Premature ejaculation

Ahead of time

By Dr. Lasantha Malavige, MBBS (Col), DIPM (Lond), PhD (SJP) Specialist in Sexual Medicine
Premature Ejaculation (PE) is a condition in which a man ejaculates earlier than he or his partner would like him to, causing distress to either or both partners. PE is also known as rapid ejaculation, rapid climax, premature climax, or early ejaculation.

Many men, occasionally, ejaculate sooner during sexual intercourse, than they or their partner would like to. As long as it happens infrequently, it is not a cause for concern. If this happens during most of their sexual encounters, it may cause significant distress, and can affect sexual satisfaction in man as well as the woman. PE is a condition that can be treated very effectively by doctors specialised in sexual medicine. Medications, psychological counselling and sexual techniques that delay ejaculation can improve sex for you and your partner. For many men, a combination of treatments works best.

PE is considered the commonest sexual problem; according to different studies 20-40% of men have this problem. It is a common problem in Sri Lanka and other South Asian countries. According to recent research carried out in the UK, it was found that PE is common among men of Sri Lankan and other South Asian origin living in the UK.

Average time from penetration to ejaculation is 5 to 6 minutes. To make a diagnosis of PE, duration from penetration to ejaculation (ejaculatory latency time) should be less than one minute. Men with ejaculatory latency time between one to two minutes also need treatment if the condition causes significant distress. PE could be broadly classified as lifelong PE (primary) or acquired (secondary). Men with lifelong PE experience rapid ejaculation in all sexual encounters including masturbation, and with all partners. Men with secondary PE develop the problem later in life, after having had a normal ejaculatory latency time. Both of these conditions are treatable.

Causes for PE
It was previously thought that this condition is primarily due to psychological factors. We now know PE is more complicated and involves a complex interaction of both psychological and biological factors. Therefore, proper evaluation by a doctor is needed to identify the underlying cause.

Psychological causes
Early sexual experiences may establish a pattern that can be difficult to change later in life, such as situations in which you may have hurried to reach climax, in order to avoid being discovered or guilty feelings that increase your tendency to rush through sexual encounters. Some of the psychosexual issues leading to PE can be less obvious to you.
Other factors that can play a role in causing PE, include problems with erection (erectile dysfunction), anxiety and relationship problems. According to a recent study done among Sri Lankan diabetic men, 70% of those with early erectile dysfunction also have PE. Men who are anxious about obtaining or maintaining their erection during sexual intercourse may form a pattern of rushing to ejaculate before losing erection. The cause for erectile problem can be psychological or biological. Often, it is due to a combination of both. Men who have PE, secondary to erectile problems, need careful evaluation in order to identify the cause for their erectile dysfunction. Treating erectile problem will often cure PE in these men.

Many men with PE are anxious of their sexual performance. Emotional or mental strain in any area of your life can play a role in PE, often limiting your ability to relax and focus during sexual encounters.
If you have previously had satisfying sexual relationships in which PE happened infrequently or not at all, it is likely that interpersonal issues between you and your current partner are contributing to the problem.

Biological causes
A number of biological factors may contribute to PE, including, abnormal hormone levels, abnormal levels of brain chemicals called neurotransmitters, abnormal reflex activity of the ejaculatory system, certain thyroid problems, inflammation and infection of the prostate or urethra and genetic factors.
Rarely, PE is caused by nervous system damage resulting from surgery, or trauma withdrawal from narcotics or a drug called trifluoperazine (Stelazine) used to treat anxiety and other mental health problems.
Although both biological and psychological factors likely play a role in most cases of PE, biological causes are more likely if it has been a lifelong problem (primary PE).

While PE doesn’t increase your risk of serious health problems, it can be a symptom of underlying medical problem like over activity of the thyroid gland and other biological conditions. Longstanding PE can affect your sexual as well as personal life. The common complications of PE include relationship distress, lack of intimacy, lower self esteem and marital disharmony. In men who ejaculate before penetration, fertilisation can be difficult or impossible, unless PE isn’t effectively treated.

All men need careful evaluation before treatment is initiated, in order to achieve better outcome. Treatment options for PE include sexual therapy, medications and psychotherapy. For many men, a combination of these treatments works best.

During the consultation with the doctor, your sexual confidence will be improved while addressing negative emotions and reducing anxiety levels. Your sexual myths will be addressed, aimed at increasing perception of control. Outcome is better if the man sees the doctor with his partner, as some of the female sexual dysfunctions, attitudes and behaviours can lead to PE. Sexual therapy is aimed at improving couple intimacy and improving sexual technique. Well established techniques used to treat PE include stop and start technique and squeeze technique. Many men improve their control and ejaculation, and learn to delay ejaculation with these techniques.

