Articles on ejaculation

Premature Ejaculation: What It Is not...

Priyadarshini Pant
Premature Ejaculation (PME) also called rapid ejaculation refers to a condition when a man reaches climax very early without much of penile stimulation. This by far is the most common sexual problem encountered by men. A man’s ability to sustain himself in the bed is described as Masculine Vigor and Masculine Power. On the other hand failing to match the Gold Standards and finishing early is viewed as a sign of weakness and inadequacy. Sadly how society views PME becomes more significant for people than how science views it. Medical Science describes PME as a treatable Sexual Disorder whereas, Society relates it with the inferiority of a man. There's enormous societal pressure on the men to be "The Performers". 'A man is a man when he proves it in the bed' - Such beliefs make it very difficult for an individual and the couples to deal with PME. There are many false notions about premature ejaculation prevalent in the society which only add pain in the lives of those who suffer from this condition. Familiarize yourself with some of the most common myths which you thought were facts- NOT MAN ENOUGHOne of the most common and threatening misconceptions surrounding premature ejaculation is, "He Isn't Man Enough If He Comes Early". It is crazy how the society measures the capacities of a man by weighing him against his ability to sustain in the bed. Truly speaking a man is not defined only by his genitals and there is a lot more in him that accounts for his masculinity. Otherwise we would have known nothing about the qualities of a Gentleman. Contrary to the prevalent societal beliefs coming early has nothing to do with his manliness.IMMATURITYVery often people relate premature ejaculation with the maturity levels of a man. Had this myth been true then men in their 30s or 40s wouldn’t have to deal with PME, or for that matter men who are accomplished personally or professionally or in both ways would last longest in bed which of course is not the case. PME may occur at any age and may defect the machinery of a man who’s mature enough.INEXPERIENCE It is one of the most frequently cited reasons for PME. Though experience does account for some control over the ejaculatory reflex but it doesn’t always safe guard against PME. Thus it is important for you to understand that there may be many other potential causes for your man’s PME than judging him for his experience.SELFISHNESS A man’s coming early is often interpreted as his self centric interests. These men are described as being selfish, caring only about their own pleasure and not bothering about their partner’s needs. PME is even seen as a man’s conscious effort to punish women or show anger, which may not be the case. On the contrary your man might be feeling guilty and ashamed for not being able to satisfy your needs. Blaming only makes the scenario worse. Try to sit with your partner, stay calm, be supportive and seek professional help.SIGN OF INTENSE EXCITEMENT & DISINTEREST Interestingly, some women attribute PME to the intense excitement and passion that their men felt inside of them, I remember a lady boasting in a kitty party “He just can’t control when he’s with me, He experiences peak immediately”. On the other hand some females perceive PME as a sign of disinterest. A young lady was distressed and came for therapy, on exploration she told she was upset because her man wasn’t interested in her anymore, she explained, “he doesn’t like having sex with me and just want to finish it quickly” on further exploration her husband was diagnosed with PME.         Ladies Intense Excitement or Disinterest may not be the reasons why your man comes early. There might be a third reason which you both should start looking for and consult a professional for suitable management.LOSS OF MANHOOD PME is also perceived as a sign of dying manhood. If we’re equating manhood with a man’s ability to procreate then we need to get the fact straight. PME doesn’t warrant poor semen count and is not necessarily related to infertility.CHRONIC & TREATMENT RESISTANT One such false belief is that PME is a chronic problem and cannot be treated. Couples…Have a Deep Sigh of relief and thank yourselves for reading this article! Most cases of PME are treatable. The two most popular and efficient ways of treating PME are, Psychotherapy and Medicines (if required). PME is stressful for individuals and to make it even worse we have misconceptions prevalent in the society. Having read this article you must have gathered some understanding of What Premature Ejaculation Is Not!There are different types of PME and there are various reasons responsible for it. The causes of PME vary from individual to individual and  so do the treatment plans. The best way to treat your PME is to consult a Professional who specializes in the treatment of Psychosexual Disorders, gain an in depth understanding of your problem and reach the management plan which is best suited for you.

