathways and delay of orgasm.
Electroencephalography and neuroimaging studies have detected abnormal spontaneous and evoked brain activation responses to erotic stimuli as well as brain structure changes in premature ejaculation patients. Patients with lifelong premature ejaculation have an abnormal brain control network, which may contribute to the reduced central control of rapid ejaculation.
A group of nerves in the lumbar spinal cord has been identified as the possible generator of ejaculation. This nerve site is thought to be linked to excitatory and inhibitory dopamine pathways in the brain, which play significant roles in sexual behaviour.
Testosterone is thought to play a role in the ejaculatory reflex. Higher free and total testosterone levels have been demonstrated in men with premature ejaculation than in men without premature ejaculation.
Some researches show that semen from men with premature ejaculation contained significantly less acid phosphatase and alpha-glucosidase than did the semen of control subjects. The researchers concluded that these biochemical parameters may reflect dysfunction of the prostate and epididymis, possibly contributing to premature ejaculation.
Another study shows that many men with premature ejaculation have low serum prolactin levels. Studies suggest that biochemical parameters play only a partial role, along with emotional and psychological factors.
Psychological factors have been found to contribute greatly to premature ejaculation, beyond merely reducing the time to ejaculation. Whereas patients with premature ejaculation show significantly lower intravaginal ejaculatory latency time (IELT) overall, IELT in those who fit DSM-5 criteria for premature ejaculation overlaps with IELT in patients who do not fit the criteria.
However, whereas a shorter IELT has been the measure of premature ejaculation in many studies, the perception of ejaculation control has been shown to mediate patient or partner satisfaction with sexual intercourse and ejaculation-related distress. Although premature ejaculation probably is not a purely psychological disorder, such associations demonstrate that psychological factors play a significant role in its pathogenesis.
Diagnosis
Physical examination
History taking including sexual history
Blood tests for male hormone (testosterone) levels and other routine tests
Treatments
A wide variety of treatment options are available for premature ejaculation including behavioural techniques, topical anaesthetics, medications and counselling. In most cases, a combination of these techniques is found useful.
Behavioural techniques
- In many cases, simple techniques such as masturbating an hour or two before intercourse so that ejaculation is delayed during sex.
- Avoiding intercourse for a period of time and focusing on other types of sexual play so that stress is avoided can also help.
- Pelvic floor exercises – Weak pelvic floor muscles might impair the ability to hold the semen and to delay ejaculation. Pelvic floor exercises (Kegel exercises) can help strengthen these muscles.
- The pause-squeeze technique
- Begin sexual activity as usual, including stimulation of the penis, until you feel almost ready to ejaculate.
- Have your partner squeeze the end of your penis, at the point where the head (glans) joins the shaft, and maintain the squeeze for several seconds, until the urge to ejaculate passes.
- Have your partner repeat the squeeze process as necessary.
By repeating as many times as necessary, the person will know how to delay ejaculation and it will become a habit that no longer requires the pause-squeeze technique. Condoms, especially climax control condoms contain numbing agents such as benzocaine or lidocaine or are made of thicker latex, might decrease penis sensitivity, which can help delay ejaculation.
Medications
External application of topical anaesthetics like anaesthetic creams and sprays that contain a numbing agent, such as benzocaine, lidocaine or prilocaine, are sometimes used to treat premature ejaculation.
A prescription cream named lidocaine-prilocaine cream for premature ejaculation (EMLA) is available. Lidocaine sprays for premature ejaculation are available over-the-counter.
Although topical anaesthetic agents are effective and well-tolerated, they have potential side effects. For example, some men report temporary loss of sensitivity and decreased sexual pleasure. Sometimes, female partners also have reported these effects.
Oral medications – Many medications might delay orgasm, including antidepressants, analgesics and phosphodiesterase-5 inhibitors.
Psychological & clinical counselling will help treat premature ejaculation
Prognosis
In many men, premature ejaculation improves on their own after a brief period. Even for men who require medical treatment, the outlook is usually good.
Complications
- Stress and relationship problems mainly due to unsatisfactory sex
- Fertility problems due to faulty ejaculation & lack of fertilisation
Disease & Ayurveda
Suklagata vaata
Nidana
Dhaatukshaya (degeneration of body tissues) or Aavarana(obstruction in channels of the body)
Purvaaroopa
Not mentioned separately
Samprapti
Due to the causative factors, Vaata gets obstructed or redirected from its normal path. When it reaches the channels that carry sukra, the disease manifests.
