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Yoga in Premature Ejaculation: A Comparative Trial with Fluoxetine

Authors:
  • Dr N Y Tasgaonkar Institute of Medical Sciences and Research

Abstract and Figures

Introduction: Yoga is a popular form of complementary and alternative treatment. It is practiced both in developing and developed countries. Use of yoga for various bodily ailments is recommended in ancient ayvurvedic (ayus = life, veda = knowledge) texts and is being increasingly investigated scientifically. Many patients and yoga protagonists claim that it is useful in sexual disorders. We are interested in knowing if it works for patients with premature ejaculation (PE) and in comparing its efficacy with fluoxetine, a known treatment option for PE. Aim: To know if yoga could be tried as a treatment option in PE and to compare it with fluoxetine. Methods: A total of 68 patients (38 yoga group; 30 fluoxetine group) attending the outpatient department of psychiatry of a tertiary care hospital were enrolled in the present study. Both subjective and objective assessment tools were administered to evaluate the efficacy of the yoga and fluoxetine in PE. Three patients dropped out of the study citing their inability to cope up with the yoga schedule as the reason. Main outcome measure: Intravaginal ejaculatory latencies in yoga group and fluoxetine control groups. Results: We found that all 38 patients (25-65.7% = good, 13-34.2% = fair) belonging to yoga and 25 out of 30 of the fluoxetine group (82.3%) had statistically significant improvement in PE. Conclusions: Yoga appears to be a feasible, safe, effective and acceptable nonpharmacological option for PE. More studies involving larger patients could be carried out to establish its utility in this condition.
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ORIGINAL RESEARCH—EJACULATORY DISORDERS
Yoga in Premature Ejaculation: A Comparative Trial
with Fluoxetine
Vikas Dhikav, MD,* Girish Karmarkar, MBBS, MD,Mallika Gupta, MBBS,* and
Kuljeet Singh Anand, DM
*All India Institute of Medical Sciences, New Delhi, India; Private Practice, Thane-Mumbai, India; Dr. RML Hospital and
Post Graduate Institute of Medical Education and Research-Guru Gobind Singh-Inderprastha University—Neurology,
Delhi, India
DOI: 10.1111/j.1743-6109.2007.00603.x
ABSTRACT
Introduction. Yoga is a popular form of complementary and alternative treatment. It is practiced both in developing
and developed countries. Use of yoga for various bodily ailments is recommended in ancient ayvurvedic (ayus =life,
veda =knowledge) texts and is being increasingly investigated scientifically. Many patients and yoga protagonists
claim that it is useful in sexual disorders. We are interested in knowing if it works for patients with premature
ejaculation (PE) and in comparing its efficacy with fluoxetine, a known treatment option for PE.
Aim. To know if yoga could be tried as a treatment option in PE and to compare it with fluoxetine.
Methods. A total of 68 patients (38 yoga group; 30 fluoxetine group) attending the outpatient department of
psychiatry of a tertiary care hospital were enrolled in the present study. Both subjective and objective assessment tools
were administered to evaluate the efficacy of the yoga and fluoxetine in PE. Three patients dropped out of the study
citing their inability to cope up with the yoga schedule as the reason.
Main Outcome Measure. Intravaginal ejaculatory latencies in yoga group and fluoxetine control groups.
Results. We found that all 38 patients (25–65.7% =good, 13–34.2% =fair) belonging to yoga and 25 out of 30 of the
fluoxetine group (82.3%) had statistically significant improvement in PE.
Conclusions. Yoga appears to be a feasible, safe, effective and acceptable nonpharmacological option for PE. More
studies involving larger patients could be carried out to establish its utility in this condition. Dhikav V, Karmarkar
G, Gupta M, and Anand KS. Yoga in premature ejaculation: A comparative trial with fluoxetine. J Sex Med
2007;4:1726–1732.
Key Words. Premature Ejaculation; Yoga; Fluoxetine; Nonpharmacological Treatment; Complementary and Alter-
native Treatments
Introduction
Premature ejaculation (PE) is the most
common sexual disorder of young males.
Normative data suggest that men with an intra-
vaginal ejaculatory latency time of less than
1 minute have “definite” PE, while men with
intravaginal ejaculatory latency times of between
1.0 and 1.5 minutes have “probable” PE [1].
Prevalence rates of 20–30% have been reported
[2].
PE is generally defined as the occurrence of
ejaculation prior to the wishes of both sexual part-
ners. This broad definition, thus, avoids specifying
a precise duration for sexual relations and reaching
a climax.
An occasional instance of PE may not be cause
for concern, but if the problem occurs with more
than 50% of attempted sexual relations, a dysfunc-
tional pattern should be suspected and appropriate
diagnostic and therapeutic measures must be
initiated.
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J Sex Med 2007;4:1726–1732 © 2007 International Society for Sexual Medicine
A number of treatment options are used for PE.
Although selective serotonin reuptake inhibitors
(SSRIs) have the potential to improve the quality
of life for men with PE and their partners [3–5],
patients’ satisfaction and drug side effects may
remain to be a problem. New treatments are
therefore desirable. Because the condition has
stigma and patients may not be aware that medical
treatment options are available, nonpharmacologi-
cal treatment options seem preferable.
Yoga is a popular nonpharmacological inter-
vention. There are many types of yoga: hatha
yoga is an element of raja yoga and deals mainly
with physical postures and breathing. Karma yoga
emphasizes spiritual practice to help the indi-
vidual “unify” body, mind, and heart through
certain practices in daily life and work. Bhakti
yoga, a devotional form, generally encompasses
chanting, reading of scriptures and worship prac-
tices. We focused mainly on hatha yoga by
various asanas.Anasana is a particular posture of
the body, which is both steady and comfortable.
