Indian Journal of Ancient Medicine and Yoga

195
Review article Volume 5 Number 4, October - December 2012

Systemic Review and Critical Analysis of Research Work

on Premature Ejaculation

Prasad V. Kulkarni*, Chandola HM**

Abstract:
Premature Ejaculation (PE) is a common male sexual dysfunction. Anxiety & stress are the main
triggering factors for PE. In modern science, many researches had been carried out to overcome this
problem but still there is no any established line of therapy. In Institute for Post Graduate Training &
Reaserch in Ayurveda, Jamangar various works had been carried out on different formulation to treat this
condition. The present study deals with systemic review and critical analysis of such 14 research studies.
Keywords: Premature Ejaculation; Shukragat Vata; Anxiety, Vajikarana.

Introduction due to a psychologically overanxious

personality was first suggested by Schapiro in
1943. He classified PE as primary (lifelong) or
Premature Ejaculation is a common male secondary (acquired)[5].
sexual disorder, affecting on average 40% of
men worldwide[1]. The World Health Vajikarana is one of the branches of Ayurveda
Organization (WHO) 2nd International which deals with the preservation and
Consultation on Sexual Health defined it as amplification of sexual potency of a healthy
“persistent or recurrent ejaculation with man and conception of healthy progeny as
minimal stimulation before, on or shortly after well as management of defective semen ,
penetration and before the person wishes it, disturbed sexual potency and spermatogenesis
over which the sufferer has little or no along with treatment of seminal related
voluntary control which causes the sufferer disorders in man[6].Vajikarana promotes the
and / or his partner bother or distress”[2]. An sexual capacity and performance as well as
increased susceptibility to premature improves the physical , psychological and
ejaculation in men from the Indian social health of individual[7]. A recent
subcontinent has been reported[3]. Kinsey’s multinational community-based age-ranging
observation that Asian men have shorter times study of an unselected “normal” population
to ejaculation than Caucasians, who in turn of 500 heterosexual couples involving
have shorter times to ejaculation than Afro- stopwatch timing of the intravaginal
Caribbean’s, has been interpreted to suggest ejaculatory latency time (IELT) during sexual
that some races are more “sexually restrained” intercourse, has provided previously lacking
than others[4]. The premise that premature normative data[8].
ejaculation is a psychosomatic disturbance Most of the clinical research studies on
sexual dysfunctions dealt in general under the
Author’s Affiliation: *MD Scholar, Dept of Kayachikitsa, heading of Klaibya were carried out at Post
**Professor & Head - Kayachikitsa, Institute for Post Graduate
Teaching & Research in Ayurveda, Gujarat Ayurved
graduate and PhD level at IPGT&RA,
University, Jamnagar – 361 008. Jamnagar.
Reprint’s request: Dr. Prasad Kulkarni, M.D.(Ayu) The term Shukragata Vata is used in three
Scholar, Dept. of Kayachikitsa, Institute for Post Graduate
Teaching & Research in Ayurveda, Gujarat Ayurved studies while only one study had been carried
University, Jamnagar – 361 008. out under the term Shukravruta Vata. Few
E-mail: [email protected] studies were conducted to assess the clinical
(Received on 21.02.2012, accepted on 22.03.2012) efficacy of single herbs viz. Erandmula churna
Volume 5 Number
©Red Flower 4, October
Publication Pvt.Ltd- December 2012
196 Prasad V. Kulkarni & Chandola HM / Systemic Review and Critical Analysis of
Research Work on Premature Ejaculation

