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Premature ejaculation

Premature ejaculation (PE) refers to the persistent or recurrent discharge of semen with minimal sexual stimulation before, on, or shortly after penetration, before the person wishes it, and earlier than he expects it. In making the diagnosis of PE, the clinician must take into account factors that affect the length of time that the man feels sexually excited. These factors include the age of the patient and his partner, the newness of the sexual partner, and the location and recent frequency of sexual activity.Most men experience premature ejaculation at least once in their lives. Often adolescents and young men experience premature ejaculation during their first sexual encounters, but eventually learn ejaculatory control.The term "premature ejaculation" is not well defined in medical circles and is sometimes considered to be more of a marketing tool than a medical condition.Because there is great variability in both how long it takes men to ejaculate and how long both partners want sex to last, researchers have begun to form a quantitative definition of premature ejaculation. Current evidence supports an average intravaginal ejaculation latency time of six and a half minutes in 18-30 year olds. If the disorder is defined as an IELT percentile below 2.5, then premature ejaculation could be suggested by an IELT of less than about one and a half minutes. Nevertheless, it is well accepted that men with IELTs below 1.5 minutes could be "happy" with their performance and do not report a lack of control and therefore do not suffer from PE. On the other hand, a man with 2 minutes IELT may have the perception of poor control over his ejaculation, distressed about his condition, has interpersonal difficulties and therefore be diagnosed with PE.

Possible psychological and environmental factors
Psychological factors commonly contribute to premature ejaculation. While men sometimes underestimate the relationship between sexual performance and emotional well-being, premature ejaculation can be caused by temporary depression, stress over financial matters, unrealistic expectations about performance, a history of sexual repression, or an overall lack of confidence. Interpersonal dynamics strongly contribute to sexual function, and premature ejaculation can be caused by a lack of communication between partners, hurt feelings, or unresolved conflicts that interfere with the ability to achieve emotional intimacy. Neurological premature ejaculation can also lead to other forms of sexual dysfunction, or intensify the existing problem, by creating performance anxiety. In a less pathological context, premature ejaculation could also be simply caused by extreme arousal.

According to the theories developed by Wilhelm Reich, premature ejaculation may be a consequence of a stasis of sexual energy in the pelvic musculature which prevents the diffusion of such energy to other parts of the body.

According to ayurveda when vayu gets vitiated it causes premature ejaculation. The following causes vitiates vata
•    Consuming stale, spicy, cold and junk food (Men who are away from
home on business mostly consume this sort of food )
•    staying up for long hours at night .
•    long gap between meals
•    Controlling natural urges (this happens during long corporate
•    Physical and mental exertion.
•    Under nourishment due to worries and grief
•    Sitting for long hours in uncomfortable chairs.
•    Traveling at high speeds.

In PE, ejaculation occurs earlier than the patient and/or the couple would like, thus preventing full satisfaction from intercourse, especially on the part of the sexual partner, who frequently fails to attain orgasm. PE is almost invariably accompanied by marked emotional upset and interpersonal difficulties that may add frustration to an already tense situation, which makes the loss of sexual fulfillment even worse. It is also important to differentiate male orgasm from ejaculation. Some men are able to distinguish between the two events and enjoy the pleasurable sensations associated with orgasm apart from the emission of semen, which usually ends the moment of orgasm. In these cases, the partner is capable of achieving orgasm and sexual satisfaction

Four stage model of the sexual response
Excitement phase
The excitement phase (also known as the arousal phase or initial excitement phase) is the first stage of the human sexual response cycle. It occurs as the result of any erotic physical or mental stimulation, such as kissing, petting, or viewing erotic images, that lead to sexual arousal. During the excitement stage, the body prepares for coitus, or sexual intercourse, in the plateau phase.

Plateau phase
The plateau phase is the period of sexual excitement prior to orgasm.

The plateau phase is the second phase of the sexual cycle, after the excitement phase. Further increases in circulation and heart rate occur in both sexes, sexual pleasure increases with increased stimulation, muscle tension increases further. Also, respiration continues at an elevated level.

During this phase, the male urinary bladder closes (so as to prevent urine from mixing with semen, and guard against retrograde ejaculation) and muscles at the base of the penis begin a steady rhythmic contraction. Males may start to secrete seminal fluid or pre-ejaculatory fluid and the testicles rise closer to the body.