In yoga, there are more than a hundred classical
poses, and these probably have as many varia-
tions. These can be subdivided into two catego-
ries: active and passive. Active poses are supposed
to tone specific muscle and nerve groups, and
benefit organs and the endocrine glands. The
passive poses are employed primarily in medita-
tion, relaxation, and pranayama practices. We
employed both active and passive poses during
the present study (see Figure 1).
Each posture, or asana, is held for a period of
time and is synchronized with the breath. Gen-
erally, a yoga session begins with gentle asanas
and works up to the more vigorous or challeng-
ing postures. A full yoga session includes exer-
cises of every part of the body, pranayama
(prana =life; breath control practices), relaxation,
and meditation.
Yoga is a popular nonpharmacological treatment
method for a number of conditions, and there are
claims of it being effective in bodily disorders
including the sexual ones; we thought it worthwhile
to investigate its efficacy and to compare it to flu-
oxetine, a commonly used SSRI for PE.
Materials and Methods
We studied 68 patients (Table 1) attending the
outpatient department of a tertiary care psychiatric
hospital in North Delhi. A detailed history of each
patient was taken. A general physical examination
of all systems was performed. After establishing
the diagnosis using Diagnostic and Statistical
Manual IV, the patients were offered to choose
between pharmacological (capsule fluoxetine–
fluoxetine group) and nonpharmacological (yoga–
yoga group) treatments. Three patients opted out
of the study citing inability to adhere to the yoga
regime. Because these opted out of the yoga group
before the study began, we did not include them in
the final analysis.
The wives of the patients were briefed about
starting the stopwatch once the penetration began
and then to stop it once the husbands ejaculated.
They was asked to note down the intra-ejaculatory
latencies in seconds in a diary.
Those who opted for drugs were given fluoxet-
ine capsule (group 1) in dose of 20–60 mg/day as a
single dose, while for those who opted for yoga
(group 2) the protocol was explained (Table 2).
The patients were encouraged to report any side
effects occurring during the course of treatment in
both groups.
Patients included in the study had PE, were
fluoxetine naïve, had no history of trauma, dia-
betes, hypertension, or any other chronic physi-
cal or mental disorder. There was no history of
substance abuse. The patients were not on any
concurrent medications and had unremarkable
general physical examinations. The mean age of
onset of PE was 28 years and the mean duration
was 1.7 1.5 years.
The patients were briefed by a sexologist and a
yoga expert about the protocol they had to follow
over 12 weeks (Tables 2 and 3). They were told to
practice 12 asnas and 2 pranayanams for 1 hour/day.
The patients were examined after 4 and 8 weeks,
respectively. Their intravaginal ejaculatory laten-
cies were noted and analyzed.
Although the average suggested duration was 1
hour, it was not rigidly fixed, and the patients were
told to practice yogasanas depending upon their
stamina. This was because in yoga, the advice gen-
erally given was that the patients should not exert
themselves. Three repetitions of each asana were
suggested. Differential relaxation was taught to the
patients once they finished their daily yoga proto-
col with a breathing technique called as anulom-
vilom (breathing via alternative nostrils) and
Table 1 Demographic data
38 cases Mean age =38.9 10.1 years
30 controls Mean age =38.6 9.2 years
Total number =68; age range =22–58 years; mean duration of premature
ejaculation =1.7 1.5 years.
Yoga in Premature Ejaculation 1727
J Sex Med 2007;4:1726–1732
shavasan (Sanskrit—shav =a dead body, lying
dead). That means in the end, the patients per-
formed breathing as mentioned and laid still for
few minutes. In this, they were able to relax those
muscles, which were stretched during yoga. That
is why this is named as “differential relaxation.” All
patients were told to practice mehabhed mudra,
which included doing perineal and pubococcygeal
exercises for 10–15 seconds at a time and for 15–20
times a day. They could do it anywhere including
at their workplace, while, e.g., traveling, reading,
or watching TV.
Statistical Analysis
Statistical analysis was performed using SPSS
version 10 (SPSS Inc., Chicago, IL, USA). Paired
A
C
F
I
J
K
GH
DE
B
Figure 1 Various yoga postures employed during the study (figures run from A to K from top left).
1728 Dhikav et al.
J Sex Med 2007;4:1726–1732
t-test was used to calculate the Pvalue. A Pvalue of
less than 0.05 was considered significant.
Results
We found that all 38 patients in the yoga group
had subjective (Table 4) and statistically significant
(P<0.0001) improvement (Table 5). Twenty-five
of 30 patients of fluoxetine (82.3%) had clinical
improvement in PE (Table 5, P<0.001). The
patients were interviewed at the end of the 4th and
8th weeks. Results in both groups at the 4th week
did not achieve statistical significance, while those
of the 8th week were significant (P<0.001—see
Table 5). A subjective evaluation was carried out by
asking the wife to rate the husband’s performance
and her satisfaction after the end of the study
period (Table 4). A side-effect profile of fluoxetine
based upon patients reporting adverse effects was
prepared (Table 6). None of the side effects,
however, required drug discontinuation.
Yoga was well tolerated by patients who chose
to enroll themselves for this form of treatment.
There were no significant side effects or dropouts
reported during the course of treatment.
Discussion
PE is an extremely common disorder affecting
young males. SSRI, like fluoxetine, is a commonly
used treatment option for PE [6,7]. Although
SSRIs offer several advantages like convenience
of administration and acceptable therapeutic
response, they have disadvantages like failure in
many patients and unacceptable side effects.
Moreover, drug prescription requires a visit to a
sexologist or psychiatrist, an idea with which many
patients of PE may not be fully comfortable. This
is due to stigma with PE. It has been said that most
patients remain unaware that PE is a medical con-
dition. A nonpharmacological treatment option in
PE should, thus, presumably be a welcome idea.