Medical treatment includes tablets, creams, sprays and special condoms. The tablets for PE can either be taken whenever needed or on daily basis. Better results can be obtained by daily treatment. Certain drugs belonging to a class of drugs known as Selective Serotonin Reuptake Inhibitors (SSRI) have been used effectively to treat PE. These medications should only be taken under medical supervision. Creams and sprays are moderately effective in treating PE.

Psychotherapy involves reducing anxiety levels and finding effective ways of coping with the stress and addressing other psychosexual issues.


My wife and I have been trying unsuccessfully to have a baby. The results of sperm analysis showed that my sperm count is zero. How is that possible?
No name
Unfortunately, it is possible. Azoospermia — a complete lack of sperm in the ejaculate — accounts for 10 percent to 15 percent of all male infertility. In some cases, it is treatable. But it depends on the underlying cause. Azoospermia has two general causes: Nonobstructive azoospermia — a lack of sperm production by the testicles. Causes of nonobstructive azoospermia include congenital defects of the testicles and damage or injury to the testicles.

Obstructive azoospermia — blockage in the sperm transport system. Causes of obstructive azoospermia include damage, injury or abnormalities of the epididymis, vas deferens or ejaculation duct — which transport sperm. In men with obstructive azoospermia, the blockage may be surgically corrected. If this isn’t possible, sperm may be harvested from the testicles for use in intracytoplasmic sperm injection (ICSI), a form of in vitro fertilisation (IVF). Treatment of infertility is more difficult in men with nonobstructive azoospermia. Azoospermia requires evaluation by a doctor skilled in reproductive medicine.

Can weather changes trigger migraines?
Shiroma P, Colombo
Some people who have migraines appear to be more sensitive to changes in the weather. Weather-related triggers include: bright sunlight, hot or cold temperatures, high humidity, dry air, windy or stormy weather, changes in barometric pressure

For some people, weather changes may cause imbalances in brain chemicals, including serotonin, which can prompt a migraine. Weather-related triggers may also worsen a headache that starts from other causes.
If you feel your migraines are triggered by weather, you may be understandably frustrated. After all, you can’t change the weather. However, you can learn which weather changes start a migraine and take steps to lessen their effects:

Keep a headache diary, listing each migraine, when it happened, how long it lasted and what could have caused it. This can help you determine if you have specific weather triggers. Monitor weather changes and avoid triggers if at all possible. For example, stay indoors during very cold or windy weather. Take your migraine medication at the first sign of a migraine. Make healthy lifestyle choices — eat healthy foods, exercise regularly, get enough sleep and keep stress under control. These factors can help reduce the number and severity of migraines.

My three-year-old son is a very poor eater. I wonder if he would benefit from multivitamins?
Achala Alles
Experts disagree on whether daily multivitamins are necessary for all children. Many young children are picky eaters, but that doesn’t necessarily mean they’ll develop nutritional deficiencies. Children don’t need large amounts of vitamins and minerals. your son may be getting more vitamins and minerals than you think. Still, it’s a good idea to consult your son’s doctor. If your son regularly omits a particular food group from his diet such as fruit, green or yellow vegetables, or dairy products or if the doctor is concerned that your son isn’t getting adequate vitamins and minerals, he may recommend a daily multivitamin. Choose multivitamins designed specifically for children. Follow the recommended dose, And remember, multivitamins don’t replace proper nutrition. Continue to offer your son healthy meals. If you choose to give your son multivitamins, make sure they contain vitamin D. A vitamin D deficiency can impair a child’s bone development.

How does HPV cause cervical cancer?
No name given
Genital human papillomavirus (HPV) — a sexually transmitted infection — is the most common cause of cervical cancer. When a woman is exposed to HPV, her immune system usually prevents the virus from doing any serious harm. But in a small number of women, the virus survives for years. Eventually, the virus can lead to the conversion of normal cells on the surface of the cervix into cancerous cells. At first, the cells may only show signs of a viral infection. Eventually, however, the cells may develop precancerous changes. This is known as cervical intraepithelial neoplasia. Typically, the precancerous changes clear spontaneously. In some cases, however — particularly for people who have weak immune systems — cervical intraepithelial neoplasia eventually progresses to invasive cervical cancer. It’s not clear why some women are more likely to develop cervical cancer. Some types of HPV are simply more aggressive than are others. Cigarette smoking also increases the risk of cervical cancer.

Is it possible to develop a food allergy as an adult? On two separate occasions in the last few months, I’ve developed bad stomach pains and itchy hives after eating shellfish. This has never happened before.