Premature Ejaculation Introduction

Dr. Ramesh Maheshwari, Sexologist
Premature Ejaculation has been recognized by modern medicine quite recently. Till 1913, this condition was not mentioned anywhere in medical literature. Dr. K Abraham was perhaps the first to call it ejaculation praecox. Earlier Victorian Physicians were more interested in nocturnal emissions and spermatorrhoea and the bad effect it produced on the mind and body of a person.Definition of premature ejaculation by American Psychiatric Association and DSM-IV is given as ‘persistent or recurrent ejaculation with minimal sexual stimulation that occurs before, during or shortly after penetration and before the person wishes it.This definition has variables like the word ‘minimal’ and a description of timing that cannot be standardized. A man may be perfectly happy if he ejaculates within half a minute whereas another may be unsatisfied even if he ejaculates after half an hour of coital activity. The definition also places emphasis on the man’s subjective feelings totally disregarding the female.In India, our very own Kama-Sutra regards this condition as a normal variation. Here Vatsyayana outlines the ejaculatory response at three levels of duration. In both men and women, the duration of lasting or kala is given as short-timed, medium – timed and long – timed .This is very well described in Kokashastra or Rati Rahasya. Here pandit Kokka gives three variations in men and women as per the duration for which the sexual act lasts. He classifies them as immediate, intermediate and delayed. According to him, this is just a variation and he suggests idea combinations for men and women based on this kala.Why premature ejaculation? What is it ‘premature’ to?It could be so called because due to the early ejaculation there is only partial experience of sexual Pleasure on part of the man which is followed by a refractory period wherein the man cannot get his interest and erection in sex for some period of time which is variable in different men. This results in the woman feeling unsatisfied as she is unable to experience her climax within that much period.Why did this issue of premature ejaculation come up ? Animals do not seem to have premature ejaculation. This question has perhaps originated because of the ‘Pleasure’ component in human sexual activity.  As a result, men and women often complain of experiencing partial pleasures that is perceived only in the genitals and not in the mind. Some believe that sexual contact was in itself the first sin. Hence sex is considered as immoral and it results in considerable guilt and shame which can adversely affect a persons sexual behavior.Multiple factors may be responsible for a man to experience a premature ejaculation. Some common causes cited are:1       Excessive excitement in earlier sexual experiences.2       Sexual  abstinence.3       New partner4       New setting, surrounding5       Extremely responsive and assertive partner6       Early experiences with friends or sex worker wherein the men is pressurized to ejaculate as early as possible7       Anxiety states like,          Will I ejaculate too fast ?          Will I be able to satisfy my partner?8       Marital disharmony with hostility towards partner.Treatment of premature ejaculationVarious research has advocated different approaches for the treatment of premature ejaculation this could be classified as1 Behavioralstart stop methodsqueeze technique2 Pharmacological

Premature Ejaculation (Early Discharge During Intercourse)