Table 2 Yogasanas followed in the protocol
Kapal bhati Sanskrit—kapal =skull, bhati =bright; “forehead brightener”
Vajarasan Sanskrit—vajra =diamond
Yog mudra Yog =after Yogis, mudra =posture; “symbol of yoga”
Bhujangasan Sanskrit—bhujang =snake, asana =posture; serpent-like posture
Dhanurasan Sanskrit—dhanu =bow, asana =posture; to adopt a bow-like posture
Paschimottoansana Sanskrit—paschim =working on posterior
Gomukasan Sanskrit—gomukh =cow’s mouth
Veerasan A typical sitting posture of soldiers
Ardhmatsyendra mudra Sanskrit—ardha =half, matsyenddra =name of a yogic practitioner, mudra =posture;
“half spinal twisting” exercises
Viparita karani mudra Sanskrit—viprit =opposite, mudra =posture; “legs-up-the-wall pose”
Sarvang Asana “Shoulder stand”
Halasan “Plow posture”
Mehabhed mudra Sanskrit—“great secret”
Agnisar mudra Sanskrit—agni =heat; a series of rapid “abdominal lifts”
Table 3 Brief description of yogasanas used in the present study
1. Kapalbhati (Figure 1A)—Sit straight in squatting posture with eyes closed. Put hands on the knees. Fix the chest and consciously
contract abdominal muscles.
2. Pranayama (Figure 1B)—Sit comfortably with eyes closed in squatting posture. Deep breathing should be done via alternating
nostrils as shown.
3. Yog mudra (Figure 1C)—Take hands to the lower back. Catch the right wrist with the left palm and bend forward.
4. Vajarasan (Figure 1D)—Fold legs at knee joints and sit on the legs, and touch knee caps as shown.
5. Bhujangasan (Figure 1E)—Lie down in prone position and transfer weight on palms. Attempt should be made to stretch the back
muscles.
6. Dhanurasan (Figure 1F)—Body gets a “bow-like shape.”
7. Halasan (Figure 1G)—Lie down flat; then, turn legs overhead while maintaining hands on the ground firmly.
8. Paschimottoasana (Figure 1H)—Sit with legs straight, touch toes, and try to bend the head forward and kiss the toes.
9. Ardhmatsyendra mudra (Figure 1I)—Sit straight, bend right knee, and put it below buttocks. Now cross the left leg and bring it in
front of the right knee.
10. Sarvang asana (Figure 1J)—Lie down straight and gradually lift legs. Then, once adequate lift is achieved; support pelvis and lower
back with the palms of both hands.
11. Shava asana (Figure 1K)—It involves lying relaxed, eyes closed with arms placed on both sides of the body. It relaxes muscles that
are stretched during yogic exercises. In practical terms, this means a posture in which patients lay still with superior and inferior
extremities asunder and perform slow deep breathing with a relaxed mind.
Yoga in Premature Ejaculation 1729
J Sex Med 2007;4:1726–1732
An online medical dictionary defines yoga as
“a way of life that includes ethical precepts,
dietary prescriptions, and physical exercise.” A
large survey shows that about one in every five
adults has used at least one such therapy in the
last 1 year [8].
Pranayama is the method of “proper” breathing.
“The way” we breathe is supposed to have an effect
on the nervous system. By regulating the breath
and increasing oxygenation to the brain cells, it is
supposed to “strengthen” the voluntary and invol-
untary nervous systems. At the beginning of each
of yoga, pranayama practice is performed in order
to prepare patients for the asanas that follow.
The present study is an attempt to explore the
therapeutic potential of yoga as a nonpharmaco-
logical treatment in PE and to compare it to flu-
oxetine, a known treatment option. Fluoxetine
had a response rate of 83.3%, which is in agree-
ment with some of the previously reported
studies [9,10]. Although fluoxetine generally pro-
duces symptomatic improvement at the end of 3
weeks, results of the present study suggest that
improvement may not be noticeable until the
end of 8 weeks, with yoga. Thus, relatively late
improvement can be an important limitation of
the present study. It could, however, be compen-
sated somewhat by some form of counseling. An
additional limitation is that the patients were
given the option of choosing between yoga and
fluoxetine, hence introducing a selection bias.
Three patients chose not to participate in the
present study because of their inability to adhere
to yoga regime.
Although we do not know an exact mechanism
by which yoga is useful in PE, several postulations
could be made about its putative mechanisms of
usefulness. Yogasanas and breathing exercises have
long been considered in obtaining the “optimum
mental and physical health state.” Yoga could
perhaps be causing better anxiety control. This
assertion is supported by several studies [11–14].
One of these studies [11] included 175 patients (98
males, 77 females) between age group 19–76 years
who belonged to the heterogenous group. The
study evaluated anxiety scores using the State Trait
Anxiety Inventory and showed that scores dipped
significantly after yogic exercises. The same study
showed that a measurable decline in anxiety scores
could be achieved as early as within 10 days if the
patients adopt healthy lifestyle interventions con-
sisting mainly of asanas,pranayama and relaxation
techniques [11]. Others have reported that yoga
promotes well-being, improves quality of life [12],
and has an antidepressant effect [13]. Additional
mechanisms contributing to a state of calm alert-
ness include increased parasympathetic drive,
calming of stress response systems, neuroendo-
crine release of hormones, and thalamic genera-
tors [13]. Relaxation induced by meditation helps
to stabilize the autonomic nervous system with a
tendency toward parasympathetic dominance.
Physiological benefits, which follow, may help
practitioners become more resilient to stressful
conditions and may reduce a variety of important
risk factors for various diseases, especially cardio-
respiratory diseases [14]. Two published clinical
trials in obsessive compulsive disorder, an anxiety
disorder using a specific form of yoga known as
kundalini yoga, have been described. This is a form
of yogic exercise consisting of yogic kriyas, mantra
chanting, following a particular dietary pattern,
etc. [15]. A recent meta-analysis, however, has
concluded that although results of studies involv-
ing yoga were positive, the methodology adopted
was poor; hence, deriving conclusions were diffi-
cult. It emphasized the need of future well-
designed studies in this regard [16].