(Ricinus communis Linn.), Bramhi (Bacopa duration of sexual act and frequency of coitus
monnieri Linn), Mandukaparni (Centella asatica (p<0.001)[11].
Linn.), Amalaki(Embelica officinalis Gaerten.), Swarna Bhasma (gold element) in a dose of
and Jatifala (Myrisitca fragrance Houtt.). Some 4mg twice daily for 1 month (n=15) showed
work establish the efficacy of compound that the duration of sexual act was improved
formulations like Akarkarbhadi Yoga , Rasayana by 147.2%; though statistically insignificant.
Vati , Manasmitra Vatak , Katafaladi kwath ; Aatmagupta Churna (Mucuna pruita Hook.) in
whereas few clinical works were conducted a dose of 3gms twice daily for 1 month (n=12)
to assess the efficacy of mineral compounds showed statistically significant result in
such as Swarnabhasma , Rasa sindur[9]. A few duration of sexual act (p<0.001)[12].
studies were conducted to evaluate the
efficacy of Shodhana Karma (bio purification) In another clinical study; Ushir Kwatha
in Premature Ejaculation & Basti and (Vetiveria zizanioids Nash.) and Sariva Churna
Shirodhara proved to be effective in its (Hemidesmus indicus R.Br.) when separately
management. administered to the patients of PE; it showed
improvement in ejaculatory score in both the
Systemic review of clinical trials on groups by 17.86% & 11.09% respectively,
Premature Ejaculation: however results were statistically
Akarakarabhadi Yoga (Aakarkarbha- insignificant[13].
Anacyclus pyrethrum Linn., Jatifala -Myrisitca Bhallataka Vati when administered without
fragrance Houtt.), showed highly significant shodhana (biopurification), and after shodhana
improvement (p< 0.001) in approximate time viz. Vamana (emesis) & Virechana (purgation),
taken for ejaculation, completion of coitus and has shown improvement in duration of sexual
satisfaction of female partner. Better relief was act by 14.65% (p<0.001) and 23.17% (p<0.05)
observed in Agnimandya (loss of apetite), respectively[14].
Bhrama (giddiness), Tamodarshana (darkness
in front of eyes), Shirashoola (headache), Amalakadi Churna 6gms thrice daily
Manasa Cancalya (mental fluctuation), (Amalaki -Embelia officinalis Gaerten., Kapikacchu
Kamnivrutti (loss of libido) and Heenabhavana -Mucuna pruita Hook., Shatavari -Asparagus
(inferiority complex)[10]. racemosus Willd.) along with Katphaladi kwatha
- Kataphala, Shati, khadir; 30 ml once daily
Shukradushti patients treated with 3 (n=11) for two months and in another group
compound drugs - 1)Musalyadi Churna (Shewta of 6 patients Swarna Bhasma administered 5mg
musali - Asparagus adscendens Roxb. twice daily with milk (30 ml) for same duration
,Ashvagandha-Withania somnifra Linn, showed a comparative better result of 147.2%
Shatavari- Asparagus racemosus Willd.), in a (p>0.05) in comparison to Amalakadi churna,
dose of 6gms thrice daily with milk (n=14); katphaladi kwatha combination 47.3%
2)Bhallataka Falmajjadi Avaleha (Semecarpus (p<0.001)[15].
anacardium Linn.) in a dose of 30 gm in two
divided dose/day with milk (n=6); 3) Baladi Vrushya Basti (Bala, atibala,
Narasimha Churna (Shatavari - Asparagus Atmagupta, Apamarga, Kalak Dravya, milk,
racemosus Willd., Gokshur -Tribulus terrestris jaggery, Tila Tail ,Saindhava) in the dose of 600
Linn., Varahi -Dioscorea bulbifera Linn., Bhallatak ml once a day for 10 days and after a gap of 1
- Semecarpus anacardium Linn., Chitrak - week same course repeated (n=6), in
Plumbago zelynica Linn., Amalaki- Embelia comparison to Shatavaryadi yoga (Shatavari,
officinalis Gaerten., Masha -Phaseolus mungo Nagbala, Vidari, gokshura, Amalaki) in the dose
Linn., milk, sugar, honey & cow’s ghee) in a of 6gms twice daily with anupana of Ghrita and
dose of 18gms in two divided dose/day with milk (n=10); provided better relief in all sexual
milk (n=6) for duration of 60 days,showed that parameters[16].
Narasimha Churna provided better result in A psychotropic drug Brahmi
(Bacopa.monnieri Linn.) caused highly

Indian Journal of Ancient Medicine and Yoga

 Prasad V. Kulkarni & Chandola HM / Systemic Review and Critical Analysis of 197
Research Work on Premature Ejaculation

