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.

Today 18th October is World Menopause Day....
Aging is an inevitable phenomenon in our lives. Often our parents or grand-parents say “we are aged now, so it’s just a matter of few years”. But is it really so? French author Jules Renard said “It`s not how old you are, it`s how you are old”. Scientific studies has shown that “we can expect to become old”. There are mainly two reasons for it. One is our life style changes, leading to faster aging of the general population. The second thing is profound improvement in medical care that made it possible to conquer death even at the age of 80 years.In 1000 BC, the life expectancy was only 18 years. By 100 BC, the time of Julius Caesar, it had reached 25 years. In 2005, it was 80 years for women and 75 years for men. And today, you can expect to reach 82 years if you are a male and 85 years if you are a female. Men and women population need to be addressed differently from social, economic and biological points of view. Half of men at 85 and above live with their wives, but only 10% of elderly women live with their husbands. Aging is nothing but a sign of maturity. There are three signs of maturity in each sex. Two of them are common in both men and women; graying of hair and cataract in eye. The third one is unique to each sex. In men, it’s increased size of prostate gland (prostatism) and in female, it’s menopause.

Menopause is unavoidable in a woman’s life. In simplest term, it is the cessation of menstruation permanently at the end of reproductive life. The ovaries stop secreting female sex hormones- mainly estrogen and progesterone. In medical terminology, menstruation should be absent for 12 consecutive cycles to define it as menopause. Though menopause is the stoppage of reproductive function, it has profound effect in almost every organ of the body. Despite our socio-economic improvement, the age of menopause remains relatively the same; average 51 years with range of 45 to 55 years. However, there are some causes that may cause early menopause. If it occurs before 40 years, it’s called premature menopause. This needs medical consultation because it is caused by some serious diseases like genetic causes (may have family history of premature menopause- in elder sisters and mother), smoking, autoimmune disorders (body makes destructive substances against itself) etc. Sometimes premature menopause is the side-effect of some treatments like drugs (especially anti-cancer drugs), radiation and removal of ovaries by surgery. On the other hand, if menstruation continues to occur after 55 years, it’s called delayed menopause. It also deserves consultation with gynaecologists, as it is often caused by diabetes, some tumours and even some cancers. So, if menopause occurs too early or too late, it should never be ignored.

But if menopause occurs in time, do the women should consult gynaecologists? Well. You can find the answers from this article. Most of the women have some common problems after menopause; they become irritable or depressed and sometimes very much emotional and moody. Even suicidal tendency is not uncommon. Often they complain of sudden sensation of excessive warmth, the hot sensation, as if there is something burning on the head, the ears or other parts of the body. This is called “hot flush”, which is often associated with excessive sweating at night, palpitation and anxiety. This happens due to absence of estrogen hormone. These problems can be solved by hormonal drugs. Even non-hormonal drugs also work well. So, timely treatment can give them good quality of life and you don’t have to say “my mother has become intolerable these days”.

Frequently our mothers and grand-mothers complain of having back-pain or pain in the bones. This is due to osteoporosis; the destruction of components of bones and joints. They often get fracture with minor trauma. Again, this is due to deficiency of estrogen and also inadequate calcium intake. So, the treatment of this problem is exercise (at least 30 minutes per day), avoidance of smoking and the drugs that inhibits bone formation and adequate calcium and vitamin D intake. Hormone therapy is also effective and there are many non-hormonal drugs that can prevent destruction of bone. Thus timely medical consultation may stop our mothers saying “I cannot go outside for pain in my knees”.

Cardiovascular disease is the leading cause of death in elderly. Before the age of 40 years, males are more likely to die, than females, due to heart attacks. After 40, the sex difference is lost. This is because of absence of estrogen in women after menopause that alters the composition of fat (especially cholesterol) in blood. Cholesterol get deposited in the wall of blood vessels. Such problems can be avoided by dietary control, control of high blood pressure and diabetes and regular medical checkup.