The yogasanas selected in the present study, in
addition to their general putative health benefits,
were primarily aimed at improving the muscle
tone and plasticity of the pelvic and perineal
muscles. Asanas supposedly improve blood flow to
Table 4 Subjective responses of patients with yoga
(n =38)
Satisfaction type Number Percentage
Good 25 65.8%
Fair 13 34.2%
Poor 0 0%
Table 5 Intravaginal ejaculatory latencies of various
study groups*
Group Before After tvalue df Pvalue
1 29.9 15.1 64.1 29.4 5.65 58 <0.0001
2 33.2 17.9 112.8 35.6 12.29 74 <0.0001
*Scores are expressed as mean standard deviation.
Table 6 Adverse effects of fluoxetine in the present
study (N =30)
Adverse drug reaction Number of patients (N) Percentage (%)
Nausea 14 46.6
Vomiting 4 13.3
Anxiety 4 13.3
Insomnia 8 26.6
1730 Dhikav et al.
J Sex Med 2007;4:1726–1732
these muscles and thus aid in their better contrac-
tion. This is probably responsible for local effect of
yogasanas in the present study. Studies have shown
that yoga can improve muscular efficiency [17,18].
In one such study [17], 42 volunteers were taken
and their oxygen utilization during yogic and con-
ventional exercises were studied. The study con-
cluded that a yogic practitioner is likely to perform
better on tasks such as cycling at average pace,
walking at average speed, and tailoring, etc.
Decreased fatigue and increased endurance were
shown in another study after 6 months of training
in yogic exercises [18].
It has been observed that a regular practitioner
of yoga shows parasympathetic dominance [11].
Stimulation of the sympathetic nerves causes
contraction of epididymis, ejaculatory ducts, and
seminal vesicles, and leads to ejaculation of semen.
Increasing parasympathetic stimulation is assum-
ably beneficial in enhancing ejaculatory control.
We report a significant therapeutic effect of yoga
in PE. This is in line with earlier studies, which
have reported the efficacy of yogic exercises in the
treatment of physical disorders [13–15].
What are the potential advantages of yoga as a
treatment option in PE? It is popular with good
acceptability, nonpharmacological, has no costs
involved, and patients could be treated without
medical or psychiatric intervention. Additionally,
it could offer other associated health benefits as
well to the patients [19,20]. Studies have shown
that yogic exercises can reduce basal cortisol, cat-
echolamines, metabolic rate, sympathetic activity,
and oxygen consumption. Parasympathetic activity
has been shown to increase [20].
Physical efficiency, autonomic functions, body
flexibility, and biochemical profile have been noted
to improve following yogasnas [19]. A study involv-
ing 48 Indian soldiers found that performance on
isometeric exercises was better after yoga training
as measured by electromyography and spring
pulling capacity [19].
Yogic exercises have been found to be useful in
a variety of “mind–body” problems. PE is often
perceived as a lifestyle problem [21], thus provid-
ing a window for such therapeutic interventions.
Studies have shown that sufferers of PE have
higher prevalence of lifestyle problems that can
affect the individual at both emotional and physi-
cal levels.
Nonpharmacological treatment options, e.g.,
behavioral therapy and psychotherapy, have long
been the mainstay of the treatment of PE [22].
These could be cumbersome and can have limited
efficacy indicating that other nonpharmacological
treatments could be desirable. Although yoga was
found to be a well-tolerated and effective treat-
ment option for PE, the therapeutic response was
delayed by 8 weeks. This is in contrast to SSRIs,
which produce symptomatic relief by the 3rd or
4th week. Some form of counseling on the part of
the physician and patience on part of patients may
be required for satisfactory results.
The etiology of PE is multifactorial; hence,
failure to appreciate this makes the diagnosis dif-
ficult and the treatment harder. Therefore, treat-
ment of PE is undergoing change in recent times
and it is suggested that an integrated approach
should be adopted [23]. This combination therapy
has become more relevant as patients relapse [23]
frequently after taking drugs and has side effects
like dry mouth, nausea, drowsiness, and reduced
libido. Its use may also facilitate the development
of other sexual dysfunctions, such as anejaculation
and erectile dysfunction [24]. Furthermore, it has
been considered that because PE involves both
psychosocial [25] and physiological components
[26], both should be addressed. It is hoped that
such a combination approach would result in pro-
longed ejaculatory latency, improved treatment
satisfaction, and superior long-term outcome. We
have tried to explore the possibility of yoga as a
nonpharmacological treatment in PE. This is
because, as stated earlier [22], nonpharmacological
treatments have been important treatment options
in this condition. A significant therapeutic benefit
of yoga is reported in the study.
Conclusions
PE is the most common male sexual disorder that
is both underdetected and undertreated. It is often
distressing and patients do not come forward for
treatment easily. This is due to shyness, stigma,
feeling of inferiority, and shame in front of the
partner. Yoga seems to be a well-tolerated, safe and
effective nonpharmacological treatment option for
PE. The present study reinforces that the “mind–
body” interventions could be beneficial in stress-
related mental and physical disorders. Because
ours is a pilot study with a small sample size, it
would be worthwhile to do more studies involving
a large number of patients in a double-blind
manner to establish yoga as a nonpharmacological
treatment option for PE.
Corresponding Author: Vikas Dhikav, Dr. RML Hos-
pital and PGIMER, GGS-IP University—Neurology,
Yoga in Premature Ejaculation 1731
J Sex Med 2007;4:1726–1732
E\3, Flat Number-280 Sector-18, Delhi Rohini
110085, India. Tel: +91-9910011205; Fax: 011-
26865165; E-mail: vikasdhikav@hotmail.com,
va212001@yahoo.com
Conflict of Interest: None declared.
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... For selecting useful yoga postures/ techniques for PME patients in this study, investigators studied previous research, relevant yoga literature, and also consulted yoga experts. [19][20][21][22][23] ...
