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
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
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
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.
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
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.
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
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
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?
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
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
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
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
My three-year-old son is a very poor eater. I
wonder if he would benefit from multivitamins?
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
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
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
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
|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
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
It affects about 1 in 1,000 people, and is thought
to be caused by a mixture of environmental and
The condition is common in developed countries,
where diets are often low in fibre and high in
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
“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
Work was carried out in laboratory-grown cells and
tissue samples from patients undergoing surgery for
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)