The worst problemof the menopause is faced by the urinary and reproductive systems, i.e., the private parts of the body. In medical terminology, this is called “pelvic atrophy”. Our women remain very silent of it; most of them do not consult doctors for such problems. There is feeling of increased frequency of urination (women has go to the toilets frequently), burning sensation during urination and sometimes inability to hold the urine until they can reach the toilet or leakage of urine during coughing and sneezing (medically called “urinary incontinence”). The incontinence is not only a medical problem but also a social and hygienic embarrassment, for which many women avoid participation in social activities and even do not want to go outside. Sexuality is a thing that is often ignored both by the elderly people as well as the doctors. Menopause does not mean end of the conjugal life. Often the women may feel decreased libido (the desire) because of low hormone levels. And again there is difficulty in keeping intimacy for problems in the concerned area (due to decreased blood supply), again due to deficiency of estrogens. This may even lead to damage to the private parts and bleeding, while leading the conjugal life. For this, the couples should not suffer silently. There are many treatments that can avoid such urinary and sexual problems. Sometimes, simple counselling and some special exercises may prove to be adequate. Otherwise hormonal drugs (estrogens) can be used. And for this purpose, even we don’t need to take the hormones orally or by injection; simple local use of some creams or jellies help a lot. You will be surprised to know that testosterone may also help some women, because testosterone is not only found in male but is also an important female hormone. Those who want to avoid hormones, can try other non-hormonal agents. Even pregnancy is possible after menopause. There have been many examples of conception, either naturally or by test-tube baby (in vitro fertilization), after menopause. The recent socio-economic trend of delaying the age of marriage and child-birth is making this issue of pregnancy after menopause very much relevant.

Cancer is the second leading cause of death in elderly, after heart attack. Lung cancer is increasing day by day in women and even non-smokers can also have lung cancers. Discharge of blood with cough or vomiting, long-standing cough, chest pain and weight loss needs consultation with chest physician. Breast cancer is a major cause of death in women. This can be avoided by monthly self-breast examination and consultation; if any abnormal swelling or discharge is found. Colo-rectal cancer (cancer of lower part of our digestive tract), recently showed increased incidence in all the age groups. So, if there is any bleeding with stool or passage of black coloured stool, it should never be ignored. Ovarian cancer is showing increased incidences all over the world. Despite significant improvement in cancer management, ovarian cancer is a nightmare of the gynaecologists. Often, even after best possible treatment, patients of ovarian cancer don’t survive beyond one year of diagnosis. So, if you have any problems in digestion, abdominal discomfort, pain and swelling, please don’t just go to medicine shop to take antacids; instead go to your doctor. Post-menopausal bleeding is a medical term, used to describe the condition where there is bleeding through vagina, after menopause. Even if the bleeding is only one drop, it should never be ignored. Though, most causes of such bleeding are not worrisome (due to drugs and ‘’pelvic atrophy”- as mentioned earlier), some cancers may present in this way. Cancer of endometrium (the inner lining of uterus) almost always present with post-menopausal bleeding. Cancer of cervix (the mouth of uterus) is the commonest cancer of reproductive system in our country, which is totally preventable by timely diagnosis by screening (even before actual cancer occurs) and timely HPV vaccination.

“What cannot be cured, must be endured”. We cannot cure the menopause, nor can we avoid it. But definitely we can give our older generation a better quality of life. The first step is obviously making them aware of the menopause and its aftermaths. Second issue is regular health checkup by physicians and gynaecologists, even if they feel no problems as such. But the most important issue is managing their problems. As mentioned above, life-style modifications (like diet, exercise) and non-hormonal drugs play important role. But if we consider the basic problem is menopause, it’s simply deficiency of secretion of female sex hormones from the ovaries. So, if we can artificially introduce those hormones in women, menopausal symptoms can be reduced. This led to emergence of a treatment modality, called HRT (Hormone Replacement Therapy).

Clearly, as discussed earlier, HRT is required in women complaining of menopausal symptoms like “hot flush”, urinary and sexual problems, osteoporosis, and mood depression and also for young women having premature menopause. HRT does not only help to improve these problems, but also has some added advantage like preventing excessive weight gain, problems in oral cavity, eyes and ears and even colorectal cancer. Majority of the women report feeling better and having improved quality of life (social, personal, biological and conjugal) after start of HRT. There are multiple ways to give HRT to a woman. Those include injections (one in 1-3 month), oral tablets, local creams or jellies, skin patches etc. And the drugs include estrogen only, estrogen plus progesterone, tibolone etc.