... Most of the participants in our study were in their thirties, as also found previously in both hospital-based prevalence and intervention studies among Indian patients with PME. [3][4][5]19] There are no data to directly compare our findings as there is no previous study which compared yoga with paroxetine for the treatment of PME with measurement of IELT. Dhikav et al. compared yoga with fluoxetine in 65 males with PME and found that response in the yoga group was relatively delayed. ...
... Dhikav et al. compared yoga with fluoxetine in 65 males with PME and found that response in the yoga group was relatively delayed. [19] However, they did not find a significant increase in IELTs after intervention in both the groups before 8 weeks. However, in our study, the difference in mean IELTs in each group was significant at all points of measurement. ...
Article
Context: Premature ejaculation (PME) is a common sexual disorder. Drugs used commonly used for its treatment have various side effects and disadvantages. Yoga is being increasingly studied in a variety of medical disorders with positive results. However, its evidence for patients with PME is very limited. Aims: The aims of this study were to investigate the effect of yoga on ejaculation time in patients with PME and to compare it with paroxetine. Settings and design: This was a nonrandomized nonblinded comparative study in a tertiary care center. Materials and methods: Among patients with PME, 40 selected paroxetine and 28 yoga. Intravaginal ejaculation latency time (IELT) was measured in seconds once before and three times after intervention. Statistical analysis used: Mean, standard deviation, paired and unpaired t-tests, and repeated measures ANOVA were used for statistical analysis. Results: IELT was significantly increased in both groups - paroxetine (from 29.85 ± 11.9 to 82.19 ± 32.9) and yoga (from 25.88 ± 16.1 to 88697 + 26.9). Although the effect of yoga was slightly delayed in onset, its effect size (η2 = 0.87, P < 0.05) was more than paroxetine (η2 = 0.73, P < 0.05). One-fifth of the patients in the paroxetine group (19.5%) and 8% in the yoga group continued to have the problem of PME at the end of the trial. Conclusions: Yoga caused improvement in both intravaginal ejaculation latency time and subjective sexual experience with minimal side effect. Therefore, yoga could be an easily accessible economical nonpharmacological treatment option for the patient with PME.
... There are few studies including Yoga therapy has been conducted for treatment of Premature ejaculation. In their, some were non-comparative [17] , some were comparative [18 ] , some were randomized control studies [19][20][21] and one study was pilot [21 ] . In these studies Asanas [17][18][19][20][21][22] , Pranayama ( breathing practice) [17][18][19][20][21][22] , Bandha (Hathyogic locks) [17] , mudra [17][18][19][20][21][22] , cleansing practices [17] and relaxation [17][18] were used as Yoga therapy for 45-60 minutes/days. ...
... In their, some were non-comparative [17] , some were comparative [18 ] , some were randomized control studies [19][20][21] and one study was pilot [21 ] . In these studies Asanas [17][18][19][20][21][22] , Pranayama ( breathing practice) [17][18][19][20][21][22] , Bandha (Hathyogic locks) [17] , mudra [17][18][19][20][21][22] , cleansing practices [17] and relaxation [17][18] were used as Yoga therapy for 45-60 minutes/days. These studies had compared with stop-start method [19 ] , pelvic floor exercise [20] , Naturopathy techniques [21] and Ayurvedic Medico-legal Update, April-June2022, Vol. ...
... In their, some were non-comparative [17] , some were comparative [18 ] , some were randomized control studies [19][20][21] and one study was pilot [21 ] . In these studies Asanas [17][18][19][20][21][22] , Pranayama ( breathing practice) [17][18][19][20][21][22] , Bandha (Hathyogic locks) [17] , mudra [17][18][19][20][21][22] , cleansing practices [17] and relaxation [17][18] were used as Yoga therapy for 45-60 minutes/days. These studies had compared with stop-start method [19 ] , pelvic floor exercise [20] , Naturopathy techniques [21] and Ayurvedic Medico-legal Update, April-June2022, Vol. ...
Article
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Background: Premature Ejaculation is a common sexual disorder which negatively affects men's life. Premature Ejaculation estimate prevalence is 20-30 %. It affects to overall quality of life and associated with anxiety, stress, and other psychological factors.
... Prospektif çalışmalarda IELT'yi uzatmada önemli ölçüde etkinlik göstermiştir. [83] Buna karşın, bazı çalışmalar plaseboya kıyasla yoganın iyileştirici etkisinin olmadığını bildirmiştir. [84] ...
... Some evidence suggests that yoga may potentially be useful in managing constipation, 74,75 improving sleep quality and sleep architecture, 19,76 increasing appetite, 77 and reducing sexual dysfunction. [78][79][80] In addition to the above-mentioned effects, a yogabased lifestyle may also help improve adherence and compliance with conventional treatments for OUD. 81 Thus, yoga therapy may serve as a useful low-cost and low-risk adjunct therapy in management of OUD. ...