No name Answer:
Symptoms such as you describe may indicate a food allergy and shouldn’t be ignored. Until you talk to your doctor, avoid eating any type of shellfish. While most food allergies start in childhood, they can develop at any time in a person’s life. So it’s possible to develop a food allergy as an adult. It’s not clear why or how this happens, but all allergies occur when the immune system mistakenly identifies a harmless substance as a dangerous invader. When you eat the food you’re allergic to, the immune system releases symptom-causing substances such as histamine. Food allergy signs and symptoms can include: Constriction and tightening of airways, a swollen throat or a lump in your throat that makes it difficult to breathe, shock, with a severe drop in blood pressure, rapid pulse, dizziness, light headedness or loss of consciousness.

A number of conditions can cause adverse food reactions. Most are caused by a food intolerance rather than a true food allergy. Unlike a true food allergy, a food intolerance doesn’t involve the immune system and may not be as severe. With a food intolerance, you may be able to eat small amounts of the offending food without trouble. But if you have a true food allergy, even a tiny amount of the allergy-causing food can cause symptoms. In any case, diagnosis is important because either condition may require treatment and avoidance of a certain food or foods.



Insulin resistance, type 2 diabetes linked to Alzheimer’s

(WASHINGTON) – People with insulin resistance and type 2 diabetes are at higher risk of developing plaques associated with Alzheimer’s, Japanese researchers said in a study.
The research, published in the American Academy of Neurology, involved 135 people with an average age of 67 from Hisayama, Japan.
The group was tested for blood sugar levels and followed over a period of 10-15 years to detect signs of Alzheimer’s.

During that time, around 16 percent developed the neuro-degenerative disease that affects cognitive functions – chiefly loss of memory, behaviour and social adaptation.
After the participants died, researchers examined their brains for plaques and tangles, which are physical signs of Alzheimer’s – and found that 65 percent had plaques.
The researchers found that people who gave abnormal results for blood sugar control had an increased risk of developing plaques.

Plaques were found in 72 percent of people with insulin resistance and 62 percent of people with no indication of insulin resistance – the stage before diabetes when insulin, a hormone in the body, becomes less effective in lowering blood sugar.

“Further studies are needed to determine if insulin resistance is a cause of the development of these plaques,” said study author Kensuke Sasaki, with Kyushu University in Fukuoka, Japan.
However, he added, “It’s possible that by controlling or preventing diabetes, we might also be helping to prevent Alzheimer’s disease.”
“Type 2 diabetes and Alzheimer’s disease are two epidemics growing at alarming levels around the world,” Sasaki said.

“With the rising obesity rates and the fact that obesity is related to the rise in type 2 diabetes, these results are very concerning,” he added.
An estimated 37 million people worldwide, including 5.3 million in the United States, live with dementia, with Alzheimer’s disease causing the majority of cases, according to the World Health Organization (WHO).


Broccoli ‘boosts’ healthy gut

Extracts of broccoli and banana may help in fighting stomach problems, research suggests.
Laboratory studies show fibres from the vegetables may boost the body’s natural defences against stomach infections.

Trials are under way to see if they could be used as a medical food for patients with Crohn’s disease.
Crohn’s disease is an inflammatory bowel disease that causes symptoms such as diarrhoea and abdominal pain.
It affects about 1 in 1,000 people, and is thought to be caused by a mixture of environmental and genetic factors.
The condition is common in developed countries, where diets are often low in fibre and high in processed food.
Scientists at the University of Liverpool looked at how roughage from vegetables influenced the passage of harmful bacteria through cells inside the gut.

They found that fibres from the plantain, a type of large banana, and broccoli, were particularly beneficial. But a common stabiliser added to processed foods during the manufacturing process had the opposite effect.
Dr Barry Campbell, from the University of Liverpool, said: “This research shows that different dietary components can have powerful effects on the movement of bacteria through the bowel.
“We have known for some time the general health benefits of eating plantain and broccoli, which are both high in vitamins and minerals, but until now we have not understood how they can boost the body’s natural defences against infection common in Crohn’s patients.
“Our work suggests that it might be important for patients with this condition to eat healthily and limit their intake of processed foods.”

The research, published in the journal Gut, and carried out in collaboration with experts in Sweden and Scotland, investigated special cells, called M-cells, which line the gut and ward off invading bacteria.
Work was carried out in laboratory-grown cells and tissue samples from patients undergoing surgery for stomach problems.
Clinical trials are now underway in 76 Crohn’s patients to find out whether a medical food containing plantain fibres could help keep the disease at bay.
“It may be that it makes sense for sufferers of Crohn’s to take supplements of these fibres to help prevent relapse,” said Professor Jon Rhodes of the University of Liverpool. (BBC Health)