Now the million-dollar question is, “is HRT absolutely safe?” The answer is difficult to give in one word. After the publication of the reports of the WHI (Women’s Health Initiative) and the MWS (Million Women Study), there have been a great hue and cry regarding safety of HRT. Those study found out many serious side effects of HRT and concluded that HRT should not be used in all the menopausal women. However, subsequently, many flaws of those studies were found out and subsequent review of the WHI study proved that HRT has few side effects. Thrombosis (increased tendency of blood to form clots) is a known side effect of hormonal drugs, but the problem occurs only to those who are at risk of thrombosis due to other causes (like obesity). Breast cancer is definitely a risk factor but the risk is small. So, the women need to continue self-breast examination and yearly checkup by their consultants. Blood fat concentration (cholesterol) may be altered, which needs regular lipid profile checkup. And finally there is increased risk of heart attacks and stroke. But possibility of heart attack is there only if HRT is started in very elderly women (after 60 years) and those who are already have some risks (obesity, smokers, and hypertensive). Even, timely initiation of HRT (before 60 years) can protect the heart and brain against stroke.

Thus HRT is found to have very minimum side-effects and that too at the expense of so many benefits. There are very few women who should not use HRT; those having thrombosis, heart disease or liver disease at present and very high blood fat level (high triglyceride). If the woman has any mass in the breast or post-menopausal bleeding, then HRT should be used only when the diagnosis of the mass or the bleeding is certain. To be on the safe side, before start of HRT, details examination by the consultant doctor is required. This includes checkup of blood pressure, heart, breast, liver and the pelvic organs. The best time to start HRT is as early as after menopause. For premature menopause, the women are relatively younger (before 40, even before 30). So, they should start HRT soon after consultation with doctors, if HRT is suitable for them. For women with natural menopause, HRT should be started before 60 years. Annual visit to the doctor is necessary to detect any side effects and to find whether HRT is needed further or not. HRT need not be continued lifelong. Most of the women can stop it after 5 years. Very few women have to continue it beyond 10 years. Actually, after 2-3 years of HRT, most of the menopausal problems subside and women do not require to continue HRT. However, before stoppage, doctor consultation is required.

In a nutshell, elderly people deserve special care. But that does not mean they should always be in the bed. They should continue their day to day activities. They have the full right to enjoy their life by themselves. What we can do is be supportive to boost up their confidence and self-esteem. That needs social as well as medical attention. Regular touch with physician and gynaecologist cannot be overemphasized. Most of the symptoms can be taken care by life style modifications and drugs. HRT should be used as necessary. HRT is very safe and cost-effective modality. “Not everyone grows to be old, but everyone has been younger than he is now”.

In our modern life, stress is an indispensable part. Career, jobs, studies, incomes, business, money, property- all are associated with some sorts of stress. The problem gets exaggerated when it affects the family life. Because, at the end of the day, we all want to enjoy a happy family life. And a family life has its sense when the husband and the wife are in harmony. Needless to say, that a family is incomplete without a kid.

How stress affects family life? Effect of stress is not limited to mind. It has serious effects in the body. It affects blood circulation and the heart. It puts pressure on nerves. It also alters the blood sugar level. And he end result is diabetes, hypertension (high blood pressure) and heart diseases. Ultimately these diseases affect all the organs of our body. Some people try to get rid of stress by smoking and alcohol. These will simply put burden on already affected heart and blood.

Stress also alters important hormone levels in our body. The hormones needed for basic reproductive function (sex, conception and pregnancy) are either increased or decreased. Prolactin hormone is increased. Normally prolactin is needed to secrete milk from breast to fed the baby. But abnormally increased prolactin leads to milk secretion from breast (even without pregnancy) and irregularities in periods. Very high prolactin may even lead to problems with ovulation (at middle of each period, the egg gets released from ovary) and as a result, the woman cannot conceive a baby. Even in male, high prolactin leads to difficulty in erection of penis. In some male, it can lead to gynaecomastia (growth of male breast). Excessive high dose of prolatin leads to loss of sex desire in male and interferes with spermatogenesis (sperm production).