Lakshana
Seeghramutsargam suklasya – premature or early ejaculation of semen
Sangam or vikruti to garbha – blockage or deformity of conception/foetus
Divisions
Not mentioned
Prognosis
Saadhya in new cases
Yaapya in chronic cases with complications
Chikithsa
Ayurvedic treatment of Suklagatavaata involves both physical and emotional satisfying & pleasure of the patient. Also nutritious diet which improves strength & vitality is advised. If there is any blockage in the channels, medicines for kaayavirechana & sukravirechana should be given first. Ballya, harshana like nourishment therapies should be done only after the peyaadikrama(restricted diet after Panchakarma, here Virechana)
Samana
Lepanam with suklakara & sothaharadravyas
Abhyangam
Harshanam
Brumhanam
Sodhana
Virechanam
Peyaadikrama
Commonly used medicines
Chyavanaprasam
Sukumaram kashayam
Brahmarasayanam
Ajamamsarasayanam
Brands available
AVS Kottakal
AVP Coimbatore
SNA oushadhasala
Vaidyaratnam oushadhasala
Home remedies
No home remedy has been proven t cure premature ejaculation. But a healthy diet & lifestyle can help improve the condition.
Diet
- To be avoided
Heavy meals and difficult to digest foods – cause indigestion.
Junk foods- cause disturbance in digestion and reduces the bioavailability of the medicine
Carbonated drinks – makes the stomach more acidic and disturbed digestion
Refrigerated and frozen foods – causes weak and sluggish digestion by weakening Agni (digestive fire)
Milk and milk products – increase kapha, cause obstruction in channels and obesity
Curd – causes vidaaha and thereby many other diseases
- To be added
Light meals and easily digestible foods
Green gram, soups, nuts, fresh fruits & vegetables
Freshly cooked and warm food processed with cumin seeds, ginger, black pepper, ajwain etc
Behaviour:
Protect yourself from extreme climate changes.
Better to avoid exposure to excessive sunlight wind rain or dust.
Maintain a regular food and sleep schedule.
Avoid holding or forcing the urges like urine, faeces, cough, sneeze etc.
Avoid sedentary lifestyle. Be active.
Yoga
Regular stretching and mild cardio exercises are advised. Also, specific yogacharya including naadisuddhi pranayama, bhujangaasana, pavanamuktasana is recommended.
Regular exercise helps improve bioavailability of the medicine and food ingested and leads to positive health.
Yoga can maintain harmony within the body and with the surrounding system.
Yoga for premature ejaculation
Pavanamuktasana
Nadisudhi pranayama
Bhujangasana
All the exercises and physical exertions must be decided and done under the supervision of a medical expert only.
Research articles
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2721550/
https://pubmed.ncbi.nlm.nih.gov/31351659/
These statements have not been evaluated by the Food and Drug Administration, United States. This product is not intended to diagnose, treat, cure or prevent any disease. Please consult your GP before the intake.
Writer:
Dr. Rajesh Nair, the co-founder and chief consultant of Ayurvedaforall.Com, is a graduate of prestigious Vaidyaratnam Ayurveda College (affiliated with the University of Calicut), Kerala, India. Additionally, he holds a Postgraduate Diploma in Yoga Therapy from Annamalai University.
Dr. Nair offers consultation at two busy clinics in and around Haripad, Alleppey, Kerala, the southern state famous worldwide for authentic ayurvedic treatment and physicians. While offering consultation on all aspects of ayurvedic treatments Dr. Nair has a special interest in Panchkarma, Yoga, and Massage.
Through Ayurvedaforall Dr. Nair offers online consultation to patients worldwide and has served hundreds of patients over the last 20 years. In addition to his Ayurvedic practice, he is the chief editor of ayurveda-amai.org, the online portal of Ayurveda Medical Association of India, and the state committee member of Ayurveda Medical Association of India.
Dr. Nair is a regular speaker at Ayurveda-related conferences and has visited Germany to propagate Ayurveda. You can write directly to him-
rajesh@ayurvedaforall.com
Whatsapp – +91 9446918019, +91 8075810816
URLs: https://www.ayurvedaforall.com/
To give you a quick idea about Ayurvedaforall, we are a group of ayurvedic practitioners committed to propagating Ayurveda in its best tradition around the world. Our online store sells authentic ayurvedic formulations backed by professional advice. Now into the seventeenth year of operation, the site has helped us build a dedicated clientele which regularly uses our products and services as well as refers others to us. Needless to say, this has been achieved through our adherence to the highest standards of customer service and professional ethics.