Article
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Context: Opioid use disorder (OUD) involves excessive use of opioids-such as heroin, morphine, fentanyl, codeine, oxycodone, and hydrocodone-leading to major health, social, and economic consequences. Yoga lifestyle interventions have been found to be useful as adjunct therapies in management of substance use disorders and chronic pain conditions. Objective: The research team intended to develop, validate, and test for feasibility a yoga program for OUD patients that could reduce opiate withdrawal symptoms-such as pain, fatigue, low mood, anxiety and sleep disturbances-and cravings associated with drugs. Design: The research team first performed a literature review of traditional and contemporary yoga texts, such as Hatha Yoga Pradipika and Light on Yoga, as well as modern scientific literature in the following search engines-Google Scholar, PubMed, and PsychInfo, using the keywords yoga, pranayama, hatha yoga, relaxation. meditation, substance use, addiction, impulsivity, craving, sleep quality, and fatigue. Using the information obtained, the team developed a yoga program and designed a pilot study that used the program. Setting: The study took place in the Department of Integrative Medicine at the National Institute of Mental Health and Neurosciences (NIMHANS) in Bangalore, India. Participants: Participants in the pilot study were 8 inpatients, 6 males and 2 females, who were on opioid agonist treatment (buprenorphine) for OUD. Intervention: The intervention was the yoga program previously validated by the research team. In the pilot study, participants were taught a one-hour, yoga-based intervention, with sessions occurring once per day, for 10 sessions. Outcome measures: For validation, 13 experts scored the yoga program that the research team had developed and gave suggestions for each yogic practice for use during the acute phase of withdrawal and the maintenance phase respectively. A content validity ratio (CVR) was calculated from their scoring, and the research team made changes to the program based on the scoring and suggestions. For the pilot study, assessments occurred at baseline and postintervention. The participants' yoga performance was rated by the yoga trainer on a yoga performance assessment scale (YPA). Other measurements included: (1) the Clinical Opiate Withdrawal Scale (COWS), (2) the Hamilton's anxiety rating scale (HAM-A), (3) the Hamilton's depression rating scale (HAM-D), (4) buprenorphine dosage, (5) the Clinical Global Impression Severity (CGI-S) scale, (6) a visual analog scale (VAS) for pain, (7) sleep quality (latency and duration), and (8) the module's safety. Results: Four practices were removed from the program due to CVR scores below the cutoff, and one practice was found not to be feasible (Kapalabhati). Two categories of yoga modules emerged: (1) for the acute symptomatic phase (40 minutes) and (2) for the maintenance phase (one hour). Practices were added or excluded based on the phase. Conclusions: The yoga module that was developed for reducing withdrawal symptoms and cravings in OUD patients was found to be safe, feasible, and potentially useful as an adjunct therapy to conventional treatment.
... The therapies for PE have already been extensively studied; however, an increasing number of treatments are emerging, such as yoga, sphincter control training (SCT), acupuncture and masturbation (Cui et al., 2017;Dhikav, Karmarkar, Gupta, & Anand, 2007;Liu et al., 2019;Ma, Zou, Lai, Zhang, & Zhang, 2018;Rodríguez, Marzo, & Piqueras, 2019 First, we analysed the efficacy of the drug for less than 8 weeks of treatment. Topical creams and 9 drugs (SSRI + PDE5i, PDE5i, sertraline, clomipramine, paroxetine, dapoxetine 60 mg, dapoxetine 30 mg, fluoxetine and citalopram) were significantly better than placebo. ...
Article
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To assess the comparative efficacy and safety of drug treatments for premature ejaculation. A systemic review and Bayesian network meta-analysis were executed on randomised controlled trials of drug interventions for premature ejaculation. Intravaginal ejaculation latency time and related adverse effects were outcome measures. A total of 44 RCTs with 11,008 patients were included in our NMA. In therapy <8 weeks, the ranking of drug efficacy was topical creams >selective serotonin reuptake inhibitor (SSRI)+ phosphodiesterase 5 inhibitor (PDE5i) > PDE5i > sertraline > clomipramine > paroxetine > dapoxetine 60 milligram (mg) > dapoxetine 30 mg > fluoxetine>citalopram > duloxetine>placebo. In therapy ≥ 8 weeks, the ranking of drug efficacy was SSRI + PDE5i > topical creams > paroxetine > tramadol > PDE5i > fluoxetine > dapoxetine 60 mg > dapoxetine 30 mg > clomipramine>citalopram > placebo. For total adverse events, clomipramine, dapoxetine 30 mg, dapoxetine 60 mg, paroxetine, PDE5i, SSRI + PDE5i and tramadol had a higher risk than placebo. In conclusion, in ≥8 weeks of therapy, the drug combination of SSRI + PDE5i was the most effective PE therapy. In <8 weeks of therapy, the efficacy of local anaesthetics was best. All drug treatments were ranked better than placebo. In general, drugs with better effects had more obvious side effects.
Chapter
Several topics in alternative medicine comprise not a single modality but entire families of treatments that have similar aims or originate from similar traditions. These umbrella topics are discussed in this chapter.
Article
Résumé Objectif La présente revue vise à tirer les enseignements généraux de plusieurs décennies de recherches empiriques consacrées aux traitements psycho-comportementaux de l’éjaculation prématurée. Méthode Trente-trois essais faisant état de mesures avant et après traitements psycho-sexologiques ont été rassemblés et analysés. Résultats Les taux d’amélioration associés aux sexothérapies s’échelonnent de 25 % à 100 %, leur taille d’effet globale (d) se situe entre 0,83 et 3,75. L’efficacité des traitements requière la réalisation d’exercices de stimulation pénienne avec pauses (« stop-start ») et/ou d’exercices visant à la régulation des composantes discrètes de l’excitation (approche « régulatrice » ou « sexo-fonctionnelle »). Il n’est pas sûr que les variantes faisant appel à des pincements (« squeeze »), à l’utilisation d’un vibreur ou à un mode particulier de masturbation produisent un surcroît d’efficacité. Quant aux exercices centrés sur le renforcement de la musculature pelvienne, ils ne semblent guère pertinents. Les traitements les plus efficaces sont également ceux qui permettent un accompagnement visant à optimiser l’intégration par les bénéficiaires des principes thérapeutiques et à aborder avec eux d’éventuelles difficultés associées. En cela les formules d’auto-traitement apparaissent moins performantes. La combinaison d’une sexothérapie et d’une pharmacothérapie donne généralement lieu à des résultats supérieurs à ceux obtenus individuellement de chacune de ces deux options. Conclusions Les recherches empiriques cumulées sur plusieurs décennies accréditent l’utilité des sexothérapies dans le domaine de l’éjaculation prématurée et spécifient leurs conditions d’efficacité.
