Brief Answer:
Grossly Premature Ejaculation

Detailed Answer:
Dear Mayanker

Thanks for your follow up and Concern raised.

1. Since problem is causing more of Psychological [marked distress and/or interpersonal difficulty in the relationship] than physical impact thus following points are worth mentioning:

i. The partner [would be wife] has a very important role to play and she should be motivated, because she may feel neglected and get frustrated. She should be explained that ultimately, it is for her pleasure also. But if she reacts with anger & frustration it will further deteriorate the problem. She has to be co -operative and sympathetic.

PS. thus Step I is counselling of your partner also.

2. Developing Ejaculatory Control: You have to practice the Exercise or Tantric Vajroli technique, described in our last Consultation.

3. Premature Ejaculation [PE] is a psychosexual disorder characterixed by persistent or recurrent ejaculation by minimal sexual stimulation. In Ayurveda the clinical condition is described under 'Shukragat Vata':

i. In Ayurveda we have to take into account the involvement of 'Vata' 'Mana' ' 'Shukra' i.e. [psychosexual parlance] while planning the management of shukragat vata, thus apart from diet and exercise following Management is effective and result oriented:

. 'Akarakkarabhadi yoga': 500 mg [two capsules each twice a day]
. 'Madhutailika Yapana Basti': for the first 10 days of therapy course.

PS.
. The yoga has vrishya [spermiotropic], balya [strengthening], vatahara [alleviates vata], XXXXXXX [psychotropic] and shukrastambhak [effective control of ejaculation] properties. You can obtain/purchase it at your place or if not possible will let you know the ingredients so that you can make it yourself at home or can send you by courier [at your discretion].

. Yapana basti is suitable for out patient [OPD] management without any complications or restrictions. You may contact nearest Ayurveda hospital or Clinic near you for the same.

4. Sexual Exercise is the most important part of treatment, and demands tremendous co- operation & motivation from the couple, especially from wife/partner.

Step I
Non genital pleasuring for 4 weeks, the couple only limits the activity to caressing each other's bodies. Strictly no attempt is made for intercourse. This helps to reduce the main problem of performance anxiety & fear of failure, at the same time increases affection.

Step II
The couple indulges in genital pleasuring with hand, but without orgasm, and strictly no attempt at intercourse. The couple is encouraged to talk & express their pleasure to each other. If there is erection, allow it to subside, then stimulate again- to remove the fear of losing erection. Continued for at least 4 weeks.

Step III
The couple is encouraged to attain extra vaginal orgasm. Gradually, penetration is permitted, but withdrawn to have ejaculation outside vagina. The husband is encouraged to practice perineal exercises [as mentioned in last consultation]

Step IV
Finally, after several weeks, when the couple has gained confidence in itself, intra vaginal ejaculation is allowed.

PS. The entire therapy is long drawn and demands tremendous co- operation from the wife/parrtner. The wife must be motivated and explained her role independently, particularly stressing that any point, she shows negative response [ager,frustration], the treatment will fail and problem will become even more difficult.

Dr. Munish
Consultant & Physician
Naimittika

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