Apart from increasing prolactin, stress can directly affect the hormones secreted from the pituitary gland of both male and female, the testes in male and the ovaries in female. As a result, all the reproductive functions get disturbed leading to problems in sex (loss of desire in both male and female, problems in erection and ejaculation in male), irregular periods in female and ultimately pregnancy cannot occur.

The diseases occurring as a result of stress (diabetes, hypertension etc) also affect the normal functions of ovaries causing irregular periods, even no periods at all. There may be problems in ovulation and thus difficulties in achieving pregnancy. Even if pregnancy occurs, it may be aborted because of these diseases. Similarly in male, diabetes and hypertension will cause sexual dysfunction and will affect sperm production.

The lifestyles accompanying stress are also responsible for harmful effects on family life. Smoking and alcohol have been mentioned earlier. Stress may be associated with abnormal weight gain and that will affect the woman’s life in badly manner. There will be disturbances in periods, ovulation problems, infertility and even pregnancy loss. Sitting for long time while driving or keeping laptops on laps, will increase the temperature of scrotum in male and thus will decrease the sperm production.

Again there is a vicious cycle- stress leads to family problems like problems in sex and in having pregnancy. That will in turn increase pressures from family (especially in-laws) and the society. This will simple aggravate the stress.
So, what can be done to avoid these problems? The answer seems to be simple- that is avoiding stress. But it’s very easy to say and difficult to commit. First thing is try to bring stress at home just keep it at your workplace. Avoid smoking and cut down alcohol consumption. Avoid sitting long time in front of computers and take periodical rests when you are working continuously. The rest does not mean that you have to lie down in bed; just have a short walk. Start exercise that will keep you healthy and reduce your stress. Yoga is an Indian culture that taught the Western world how to reduce stress. Take plenty of water and green vegetables and fruits. Avoid fast food. Always put on comfortable dresses. And if all of these do not work, try if you can do something to avoid the stress- like changing the workplace, talking directly to your co-employees or the employer. If still all these cannot help, consult psychological counselor. A timely counseling will reduce stress significantly. In very few cases, drugs may be needed to reduce stress. But remember, drugs can only be useful if you are trying all the other measures. Simple dependence on drugs won’t help much.

Now regarding family problems associated with stress follow simple measures. Often we feel embarrassed to discuss these issues. Try to enjoy time of personal intimacy to the fullest. Don’t think of any problems during that time. If still there are problems, don’t hesitate to take medical help. And please remember, the drugs used to solve sexual problems may have side effects. So, these should be taken only after medical consultation.
In case of female, maintain optimum weight. Avoid fast food, alcohol and smoking. If periods are irregular, maintain a menstrual diary. Consult a doctor to find out if there are some serious issues associated with these problems (like hormonal problems, thyroid diseases, even some tumours). You doctor will then decide the best treatment for you. If there are low desire for sex, don’t hesitate to take help of doctor. It may be a symptom of hormone deficiency that can affect your different systems (like bone, heart, blood etc). Now a days, there are lots of treatment options available for this.

For male, if there is low desire, consult your doctor to find out the cause of this problem. At the same time, avoid any anxiety, alcohol and smoking. Sometimes there are problems with erection. Instead of trying drugs shown in media or newspaper, feel free to talk to your doctor; because erection problem may be caused by some serious issues like heart disease, diabetes etc. So, if you have erection problems, consult doctor. He/ she will counsel you and give you the best treatment. Now if the problem is with ejaculation (like early loss of semen or very low semen), that issue can also be solved in the same way.

What’s about infertility problems? Stress and infertility are inter-related, as described before. Now, if there is problem with fertility, please remember few facts. Even in totally healthy couples, the chance of pregnancy after regular intercourse in fertile period (in the middle of menstrual cycle, usually) is only 20%. Though it appears disappointing, majority of couples conceive in course of time. So, couples are requested to report to doctor only if they tried regularly for one year without any protection. Then your doctor will assess you and try to find out the problem. And again, treatment of infertility is also depending on chance. Hat means we have to increase the chance above the natural chance (which is 20%). So, even one treatment fails, there is enough scope, so no need to lose hope. In other words, there is no need to increase the stress.

So, stay healthy, keep your mind healthy by avoiding stress and keep your family relationship totally stress-free.