Article
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Background: Premature ejaculation (PE) is a common problem among men that occurs when ejaculation happens sooner than a man or his partner would like during sex; it may cause unhappiness and relationship problems. Selective serotonin re-uptake inhibitors (SSRIs), which are most commonly used as antidepressants are being used to treat this condition. Objectives: To assess the effects of SSRIs in the treatment of PE in adult men. Search methods: We performed a comprehensive search using multiple databases (the Cochrane Library, MEDLINE, Embase, Scopus, CINAHL), clinical trial registries, conference proceedings, and other sources of grey literature, up to 1 May 2020. We applied no restrictions on publication language or status. Selection criteria: We included only randomized controlled clinical trials (parallel group and cross-over trials) in which men with PE were administered SSRIs or placebo. We also considered 'no treatment' to be an eligible comparator but did not find any relevant studies. Data collection and analysis: Two review authors independently classified and abstracted data from the included studies. Primary outcomes were participant-perceived change with treatment, satisfaction with intercourse and study withdrawal due to adverse events. Secondary outcomes included self-perceived control over ejaculation, participant distress about PE, adverse events and intravaginal ejaculatory latency time (IELT). We performed statistical analyses using a random-effects model. We rated the certainty of evidence according to GRADE. Main results: We identified 31 studies in which 8254 participants were randomized to receiving either SSRIs or placebo. Primary outcomes: SSRI treatment probably improves self-perceived PE symptoms (defined as a rating of 'better' or 'much better') compared to placebo (risk ratio (RR) 1.92, 95% confidence interval (CI) 1.66 to 2.23; moderate-certainty evidence). Based on 220 participants per 1000 reporting improvement with placebo, this corresponds to 202 more men per 1000 (95% CI 145 more to 270 more) with improved symptoms with SSRIs. SSRI treatment probably improves satisfaction with intercourse compared to placebo (defined as a rating of 'good' or 'very good'; RR 1.63, 95% CI 1.42 to 1.87; moderate-certainty evidence). Based on 278 participants per 1000 reporting improved satisfaction with placebo, this corresponds to 175 more (117 more to 242 more) per 1000 men with greater satisfaction with intercourse with SSRIs. SSRI treatment may increase treatment cessations due to adverse events compared to placebo (RR 3.80, 95% CI 2.61 to 5.51; low-certainty evidence). Based 11 study withdrawals per 1000 participants with placebo, this corresponds to 30 more men per 1000 (95% CI 17 more to 49 more) ceasing treatment due to adverse events with SSRIs. Secondary outcomes: SSRI treatment likely improve participants' self-perceived control over ejaculation (defined as rating of 'good' or 'very good') compared to placebo (RR 2.29, 95% CI 1.72 to 3.05; moderate-certainty evidence). Assuming 132 per 1000 participants perceived at least good control, this corresponds to 170 more (95 more to 270 more) reporting at least good control with SSRIs. SSRI probably lessens distress (defined as rating of 'a little bit' or 'not at all') about PE (RR 1.54, 95% CI 1.26 to 1.88; moderate-certainty evidence). Based on 353 per 1000 participants reporting low levels of distress, this corresponds to 191 more men (92 more to 311 more) per 1000 reporting low levels of distress with SSRIs. SSRI treatment probably increases adverse events compared to placebo (RR 1.71, 95% CI 1.48 to 1.99; moderate-certainty evidence). Based on 243 adverse events per 1000 among men receiving placebo, this corresponds to 173 more (117 more to 241 more) men having an adverse event with SSRIs. SSRI treatment may increase IELT compared to placebo (mean difference (MD) 3.09 minutes longer, 95% CI 1.94 longer to 4.25 longer; low-certainty evidence). Authors' conclusions: SSRI treatment for PE appears to substantially improve a number of outcomes of direct patient importance such as symptom improvement, satisfaction with intercourse and perceived control over ejaculation when compared to placebo. Undesirable effects are a small increase in treatment withdrawals due to adverse events as well as substantially increased adverse event rates. Issues affecting the certainty of evidence of outcomes were study limitations and imprecision.
Article
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Introduction. Premature ejaculation is a common sexual problem in men. Although the etiology is unclear, there is emerging evidence that men from different ethnic backgrounds may be more at risk. Aim and Objective. The aim of this study was to generate themes and hypotheses around the etiology of premature ejaculation with particular reference to men from Islamic backgrounds. Methods. This is ail explorative qualitative study using semi-structured interviews with 10 male volunteers with a clinical diagnosis of premature ejaculation. Interviews were tape-recorded and transcribed. Transcriptions were then hand-coded and analyzed using grounded theory. Results. Anxious first sexual experience (with subtheme: fear of being discovered and wanting to finish early); sex before marriage; sex outside of marriage; religion; "stress;" exposure to Western images; living in the United Kingdom; and the subsequent feeling of freedom were themes that emerged from the transcripts. Conclusions. We have identified factors associated with premature ejaculation in patients with Islamic backgrounds attending our unit. This may have useful therapeutic implications when consulting Islamic men with premature ejaculation.
Article
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Introduction. Premature ejaculation is a common sexual problem in men. Although the etiology is unclear, there is emerging evidence that men from different ethnic backgrounds may be more at risk. Aim and Objective. The aim of this study was to generate themes and hypotheses around the etiology of premature ejaculation with particular reference to men from Islamic backgrounds. Methods. This is an explorative qualitative study using semi-structured interviews with 10 male volunteers with a clinical diagnosis of premature ejaculation. Interviews were tape-recorded and transcribed. Transcriptions were then hand-coded and analyzed using grounded theory. Results. Anxious first sexual experience (with subtheme: fear of being discovered and wanting to finish early); sex before marriage; sex outside of marriage; religion; “stress;” exposure to Western images; living in the United Kingdom; and the subsequent feeling of freedom were themes that emerged from the transcripts. Conclusions. We have identified factors associated with premature ejaculation in patients with Islamic backgrounds attending our unit. This may have useful therapeutic implications when consulting Islamic men with premature ejaculation. Richardson D, Wood K, and Goldmeier D. A qualitative pilot study of Islamic men with lifelong premature (rapid) ejaculation. J Sex Med 2006;3:337–343.