Dr. Sujoy Dasgupta, Gynecologist/Obstetrician
Often many men come to our clinic with complaint of early discharge to such extent that they cannot enjoy sex. Often the partners are also disturbed by this short duration of intercourse. We call it Premature Ejaculation (PE). The problem of premature ejaculation occurs either prior to or a few moments after sexual penetration, leading to unsatisfactory sex for both you and your partner. What is Premature ejaculation? You are having PE if you ejaculate within one minute or before penetration and thus unable to enjoy intercourse and may try to avoid intercourse due to this fear and you have lost ability to control the ejaculation. The problem may even occur during masturbation.Premature ejaculation can be classified as lifelong (primary) or acquired (secondary). Lifelong premature ejaculation occurs all or nearly all of the time beginning with your first sexual encounters. Acquired premature ejaculation has the same symptoms but develops after you've had previous sexual experiences without ejaculatory problems. But whatever be the problem, it is easily treatable although for some men it can take some time. What are the causes of PE?It may be due to anxiety or stress. Many men with relationship problems with their partners or wives feel this problem. Nut make sure that it's not due to Erectile Dysfunction (ED). Men who are anxious about obtaining or maintaining an erection during sexual intercourse may form a pattern of rushing to ejaculate, which can be difficult to change. Smoking and alcohol can worsen the problems. Some other diseases may sometimes be responsible- like prostatitis (infection of the prostate gland), problems in nerves supplying the penis, problems in some hormones and rarely diabetes. So, it's important to pinpoint the cause so that the treatment can be started sooner and easily. Is it a serious illness?Unlike erectile dysfunction, PE is not usually related to any serious diseases (remember erectile dysfunction can be sign of early heart disease or diabetes). But it can affect your family relationship. In severe cases, it may be responsible for infertility.What to do?Initially you can try home-remedies. Avoid anxiety and stress. Reduce alcohol and stop smoking. Other simple strategies are avoiding intercourse for 2-3 days so that you can achieve better control in it. Alternatively you can try masturbation one or two hours before actual intercourse so that the discharge can be delayed. You can try squeeze and release technique (squeezing the penis when you feel urge to ejaculate). Using thick condoms can help some men by reducing sensitivity. If these do not work, you should consult your doctor.Why should I consult doctor for PE? There are advertisements of various untested drugs in newspaper and TV. If you try these, you can damage your sex organs or sex life as a whole. Because, we do not know what are the contents of these medicines or oil and how do they work. Moreover, we do not know how far they are safe. So if home-strategies do not work, get rid of hesitancy and consult doctor. Your doctor may ask you some questions but please be free to reply to them, however embarrassing these might be. He may examine you to find out the cause of this PE. It is important to be sure that you are not having any ED, for which separate treatment is needed. Often counseling and talking to doctor help a lot. He may help you to perform some exercises and follow some tips properly. If you cannot do these exercises properly, these will be of no benefit. Finally your doctor may give you some drugs or ointments to improve your performance. It is important to follow doctor's advice properly- to take drugs in prescribed doses and timing. Usually men with secondary or acquired PE improve faster than men with primary PE.Conclusion:You and your partner have full right to enjoy sex for the duration as you want. Do not disappoint you and your partner. If you feel that you cannot control your early discharge, do not feel embarrassed. Consult doctor and get cured.

How to Manage "Non Medical Methods" of Premature Ejaculation?

Dr. Yuvraj Arora Monga, General Physician
As mentioned before because of premature ejaculation, both the partners may end up experiencing highly unsatisfactory sex. In fact, it can increase anxiety, which may deteriorate the problem.So, before seeking any medical treatment for Premature Ejaculation (PE), it is appropriate to consider the varied options available for solving this issue. These include counselling with a sexual therapist, non- medical treatments like various exercises / techniques and medical treatments including both modern and alternative medicine.Just 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.Counselling from an expert - Sexual therapist or sexual medicine practitioner:It is well understood that sex is in the mind. But repeated Premature Ejaculation (PE) failures can lead to lot of stress and disappointments. Anxiety due to PE itself is a big issue and can lead to re occurrence of PE. So the stress  / anxiety linked to your problem needs foremost attention.Many a times, if your family physician is not able to help you overcome the stress you are facing with your problem of PE then you must seek advice from an expert.Reassurance from sexual therapist / counsellor that PE is not a disease and can be easily treatable is very soothing and relaxing for the 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.Behavioural Changes:Some basic things may also help you to deal with the problem.  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.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.Using condoms is known to help in premature ejaculation in some men by decreasing sensation.Women on Top position also helps to delay orgasm in men.Exercises & Techniques: There are several Exercise and techniques you can try sitting in your home.The "Stop and Start" method:This technique involves sexually stimulating the man himself 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.The "Squeeze" method: This technique involves sexually stimulating the man himself or by his partner until he recognises 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.Practice breathing exercises: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 you should do is spend 5 seconds taking in 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.Hope all above may be useful to you help you get relief from PE and feel free to consult a specialist.

