NIL sperms (Azoospermia)





Azoospermia is called when there is no sperm in semen. This type of semen disorder is found in approximately 3% of infertile men i.e. absent sperm. You should know that testis has two separate functions

 Production of normal sperms in semen which needed for pregnancy & normal fertility.

 The other function of testis is production of male hormones i.e. testosterone & others. So in most patients with nil sperms though semen has absent sperms still production of male hormones remains normal.

How sperms develop:

When boy becomes of 14 years of age then L.H. & F.S.H. hormone secretion from pituitary increases. The rise in these hormones leads to proliferation of sperm forming cells (Germ Cells) in the testis. These germ cells start multiplying under the effect of above-mentioned pituitary hormones along with assistance of other hormones as testosterones, Growth hormones, Androstenidione, insulin like growth factor-I, Thyroids hormone, paracrine hormone & growth factors. Under the control of above-mentioned hormones germs cells divide & transformed into primary spermatocytes. Then further maturation of primary spermatocytes to spermatids & then finally into mature spermatozoa (i.e. normal sperms) occurs under the control of above-mentioned hormones. After few weeks of progressive maturation inside the testis these sperms become normally motile & develop the capacity to fertilize the ovum. This total sperm cycle, from first stage to final stage of normal mature sperms is of three months. Thus to produce normal sperms testis should have normal sperm producing germ cells & normal regulating hormones. Any major hindrance in the development of these spermatozoa will lead to absent sperm production resulting into nil sperm..

Causes of Nil Sperms:

 Hormone disorder : Hormone deficiency of pituitary gland as L.H., F.S.H., Prolactin, thyroids hormone, hypothalmic deficiency of GnRH, Pituitary gland failure, Hypopituitarism, Idiopathic hypopituitarism, Kallman syndrome, Isolated hypogonadotropic hypogonadism, Drugs, toxins, Idiopathic hypogonadotropic hypogonadism & due to many more causes.

 Obstruction in the outflow of semen (Sperms) from testis to outside through urethral opening. Many times the production of sperms in testis is absolutely normal but these sperm are unable to come out due to obstruction in the out flow tract leading to absent sperms in the semen. The various causes of obstruction are absent vas deferens, absent seminal vesicle, posttraumatic, post surgical ligation of vas deferens. After some infections, as chlamydial, gonococcal urethritis. It may also be due to post tubercular epididimo-orchitis. The sperm may also not come out of testis if the are imotile due to any of the following causes as imotile cilia syndrome, kartagener syndrome cystic fibrosis & many other rare diseases.

  Absence of germ cells in testis also called sertoli cell only syndrome. In this there are no germs cells i.e. sperm forming cells in the testis. For you knowledge, I wish to inform you that in testis germ cell come to testis from neural cord area of the body during neural cord area of the body during development of fetus. So in some fetuses this migration of sperm cells do not occurs leading to testis only having testosterone forming & sertoli cells. Thus this condition is called sertoli sell only syndrome it is a developmental defect.

 Maturation Arrest (. Spermatid arrest): of primary spermatocytes to secondary spermatocyte, spermatids or to mature spermatozoa. Due to may local, systemic, hormonal growth factor deficiency or due to idiopathic factor. The various paracrine hormones and growth factors are essential for normal development i.e. maturation of one germ cells to multiplication of ultimately production of multiple mature, normal & motile sperms. Many other factor as infection, varicocele, drugs, chemotherapy may also lead to maturation arrest. The other causes may by developmentally defective germs cells & spermatocyte. So that they did not have inherent capacity of developing into a mature & motile sperms.

 Testicular disorders (primary leydig cell dysfunction), Chromosomal (Klinefelter syndrome and variants, XX male gonadal dysgenesis), Defects in androgen biosynthesis, Orchitis (mumps, HIV, other viral, ),Myotonia dystrophica, Toxins (alcohol, opiates, fungicides, insecticides, heavy metals, cotton seed oil), Drugs (cytotoxic drugs, ketoconazole, cimetidine, spironolactone)

 Varicocele (Grade 3 or more severe): A varicocele is a varicose vein in the cord that connects to the testicle. (A varicose vein is one that is abnormally enlarged and twisted.)
Varicocele decreases sperm productions by elevating temperature of the testis, may produce higher levels of nitric oxide chemical in the testis which blocks sperm production, varicocele damages sperms directly & lastly varicocele decrease the oxygen supply to testis.