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The ancient system of Kundalini yoga includes a vast array of meditation techniques and many were discovered to be specific for treating the psychiatric disorders as we know them today. One such technique was found to be specific for treating obsessive-compulsive disorder (OCD), the fourth most common psychiatric disorder, and the tenth most disabling disorder worldwide. Two published clinical trials are described here for treating OCD using a specific Kundalini yoga protocol. This OCD protocol also includes techniques that are useful for a wide range of anxiety disorders, as well as a technique specific for learning to manage fear, one for tranquilizing an angry mind, one for meeting mental challenges, and one for turning negative thoughts into positive thoughts. Part of that protocol is included here and published in detail elsewhere. In addition, a number of other disorder-specific meditation techniques are included here to help bring these tools to the attention of the medical and scientific community. These techniques are specific for phobias, addictive and substance abuse disorders, major depressive disorders, dyslexia, grief, insomnia and other sleep disorders.
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OBJECT: Research demonstrating connections between the mind and body has increased interest in the potential of mind-body therapies. Our aim was to examine the use of mind-body therapies, using data available from a national survey. DESIGN: Analysis of a large nationally representative dataset that comprehensively evaluated the use of mind-body therapies in the last year. SETTING: United States households. PATIENTS/PARTICIPANTS: A total of 2,055 American adults in 1997–1998. INTERVENTIONS: Random national telephone survey. MEASURES AND MAIN RESULTS: We obtained a 60% weighted overall response rate among eligible respondents. We found that 18.9% of adults had used at least 1 mind-body therapy in the last year, with 20.5% of these therapies involving visits to a mind-body professional. Meditation, imagery, and yoga were the most commonly used techniques. Factors independently and positively associated with the use of mind-body therapies in the last year were being 40 to 49 years old (adjusted odds ratio [AOR], 2.03; 95% confidence interval [CI], 1.33 to 3.10), being not married (AOR, 1.78; 95% CI, 1.34 to 2.36), having an educational level of college or greater (AOR, 2.21; 95% CI, 1.57 to 3.09), having used self-prayer for a medical concern (AOR, 2.53; 95% CI, 1.87 to 3.42), and having used another complementary medicine therapy in the last year (AOR, 3.77; 95% CI, 2.74 to 5.20). While used for the full array of medical conditions, they were used infrequently for chronic pain (used by 20% of those with chronic pain) and insomnia (used by 13% of those with insomnia), conditions for which consensus panels have concluded that mind-body therapies are effective. They were also used by less than 20% of those with heart disease, headaches, back or neck pain, and cancer, conditions for which there is strong research support. Mind-body therapies were generally used concomitantly with conventional care: 90% of those using a mind-body therapy in the last year had seen a physician and 80% of mind-body therapies used were discussed with a physician. CONCLUSIONS: Although mind-body therapies were commonly used, much opportunity exists to increase use of mind-body therapies for indications with demonstrated efficacy.
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We compare the efficacy and side effects of 90 mg fluoxetine once weekly versus 20 mg fluoxetine as single oral therapy for patients complaining of premature ejaculation without evident organic causes. The study comprised 80 patients with a mean age of 36 years with premature ejaculation who presented to the urology clinic of 3 hospitals in Barcelona. Pretreatment evaluation included history and physical examination, International Index of Erectile Function (IIEF), Meares-Stamey test and ejaculatory latency time evaluation. The patients were randomized into treatment groups receiving 1 capsule of 90 mg fluoxetine a week (group 1) and 1 capsule of 20 mg fluoxetine a day (group 2) for 3 months. The 4-month followup included: ejaculatory latency time measurement, IIEF and partner sexual satisfaction. Mean pretreatment ejaculatory latency times for groups 1 and 2 were 0.48 minute (range 0 to 2.10) and 0.50 minute (0 to 2.04), respectively. After 3 months of treatment of weekly and daily administration of fluoxetine mean ejaculatory latency time was 3.57 and 3.37 minutes, respectively (p >0.01). Partner sexual satisfaction and IIEF rate were greater with 90 mg fluoxetine but no statistical difference was found. Nausea, insomnia and headache were reported side effects but no significant difference was noted between 90 and 20 mg fluoxetine. In men with premature ejaculation 90 mg fluoxetine weekly may be regarded as an effective and safe treatment.
Article
The introduction of selective serotonin reuptake inhibitors (SSRIs) has revolutionized our understanding of the treatment of premature ejaculation. Lifelong premature ejaculation may be a neurobiological phenomenon, namely part of a biological variability of the intravaginal ejaculation latency time in men. Animal studies support this view, and an animal model for premature and delayed ejaculation has recently been developed. It is proposed that drug treatment of premature ejaculation should consist of 5-hydroxytryptamine (5-HT)2c receptor stimulation and/or 5-HT1A receptor inhibition. A meta-analysis of 35 daily treatment studies with selective serotonin reuptake inhibitors (SSRIs) and clomipramine demonstrated comparable efficacy of clomipramine with the SSRIs sertraline and fluoxetine in delaying ejaculation, whereas the efficacy of the SSRI paroxetine was greater than all other SSRIs and clomipramine. It is postulated that acute treatment with SSRIs, including those with short half-lives, will not produce an ejaculation delay equivalent to that induced by daily treatment of SSRIs.
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The state of the mind and that of the body are intimately related. If the mind is relaxed, the muscles in the body will also be relaxed. Stress produces a state of physical and mental tension. Yoga, developed thousands of years ago, is recognized as a form of mind-body medicine. In yoga, physical postures and breathing exercises improve muscle strength, flexibility, blood circulation and oxygen uptake as well as hormone function. In addition, the relaxation induced by meditation helps to stabilize the autonomic nervous system with a tendency towards parasympathetic dominance. Physiological benefits which follow, help yoga practitioners become more resilient to stressful conditions and reduce a variety of important risk factors for various diseases, especially cardio-respiratory diseases.