Premature Ejaculation: A Deeper Study of Statistics, Causes & Diagnosis

Dr. Yuvraj Arora Monga, General Physician
In my previous article posted, we learnt about premature ejaculation, what is this actual condition and how it is defined. Today we will learn about Statistics, Diagnosis & Type of Premature Ejaculation, Why and how it happens?Statistics of PE:Premature Ejaculation-PE is a common sexual complaint. You are not alone! Estimates vary, but as many as 30-40 % men across the world including India experience problem of PE at some time of 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 fairly spread across all adult age groups.Diagnosis of PE:As per DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition ), the specific criteria for premature (early) ejaculation are as follows:In almost 75-100% sexual activity, the experience of ejaculation occurring during sexualintercourse within 1 minute after vaginal penetration and before the individual wishes it.The problem above has persisted for at least 6 months.  The symptoms above cause significant mental stress to the person. The dysfunction cannot be better explained by any other nonsexual mental disorder, any medicaldisease, the effects of a drug or medication, etcSeverity of P.E.The severity of premature (early) ejaculation is broadly defined as follows: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 is occurring again and again. Not able to achieve pregnancy is another big 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. Types and Characteristics of P.E.Premature ejaculation can be Chronic (lifelong) or acquired (recent).With chronic (lifelong) premature ejaculation, the person has been experiencing premature ejaculation since he became sexually active (ie, post puberty). Usually it is seen that premature ejaculation starts occurring from the beginning of his sexual activity probably the first sexual intercourse or even the discharge occurs early on masturbation as well.With acquired (recent) premature ejaculation means that the condition began in an individual who previously experienced an acceptable level of ejaculatory control and had successful sexual relationships and only now has developed premature ejaculation in the recent past (few weeks to months). How to approach a person with Chronic (lifelong) or acquired (recent) Premature EjaculationIn patients with Chronic (lifelong) premature ejaculation, the treating doctor or sexual therapist should enquire about the following:ü  Atmospher at Work or schoolü Relationships with friends or brother /sistersü General attitude toward sex by himself and or familyü Previous psychological problemsü Early sexual experiencesü Any bad feelings about sex that relates to 1 or more bad experiences encountered duringgrowing years of lifeü Type of the relationship / sexual engagement (eg, married / non married / live inrelationship)ü Sexual attitude and response of the female partnerü Non sexual aspects of the current relationship ( comfort level & trust factors)Clues from above and similar questions usually point toward possible reasons/factors that may be addressed specifically with therapy by the treating physician or sexual therapist.In patients with acquired (recent) premature ejaculation, the treating doctor or sexual therapist should enquire about the following:         Erectile dysfunction  Performance anxiety ( it is seen very commonly in men i.e., they want to show a good performance in the sexual act with the female partner)ü Psychotropic drug use or alcohol consumptionü Previous & Current relationshipü Nonsexual aspect of the current relationship ( comfort level & trust factors)ü Level of involvement of the sexual partner during sexual actsü Sexual response of partnerü Stamina or fitness level for prolonged intercourseWHAT CAUSES P.E.?Not a single particular cause is responsible for causing premature ejaculation. It can either occur when you indulge in sexual activity with a new partner or if it’s been too long since the previous ejaculation.However, the causes of premature ejaculation can be divided into two broad sub-heads, which are psychological or biological cause: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.Psychological causes behind premature ejaculation may include the development of a certain pattern that is hard to change and is a result of your previous sexual experiences.One of them most common reason is childhood habit of reaching climax / ejaculation quickly because of fear of discovery 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.Other reason is situations 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. Other 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 (e.g. incest, sexual assault, conflict with parents, etc.)Biological causes of premature ejaculation:Many scientists have questioned whether premature ejaculation is purely psychological. A number of investigators 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 over-sensitivity of their genitalia, which is again not proven.Abnormal functioning of the ejaculatory systemThyroid problemsInfection 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) have been many times said to be responsible for PE likeTestosterone 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 Recent article in a Chinese andrology journal showed that semen from men withpremature ejaculation contained significantly less acid phosphatase and alpha-glucosidase than did the semen of control subjects.Another study found that many men with premature ejaculation have low serum prolactin levelsSomehow these biochemical markers may contribute to premature ejaculation, organic and psychological associations (eg, anxiety) suggest that these biochemical markers play only a partial role. Further research is needed.In part 3 and 4, we will discuss how to approach the men / couple suffering from premature ejaculation to resolve this problem. The therapy includes wide spectrum of approach including counselling, behavioural methods, exercises, techniques and medical remedies both modern as well as alternative medicines.