At this stage females show a number of effects. The areola and labia further increase in size, the clitoris withdraws slightly and the Bartholin glands produce further lubrication. The tissues of the outer third of the vagina swell considerably, and the pubococcygeus muscle tightens, reducing the diameter of the opening of the vagina and creating what Masters and Johnson refer to as the orgasmic platform. For those who never achieve orgasm, this is the peak of sexual excitement. Both men and women may also begin to vocalize involuntarily at this stage.

Prolonged time in the plateau phase without progression to the orgasmic phase may result in frustration if continued for too long (see Orgasm control).

Orgasmic phase

Orgasm is the conclusion of the plateau phase of the sexual response cycle, and is experienced by both males and females. It is accompanied by quick cycles of muscle contraction in the lower pelvic muscles, which surround both the anus and the primary sexual organs. Women also experience uterine and vaginal contractions. Orgasms are often associated with other involuntary actions, including vocalizations and muscular spasms in other areas of the body, and a generally euphoric sensation. Heart rate is increased even further.

In men, orgasm is usually associated with ejaculation. Each spurt is associated with a wave of sexual pleasure, especially in the penis and loins. Other sensations may be felt strongly among the lower spine, or lower back. The first and second convulsions are usually the most intense in sensation, and produce the greatest quantity of semen. Thereafter, each contraction is associated with a diminishing volume of semen and a milder wave of pleasure.

Orgasms in females may also play a significant role in fertilization. The muscular spasms are theorized to aid in the locomotion of sperm up the vaginal walls into the uterus.

Resolution phase
The resolution phase occurs after orgasm and allows the muscles to relax, blood pressure to drop and the body to slow down from its excited state.

Men and women may or may not experience a refractory period, and further stimulation may cause a return to the plateau stage. This allows the possibility of multiple orgasms in both sexes. However, typically men enter this refractory period and some may find continued stimulation to be painful after the orgasmic phase. Women do not have a similar refractory period and can repeat the cycle almost immediately.

In addition, refractory periods range from human to human, with some being immediate (no refractory) and some being as long as 12 to 24 hours.

Many techniques are used to control premature ejaculation. “The squeeze technique” is popular and effective amongst all. Squeeze technique is a behavioral therapy. If a man senses that he is about to experience premature ejaculation, he interrupts sexual relations. Then the man or his partner squeezes the shaft of his penis between a thumb and two fingers applying gentle pressure just below the head of the penis for 20 seconds. And then sexual relations can be resumed. The technique can be repeated as often as necessary. When this technique is successful, it enables the man to learn to delay ejaculation with the squeeze, and eventually, to gain control over ejaculation without the squeeze.

The Masters & Johnson method:
•    The best way to combat premature ejaculation is by learning to
control the sensations prior to orgasm. This method takes time and
practice, but it is very effective.
•    First you need to bring yourself close to orgasm (this can be
done via masturbation, without the involvement of your partner) and then
stop and relax before recommencing. Each time you need to bring yourself
closer to orgasm until finally you cannot control it. If you do this
often enough, you will learn where your point of climax is. This is
helpful when interacting with your partner.
•    You will need to practice reaching your climax point with your
partner by engaging in non-penetrative sex so that when you feel it is
near, you signal them to stop and you allow your erection to subside.
This also needs to be repeated so that you and your partner are familiar
with the procedure.
•    Once you feel you are ready for intercourse, it is best to start
by lying on your back so that you can guide your partner during
penetration. When you are near orgasm, give your partner a signal to stop
and you should relax and start again. Once you get the hang of it (it may
take several weeks or months), premature ejaculation shouldn’t be too
much of a problem.
•    A variant of this method involves the partner squeezing the tip
of the penis just before orgasm ("squeeze technique"). This pushes blood out of the penis and reduces the erection.

Herbal Remedy:
a) Shilajit
b) Chandraorava wati
c) Banga Bhasma
d) Sukrastambhana Rasayan etc.

Patent Drug for sexual Debility
SHAKTITON CAPSULE (Gorkha Ayurved Company)
Dose: Two capsules twice a day with milk.
SHILAZIT CAPSULE (Gorkha Ayurved Company)
Dose: two capsules twice daily. To be taken with water or milk or as directed by physician. It can be taken for long periods of time.

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