 Drugs (e.g. spironolactone, alcohol, ketoconazole, cyclophosphamide, estrogen administration, sulfasalazine)

 Presence of Antisperm antibody. These Antisperm antibodies bind with sperms & either make them less motile, totally immotile or even dead which is called necrospermia

 Trauma

  Environmental toxins

  Viral orchits

 Granulomatous disease as tuberculosis, sarcoidosis of the testis

  Defects associated with systemic diseases, Liver diseases, Renal failure, Sickle cell disease, Celiac disease

  Neurological disease as myotonic dystrophy

  Development and structural defects, Germinal cell aplasia, sertoli cell only syndrome, Cypt-orchidism

  Androgen resistance

 Mycoplasma infection

 Cystic fibrosis patients often have missing or obstructed vas deferens (the tubes that carry sperm) and hence a low sperm count.

 Klinefelter syndrome patients carry two X and one Y chromosomes (the norm is one X and one Y), which leads to the destruction of the lining of the sperm forming germ cell in the testis.

 Environmental Assaults: Over exposure to environmental assaults (toxins, chemicals, infections) can cause nil sperm either by direct suppression of sperm production or on the hormone. Some chemicals that affect sperm production men are: Oxygen-Free Radicals, Estrogen emulation pesticidal chemicals (DDT, aldrin, dieldrin, PCPs, dioxins, and furans), plastic softening chemicals like Phthalates, hydrocarbons (ethylbenzene, benzene, toluene, and xylene)

  Exposure to Heavy Metals: Chronic exposure to heavy metals such as lead, cadmium, or arsenic may affect sperm production and may cause nil sperms in otherwise healthy men. Trace amounts of these metals in semen seem to inhibit the function of enzymes contained in the sperms, the membrane that covers the head of the sperm.

  Radiation Treatment: Over-exposure to radiation & xrays affect any rapidly dividing cell, so cells that produce sperm are quite sensitive to radiation damage. Cells exposed to significant levels of radiation may take up to two years to resume normal sperm production, and, in severe circumstances, may never recover.

 Misuse of substances: There are a number of banned substances that can have potentially lethal effects on sperm production. Taking anabolic steroids, for example, to increase performance in sports such as weight lifting, can dramatically alter both the motility and the health of the spermatozoa. Other banned substances, such as cocaine, marijuana and heroin can reduce sperm production & may make a man infertile.









Oligospermia















Oligospermia defined as less number of sperm in the ejaculate of the male or less than 20 million sperm per milliliter.

Normal Sperm count : 20 million / milliliter to 120 million / milliliter

Sperm count below 20 million/ml called Oligospermia.

Azoospermia is defined as the absence of spermatozoa in the ejaculation.

Oligoasthenoteratozoospermia, Polyzoospermia, Oligozoospermia, Oligospermie, Asthenozoospermia, Asthenospermia, Teratospermia, Asthenoteratozoospermia and Teratozoospermia are terms associated with male fertility factor.

Oligospermia, Oligospermaesthenia (Poor Sperm Motility), oligoasthenospermia and Oligoasthenoteratospermia are the most common type of male infertility factor exist in repeated semen analysis with no known urological or endocrinology abnormalities found during examination and therefore in Allopathy there is no specific treatment. So we stressed on looking into alternative systems and find out solution to Increase Sperm Count, Motility and Volume, simultaneously Sperm Morphology comes normal with treatment. Spermatogenesis is corrected and all parameter of sperm analysis become normal with 7 to 9 month of treatment and remains normal for 8 to 10 year after completion of treatment.

Male Infertility Factor responsible in 30 % of infertile couple, and addition to this additional 20 %there is contributing male factor. There are several advantages when the man and the women treated simultaneously, prevents more expenses behind unnecessary investigations and saves time.

IUI (Intra-Uterine Insemination) indicated in Male Fertility Factor abnormalities prevented in so many cases, treatment also helpful in cervical problem with Female Fertility abnormalities.IUI and IVF prevention is possible in case when it is indicated because of male infertility.

Ayurvedic medicine found to be most effective therapy in treatment of Low Sperm Count, Low Sperm Motility, Low Sperm Volume, Abnormal Sperm cell Morphology, Delayed Seminal Liquefaction, Semen Viscosity, Anti Sperm Antibody and combination of the any of the disorder either Endocrine or Urology or of both.