How to Control Premature Ejaculations

Dr. S S Tanwar, Homeopath
I don't last very long during sexual intercourse. How do I improve my staying power? Saving yourself (and your pride) from the Great Unexpected Flood is not as hard. Yes, premature ejaculation can be embarrassing, especially as your partner tries to soothe your punctured male ego: "Never mind, it was still good, honey," How can you're explain to her that it could have been stress, anxieties caused by high expectations, or even just over stimulation? Or that an astonishing one-third of men under the age of 25 are prone to PE? Firing too soon is very common, and doesn't mean there is anything 'wrong' with your (most women usually need twice as long to climax anyway).Assuming conditions are relaxed, you're comfortable with your lover and not sublimating personal problems, it's just a question of learning to get it right. Because you can master techniques until you have multiple, ejaculation-free orgasms, which also enhances your levels of sexual energy. A simple method is the stop-start one, which helps build an awareness of gauging the sensations leading to release. what's power without control? Simply put, your partner stimulates your genitals, and stops as you feel orgasm, approach. As you defuse, the stimulation is restarted, and so on. Another is the pause- Squeeze technique. Withdraw as your climax builds, and have your partner (on top) firmly squeeze your organ for a few seconds with thumb and forefinger, where the glans meets the shaft. This gradually leads to ejaculatory control. Relax your body as ejaculation nears, starting with an erotic massage. Breathe deeply, in rhythm together. Pressure on the perineum (about midway) also works. Move your sexual energy away from your genitals. Be vocally expressive, and let your hands foam your partner's body. Switch positions and experiment with which makes you last longer. Out of bed, exercise your pubococcygeal (PC) muscles, the ones that control urine flow, with alternate contractions and relaxations. You can do this anywhere, be it while driving a car or watching TV. Finally, remember it's all in the head. The one with ears! Communicate your feelings. Sometimes women actually don't want the guy to be banging on on, to prove his 'manhood'. And if you think of sex as a task, half the battle is already lost. Express yurt love, be vulnerable and abandon yourself to it, and the rest will follow.

All You Need to Know About Premature Ejaculation: Part I

Dr. Yuvraj Arora Monga, General Physician
What is Premature Ejaculation (PE)?  Definitions and how commonly it occurs!Background:Many of the sexual issues are primarily not big problems. Because of the taboos and social beliefs they are not discussed openly, hence failed to get resolved. And they become big, because of continuous worry they give.In fact most of the times they are not even any symptom of any organic disease processor functional problem. Many of them are very basic issues because of ignorance, myths, and social taboos lead to development of anxieties, distress and further worsening of the problem in question.With basic issues what I mean is, that very commonly men are concerned about their performance in bed with their partner either wife or girlfriend. How best then can do, concern about their masturbation habits, size of penis, sperm quality and many more.  I am not writing this as a routine article for the sake of it, but truly it is the synopsis of a practice / experience spread over few years and interaction with hundred / thousands of people (shall not call them patients barring small percentage).Premature Ejaculation (PE) is one of them. Not a disease; Not at all! The person is sexually fit, having normal erections but just fails to hold the orgasm/ discharge for reasonable time. A very basic problem, but one gets worried. But we need to reassure it is not a disease and can be easily manageable.We will discuss this topic of Premature Ejaculation (PE) in 4 parts including what is it, how it happens, how to approach to resolve this problem with behavioural methods, exercises, techniques and medical remedies both modern as well as alternative medicine. Defining Premature Ejaculation (PE):Premature (early) ejaculation (PE) many a times is called with different names like "rapid ejaculation", "early ejaculation" or simply 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, more than 60 years of men, erectile dysfunction can be seen more commonly. In a study conducted by the Journal of Sexual Medicine, that 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), you may be suffering from premature ejaculation. Mayo clinic at USA defines PE when a man “always or nearly always ejaculates within one minute of penetration”.An occasional instance of premature ejaculation might not be cause for concern, but, if the problem occurs with more than 50% of attempted sexual relations, an abnormal pattern usually exists for which treatment may be required.Premature ejaculation typically takes place with negligible sexual stimulation and even before you wish to ejaculate. As a consequence of premature ejaculation, both you and your partner may end up experiencing highly unsatisfactory sex. In fact, it can dramatically increase anxiety, which may worsen the problem. Another way of describing premature ejaculation by most therapist or clinicians who treat PE is that 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 is highly variable 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 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 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 behaviour with different partners at 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! Premature Ejaculation-PE is a common sexual complaint. Estimates vary, but as many as 30-40 % men across the world including India experience problem of PE at some time of 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 fairly spread across all adult age groups. Estimates of premature ejaculation rates in India and many European countries are similar to those of the United States.That is all for today’s information on this topic. In the next follow up parts, I shall discuss, types of PE, how it happens, how to approach the men / couple suffering from it to resolve this problem. The therapy includes wide spectrum of approach including counselling, behavioural methods, exercises, techniques and medical remedies both modern as well as alternative medicines.

Sexual Problems in Men

Dr. Rahman, Sexologist
Sexual problems in menFortunately, most sexual problems are treatable, so it is important to share your concerns with your partner and doctor.What causes sexual problems?Sexual dysfunction can be a result of a physical or psychological problem.Physical causes: Many physical and/or medical conditions can cause problems with sexual function. These conditions include diabetes, heart and vascular ( blood vessel) disease, neurological disorders, hormonal imbalances, chronic diseases such as kidney or liver failure, and alcoholism and drug abuse. In addition, the side effects of certain medicines, including some antidepressant medication, can affect sexual desire and function.Psychological causes: These include work-related stress and anxiety, concern about sexual performance, marital or relationship problems, depression, feelings of guilt, and the effects of a past sexual trauma.Who is affected by sexual problems?Both men and women are affected by sexual problems. Sexual problems occur in adults of all ages. Among those commonly affected are those in the older population, which may be related to a decline in health associated with ageing.How do sexual problems affect men?The most common sexual problems in men are ejaculation disorders, erectile dysfunction, and inhibited sexual desire.What are ejaculation disorders?There are different types of ejaculation disorders, including:Premature ejaculation -- This refers to ejaculation that occurs before or soon after penetration.Inhibited or retarded ejaculation -- This is when ejaculation is slow to occur.Retrograde ejaculation -- This occurs when, at orgasm, the ejaculate is forced back into the bladder rather than through the urethra and out the end of the penis.In some cases, premature and inhibited ejaculation are caused by a lack of attraction for a partner, past traumatic events and psychological factors, including a strict religious background that causes the person to view sex as sinful. Premature ejaculation is often is due to nervousness over how well a man will perform during sex. Certain medications, including some anti-depressants, may affect ejaculation, as can nerve damage to the spinal cord.Retrograde ejaculation is common in males with diabetes who suffer from diabetic neuropathy (nerve damage). This is due to problems with the nerves in the bladder and the bladder neck that allow the ejaculate to flow backwards and into the bladder. In other men, retrograde ejaculation occurs after operations on the bladder neck or prostate, or after certain abdominal operations. In addition, certain medicines, particularly those used to treat mood disorders, may cause problems with ejaculation. This does not generally require treatment unless it impairs fertilityWhat is erectile dysfunction?Also known as impotence, erectile dysfunction is defined as the inability to attain and/or maintain an erection suitable for intercourse. Causes of erectile dysfunction include diseases affecting blood flow, such as atherosclerosis (narrowing of the arteries); nerve disorders; psychological factors, such as stress, depression, and performance anxiety (nervousness over his ability to sexually perform); and injury to the penis. Chronic illness, certain medications, and a condition called Peyronie's disease (scar tissue in the penis) can also cause erectile dysfunction.What is inhibited sexual desire?Inhibited desire, or loss of libido, refers to a decrease in desire for, or interest in sexual activity. Reduced libido can result from physical or psychological factors. It has been associated with low levels of the hormone testosterone. It also may be caused by psychological problems, such as anxiety and depression; medical illnesses, such as diabetes and high blood pressure; certain medications, including some anti-depressants; and relationship difficulties

Squeeze It - The Right Way!