Dhat SyndromeDhat syndrome is a condition found in the cultures of the Indian subcontinent in which male patients report that they suffer from premature ejaculation or impotence, and believe that they are passing semen in their urine. The condition has no organic etiology.

In traditional Hindu spirituality, semen is described as a "vital fluid". The discharge of this "vital fluid", either through sex or masturbation, is associated with marked feelings of anxiety and dysphoria. Often the patient describes the loss of a whitish fluid while passing urine. At other times, marked feelings of guilt associated with what the patient assumes is "excessive" masturbation are noted.

Symptoms

Young males are most often affected, though similar symptoms have been reported in females with excessive vaginal discharge or leucorrhea, which is also considered a "vital fluid".

Premature ejaculation and impotence are commonly seen. Other somatic symptoms like weakness, easy fatiguability, palpitations, insomnia, low mood, guilt and anxiety are often present. Males sometimes report a subjective feeling that their penises have shortened. These symptoms are usually associated with an anxious and dysphoric mood state.






​​​​​​Rai Piles & Health Clinic 

Dr Yogendra Rai has been awarded "BEST SEX CLINIC OF THE MILLENIUM" FOR OUTSTANDING ACHIEVMENTS IN TREATMNET OF SEXUAL PROBLEMS".

A tribute to our excellence over the decades

​​

We offer highly effective treatments for all sex related problems. To avail our services you can contact us either in person or over the phone for initial enquiry.


Dr Yogendra Rai has been awarded "BEST SEX CLINIC OF THE MILLENIUM" FOR OUTSTANDING ACHIEVMENTS IN TREATMNET OF SEXUAL RPOBLEMS". A tribute to our excellence over the decades.







Sex is considered taboo in our orthodox society, which prudishly discourages questions about this intimate and integral part of our lives. Hence, one's natural curiosity remains largely unsatisfied and the existing myths, misconceptions & ignorance continue to be perpetuated & passed on from generation to generation, like an inherited social disease. Out of these misconceptions, people silently suffer from sexual disorders. Especially modern medicine does not have a complete cure for sexual ailments. And it is a universal truth that ayurveda herbalism with its long years of existence & enlargement has potential cures & remedies to cure incurable sexual diseases. Sexual medicine rightfully deserves its long over due respect and recognition as an independent science. True to our traditional legacy of social honesty from an ancient cultural past, we promote this site to help whole of mankind across the globe to lead a healthy & happy life.
ragraph here.

Erectile Dysfunction


Erectile dysfunction (ED) is the inability of a man to achieve or maintain an erection sufficient for his sexual needs or the needs of his partner. Erectile dysfunction is sometimes called as "impotence".

The term "erectile dysfunction" can mean the inability to achieve erection, an inconsistent ability to do so, or the ability to achieve only brief erections.

Even though a man has a strong desire to perform sexual act with a cooperative partner, he cannot perform sexual act because of looseness (absence of erection ) of his phallus ( penis). Even if he performs sexual act with his determined efforts he does not get erection and gets afflicted with tiredness, perspiration and frustration to perform sex.


















Physiology of erection:


The two chambers of penis (corpora cavernosa,) which run throught the organ are filled with spongy tissue. The corpora cavernosa are surrounded by a membrane, called the tunica albuginea. The spongy tissue contains smooth muscles, fibrous tissues, spaces, veins, and arteries. The urethra, which is the channel for urine and semen runs along underside of the corpora cavernosa..

Due to sensory or mental stimulation, or both, the erection begins. Due to impulses from brain and local nerves the muscles of corpora cavernosa relax and allow blood to flow in and fill the spaces of spongy tissue.

The flow of blood creates pressure in the corpora cavernosa, making the penis expand. The tunica albuginea helps trap the blood in the chambers, thereby sustaining erection. When muscles in the penis contract to stop the inflow of blood and open outflow channels, erection recedes.

In Infertility physiology of erection and ejaculation is described as follows:

The "apaanavayu" one of the five types of vayu is located in the testicles, urinary bladder, phallus, umbilicus, thighs, groin, anus and colon. Its functions are ejaculation of semen, voiding of urine and stools".

Shushruta explains the process of erection and ejaculation as " When a man has desire (iccha) to have sex, his response to touch increases ( Vayu located in skin causes flow of signals from skin to brain, thus causing sensation of touch). This causes arousal or "harsha" . Arousal or Harsha intensifies actions of vayu and at this moment highly active vayu liberates the "teja "or heat of pitta. Thus tejas and vayu increase body temperature , heart beat and blood flow causing erection. "

Causes of Erectile Dysfunction:

Erection requires a sequence of events. Erectile dysfunction can occur when any of the events is disturbed. Nerve impulses in the brain, spinal column, around the penis and response in muscles, fibrous tissues, veins, and arteries in and around the corpora cavernosa constitute this sequence of events. Injury to any of these parts which are part of this sequence ( nerves, arteries, smooth muscles, fibrous tissue ) can cause ED.

Lowered level of testosterone hormone: The primary male hormone is testosterone. After age 40, a man's testosterone level gradually declines. About 5% of men that doctors see for erectile dysfunction have low testosterone levels. In many of these cases, low testosterone causes lower sexual interest, not erectile dysfunction.

Even sushruta has illustrated about this response of body to the element "Shukra" . He has said " The shukra ( the element which helps in reproduction) is present all over the body .

This can be explained with the following examples.

1. The ghee is present in milk in an invisible form. This is extracted from milk using many processes.

2. The sugar is present all over the sugarcane. It is extracted by subjecting the sugarcane to number of processes.

Same way shukra is present all over the body. But the cream of shukra (semen) comes out of the body only during the process of ejaculation. But this process of ejaculation needs a joyful union of mind and body.

Decrease in production of "Shukra" causes erectile dysfunction.

Over exertion - physically and mentally : Working for long hours in office, mental stress at office and home, short temperedness ,insufficient sleep cause erectile dysfunction.

These causes are explained in Infertility as "shoka chintaa, bhaya, traasaat .... " which means that erectile dysfunction or Impotence occurs due to grief, fear, anxiety and terror.

Strained relationship with sexual partner: Erectile dysfunction also occurs when there is a disliking towards sexual partner.

Diseases that cause Erectile dysfunction: Neurological disorders, hypothyroidism, Parkinson's disease, anemia, depression, arthritis, endocrine disorders,diabetes, diseases related to cardiovascular system also become reasons for erectile dysfunction..

According to Infertility the diseases which cause erectile dysfunction are:

Heart diseases , anemia , asthma , liver disorders , tiredness .Apart from these the imbalance in tridoshas also cause impotence or erectile dysfunction.

Consumption of medicines, drugs and tobacco:

Using antidepressants, tranquilizers and antihypertensive medicines for a long time, addiction to tobacco especially smoking, excessive consumption of alcohol, addiction to cocaine, heroin and marijuana cause erectile dysfunction.

In Infertility texts these causes have been said in brief as - "dry food , drinks and medicines" cause impotence or erectile dysfunction.

Trauma to pelvic region: accidental injury to pelvic region and surgeries for the conditions of prostate, bladder, colon, or rectal area may lead to erectile dysfunction.

These causes are mentioned as trauma, injury from weapons, teeth and nail.) in Infertility.

Other reasons: Obesity, prolonged bicycle riding, past history of sexual abuse and old age also cause Erectile dysfunction.

Home Remedies for ED:

 Cut down on smoking, alcohol, and illegal drugs.

 Get plenty of rest and take time to relax.

 Exercise and eat a healthy diet to maintain good circulation.

 Use safe sex practices, which reduces fear of HIV and STDs.

 Talk openly to your partner about sex and your relationship. If you are unable to do this, counseling can help.


Loss of Libido



Libido is conscious or unconscious sexual desire. Loss of libido is a sexual dysfunction relating to loss of sexual desire or sexual drive and is also termed hypoactive sexual desire disorder (DSM-IV). Loss of libido must not be confused with other sexual dysfunctions as these can impair libido.Contrary to beliefs that problems surrounding female sexuality are psychological in nature, Recent research has discovered that many forms of female sexual dysfunction often are the result of low hormonal levels. Hormones are directly responsible for female sex drive and libido. Loss of libido can lead to difficulty in intimate relationships and contribute to marital problems.