Dr. Ramesh Maheshwari, Sexologist
For years together, Players around the world have countered Premature Ejaculation with the squeeze technique. There is always a method to the madness. And if your problem is Premature Ejaculation, let's get you a better solution.Introducing : BASILAR SQUEEZEThe standard squeeze involves pressing the penis near the glans which means interruption during penetrative sex. Now, who wants interruption? Right?Masters and Johnson devised a modified version of the squeeze to overcome this problem. They called it the BASILAR SQUEEZE. This involves the pressing of this penis at the point where it joins the scrotum. It can be squeezed with the correct movement.The squeeze is to be maintained for 4-8 second similar to the earlier method. They do admit that it should not be used as an alternative to the standard method, as it is not as effective.One of the major problems faced before entering into this therapy is that "other issues" have to be resolved. They are: dislike for each other (partners), anger, alcohol, tobacco, or drug abuse, infidelity, distrust, mental or physical torture, economic strain, etc. Medical conditions also have to be diagnosed and treated properly. In India, motivating the man to come and openly discuss these issues with his partner is very difficult.Important Considerations for this therapy:1. Time and repeated practice is essential to achieve ejaculatory control.2. ‘Refresher Course’ is required if gains made earlier are lost due to lack of time.3. Do not expect total control each time. Some failures are bound to occur.4. Change of position i.e. woman -on- top to side-by side to man-on-top is to be done slowly over a longer period of time and failures are to be expected in the initial stages.What are the alternatives?PHARMACOLOGICALThe first choice as mentioned before is behavioral but pharmacotherapy can be concurrently used for better results.ANAESTHETIC AGENTSExcessive sensitivity of the penis especially the glans has been thought to be one of the causes of premature ejaculation. Local anesthetics have been used with the intention of reducing sensory input from the penis thereby delaying ejaculation.RETARDED EJACULATIONRetarded ejaculation is defined as the man being able to ejaculate only after what seems to him to be an ‘excessive’ period of time. It is usually reported when the man requires ½ an hour or more of vigorous coital thrusting. It is interesting to note that most of these men do not seem to have any difficulties with erection but sometimes seems to hold them back and they are unable to trigger the ejaculatory reflex at the proper time.This is a very common symptom in men who are regular abusers of recreational drugs or alcohol. The usual story from the couple is that the woman becomes weary and uninterested once she has had her orgasm and the man becomes tried, exhausted and fatigue which is frustrating for the couple.Let's talk about TreatmentA three steps process is useful in treating delayed ejaculation:Teaching masturbating to the point of ejaculation as a solo activity. (focus on the "solo" part)Masturbation to the point of ejaculation with a partner. (focus on the "point of ejaculation" part)Finally, coital connection with ejaculation to be established. (focus on the "connection")This is easier said than done and the following aspects have to be considered:Allay fears, anxieties and myths about masturbating in both partners.Liberal use of lubricating jelly during masturbation.Mechanical means of stimulation with vibrators is useful stimulation which should initially be used for short periods.Encouragement of the partner to stimulate the penis with sufficient force and speed as many men use vigorous stimulation which the female may not understand.Use of fantasy to evoke psychological stimulus as many men ‘use’ only mechanical arousal methods.Those who cannot fantasize, could be advised to use erotic videos.Drugs like midodrine may help.

Sexual Problems in Men

Dr. Rahman, Sexologist
Many men have sexual problems. They become more common as men age. Problems can include:• Erectile dysfunction• Reduced or lost interest in sex• Problems with ejaculation• Low testosteroneStress, illness, medicines, or emotional problems may also be factors. Occasional problems with sexual function are common. If problems last more than a few months or cause distress for you or your partner,The main types of male sexual dysfunction are:• Erectile dysfunction (difficulty getting/keeping an erection)• Premature ejaculation (reaching orgasm too quickly)• Delayed or inhibited ejaculation (reaching orgasm too slowly or not at all)• Low libido (reduced interest in sex)How does sexual dysfunction affect men?The most common problems men face with sexual dysfunction are troubles with ejaculation, getting and keeping an erection, and reduced sexual desire.Ejaculation disordersProblems with ejaculation are:• Premature ejaculation (PE) — ejaculation that occurs before or too soon after penetration• Inhibited or delayed ejaculation — ejaculation does not happen or takes a very long time• Retrograde ejaculation — at orgasm, the ejaculate is forced back into the bladder rather than through the  end of the penisThe exact cause of premature ejaculation (PE) is not known. While in many cases PE is due to performance anxiety during sex, other factors may be:• Stress• Temporary depression• History of sexual repression• Low self-confidence• Lack of communication or unresolved conflict with partnerWhile male sexual dysfunction cannot be prevented, dealing with the causes of the dysfunction can help you better understand and cope with the problem when it happens. To help maintain good sexual function:• Follow your doctor’s treatment plan for any of your medical/health conditions• Limit your alcohol intake• Quit smoking• Communicate better and more often with your partner