Physical factors contributing to sexual problems include:

Drugs, such as alcohol, nicotine, narcotics, stimulants, antihypertensives (medicines that lower blood pressure), antihistamines, and some psychotherapeutic (drugs that treat psychological problems such as depression) drugs

- Emotional conditions
- General stress
- Normal relationship
- Fear of pregnancy
- Relationship problems
- Anxiety
- Depression
- Depressive conditions
- Post-natal depression
- Homosexuality - reduced libido regarding the opposite gender.
- Illness - a current illness
- Recent physical illness - recovery phase of an illness can still have reduced libido.
- Physical sexual performance conditions
- Painful intercourse
- Recent childbirth - causes both emotional changes reducing libido, and physical injury related to a vaginal birth.
Sexual problems (see Sexual symptoms)
- Impotence
- Vaginal dryness
- Medical conditions
- Hormonal conditions
- Menopause
- Pregnancy
- Low testosterone
- Flu
- Glandular fever
- Any medical condition causing fatigue, tiredness, etc
Certain illicit drugs (see Drug abuse)
- Marijuana - a form of cannabis
- Cannabis
Home Remides

Garlic:
Garlic is one of the most remarkable home remedies in the treatment of sexual disorder & loss of libido. It is a natural and harmless aphrodisiac. Garlic has a pronounced aphrodisiac effect.

Drumstick:
A soup made with drumstick flowers boiled in milk is very useful as a sexual tonic in the treatment of loss of libido. It is also useful in the functional sterility in both males and females. The powder of the dry bark is also valuable in impotency, premature ejaculation and thinness of semen. Powder of the dry bark should be boiled in half a liter of water of about half an hour. Thirty grams of powder, mixed with tablespoon of honey, should be taken thrice daily.


 Ginger:
The juice extracted from ginger is a valuable aphrodisiac and beneficial in the treatment of loss of libido. For better results, half a teaspoon of ginger juice should be taken with a half boiled egg and honey, once daily at night for a month. It is said to relieve impotency, premature ejaculation and spermatorrhoea.

Diet:
Diet is an important factors, to begin with the patient should adopt an exclusive fresh fruit diet. Take fresh fruits and fresh fruit juice twice daily. Concentrate on foods like nut, cereals , some green vegetables, fruits, milk, honey etc.
Avoid smoking, alcohol, tea, coffee all processed canned refined and denatured foods especially white sugar and white flour and products made from them.




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.

Symptoms

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.

Remedies

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.



Enlarged Prostate











The prostate is a small gland found in men. It sits just under the bladder and with age, the prostate has a tendency to enlarge. This condition is commonly referred to simply as 'an enlarged prostate'. The medical term for an enlarged prostate is benign prostatic hyperplasia (BPH). The use of the word benign is significant – it indicates that the condition is not life-threatening, in contrast to prostate cancer, the prostate problem we hear about more frequently. The enlarged prostate is an increasingly common problem as a man becomes older. It is estimated that:

 Around 2 million men in the UK have symptoms arising from an enlarged prostate
 50% of men over the age of 50 show signs of prostate enlargement
 By the age of 70, about 80% of men have an enlarged prostate

Symptoms

Although an enlarged prostate is not in itself a life-threatening condition, it can give rise to a number of inconvenient symptoms which if severe enough, can affect your health and quality of life. As the prostate enlarges, it presses against the bladder and interferes with the way it works. This gives rise to a number of symptoms relating to bladder function and urination. The most common of these are:

 Having to get up at night for a pee
 The need to pass water frequently
 Poor urine flow – also known as poor stream
 Dribbling at the end of urination
More information on what you can expect if you suffer from prostate enlargement may be found on our page on enlarged prostate symptoms.

If you are experiencing the symptoms described on this page, have used our Symptom Checker page and think you have an enlarged prostate gland, the next thing you should do is to have the diagnosis confirmed by your doctor. This visit should be fairly straightforward as in most cases, a diagnosis can be made on the medical history and symptoms. However, in order to exclude other causes of your symptoms, the visit may involve an internal examination to assess the size of your prostate gland and blood tests.

Treatment options

Having formed a diagnosis, your doctor will be in a position to discuss treatment options with you. In general, the treatment of an enlarged prostate will depend on the severity of your symptoms.

If you suffer mild symptoms, your doctor may suggest that you simply sit and wait. This is known as 'watchful waiting' - seeing how the condition develops

If you have moderate symptoms, your doctor may recommend that you use one of a number of prescribed drugs known as α-blockers and 5α-reductase inhibitors

If your symptoms are severe, your doctor may refer you for a hospital appointment with a urologist, with the view of considering whether surgery may be of benefit.

Herbal remedies. An increasing number of doctors may also discuss with you the use of the herb Saw Palmetto in treating mild to moderate symptoms of an enlarged prostate. The herb can be used as an alternative to 'watchful waiting' or if there is a need to avoid the use of prescribed medicines.