significant improvement in performance seminal parameters. The overall effect of

anxiety (75%) and Mandukaparni (Centella therapy was higher in group III with better
asiatica Urban.) showed 44.41% improvement percentage of cure and marked improvement
in performance anxiety which was statistically as compared to group II and group I[20].
insignificant[17]. While analyzing the therapeutic efficacy of
Erandmula Churna in the dose of 3 gms twice Shirodhara , patients of PE showed that in
daily with water (n=28) and Kapikacchu Beeja group A (Placebo - roasted wheat tablets),
Churna was administered in the dose of 3 gms 12.5% subjects had moderate improvement
twice daily with water(n=28) for 1 month in while 87.5% remained unchanged; while in
separate groups showed that Erandmula was the group B treated with Tab. Rasayana Yoga.
better in improving seminal parameters, while (Brahmi, Gokshura, Guduchi, Amalaki and
Kapikacchu was proved more effective on Jatamansi), 56.2% subjects showed marked
sexual parameters[18]. and 43.8% moderate improvement. In group
In another study three separate drugs were C treated with Tab. Rasayana Yoga along with
evaluated viz. Swarna Bhasma (n=10) 10mg Shirodhara (Tila Taila- Seasum oil), 10.5%
twice daily for 30 days with milk as Anupana ; subjects were cured, 79% showed marked
Kokilaksha Beeja Churna (n=25) 5gms thrice improvement while 10.5% had moderate
daily for 30 days and Ashvagandha Churna improvement[21].
(n=33) 3 gms twice daily for 30 days with milk In another study carried out on
as Anupana. In nut shell, Ashvagandha Akarkarbhadi Yoga (n=15); it was revealed that
increased sexual desire (28%); erection (23%) the intra-vaginal ejaculatory latency time
and ejaculation score (33%)[19]. improved by 50.00%, voluntary control over
Psychological counselling has its own ejaculation improved by 56.25%,Subjects
importance in treatment of Premature satisfaction by 79.82%,Partner satisfaction
ejaculation. These patients were subjected to improved by 69.16%, Performance anxiety by
I) Placebo + psychological counselling, 59.37 %,number of penile thrusts improved
II)Akarakarabhadi + psychological counselling, by 63.73%. Improvement of patient
III) Yapanavasti + Akarakarabhadi + satisfaction, partner’s satisfaction and number
psychological counseling. It was observed that of penile thrusts were statistically highly
reduction in ejaculatory score and significant (p<0.001); with significant
improvement in the performance was 36.58%, improvement (p<0.05) in IELT. The voluntary
49.81% and 55.37% at significant level control over ejaculation and performance
(p<0.001) respectively in these three groups. anxiety was significant[22].
The number of penile thrusts and duration of Comparing the therapeutic efficacy of kala
sexual act were more than doubled in groups basti it was administered by traditional basti
I & II at significant level (p<0.001). The number putak method (n=6) and Enema pot Method
of penile thrusts improved more than 4 times (n=6) in rainy season (Varsha and Pravrit ritu)
and than 7 times in group III. Analysis of with two placebo capsules each of 250 mg
GRISS questionnaire showed that a twice daily with milk for 30 days (during
considerable number of patients (27%) in follow up period) to avoid drop out from
group III achieved certain voluntary control study. Kala Basti are 16 in number. Out of 16,
over ejaculation (p<0.01). Performance anxiety ten Anuvasana Basti with 1 ml of Erand Taila
was considerably reduced in group II and III were administered in both the groups. The
(61.29% and 69.80% resepetively) than Group patients were subjected for Abhyanga (massage)
I (45.31%) all at significant levels (p<0.001). with Bala Taila and Bashpa Sweda (steam
Satisfaction of partner and self were sudation) prior to administration of Basti in
considerably improved in group III (p<0.001) both the groups.Basti given by Basti putak
followed by group II and group I. Neither significantly increased the erectile function by
therapy showed any significant changes in 75%, sexual desire by 73.33%, ejaculatory

Volume 5 Number 4, October - December 2012

198 Prasad V. Kulkarni & Chandola HM / Systemic Review and Critical Analysis of
Research Work on Premature Ejaculation

function by 72.22%, frequency of coitus by The line of management described by

60%, duration of coitus by 35%. Whereas , Acharyas for Shukragata vata in the classics is
Basti given by Enema pot increase the erectile more or less same. Praharsha anna, balya and
function by 53.33%, sexual desire by 68.75%, Shukrakara drugs should be administered in
ejaculatory function by 52.63%, frequency of Shukragata vata. If Shukra is vibadhamarga
coitus by 45.45%, duration of coitus by (obstructed), virecana should be performed.
25.64%.Hence Basti putak Traditional method After virecana the above line of treatment
showed excellent result in all sexual should be done[28]. The treatment of
parameters compare to Basti given by Enema Shukradosha can be adopted in Shukragata
pot method[23]. vata[29]. The treatment explained in the
‘putrakasmeeya’ chapter can be employed in
the management of shukragata vata[30].
Discussion and Conclusion Psychological counselling is also prime
important while treating PE, because anxiety
Premature ejaculation (PE) is a common is main factor that trigger PE[31]. Existing
male sexual disorder. Recent normative data definitions of PE include distress as an
suggests that men with an intravaginal important dimension of PE[32].
ejaculatory latency time (IELT) of less than 1 Pharmacological modulation of ejaculatory
minute have “definite” PE, while men with threshold represents a novel and refreshing
IELTs between 1 and 1.5 minutes have approach to the treatment of PE and a radical
“probable” PE. Although there is insufficient departure from the psychosexual model of
empirical evidence to identify the etiology of treatment, previously regarded as the
PE, there is limited correlational evidence to cornerstone of treatment. The introduction of
suggest that men with PE have high levels of SSRIs has revolutionized the approach to and
sexual anxiety. An increased susceptibility to treatment of PE. SSRIs consist of five
premature ejaculation in men from the Indian compounds citalopram, fluoxetine,
subcontinent has been reported[24]. Anxiety fluvoxamine, paroxetine and sertraline with
has been reported as a cause of PE by multiple a similar pharmacological mechanism of
authors and is entrenched in the folklore of action.
sexual medicine as its most likely cause despite Systemic review of 14 clinical trials on sexual
scant empirical research evidence to support parameters carried out in IPGT &RA; Gujarat
any causal role[25]. Recent data demonstrates Ayurved University showed that Ayurvedic
that almost half of the men with Erectile treatment would be more helpful in the
Dysfunction also experience PE[26]. Men with management of Premature Ejaculation. Most
early ED may intentionally “rush” sexual of the drugs, used in the studies, have the
intercourse to prevent premature loss of their properties like vrishya, balya, medhya and
erection and ejaculate with a brief latency. shukrastambhakarak. The Swarna Bhasma has
This may be compounded by the presence of the qualities like snigdha guna, Madhur Vipaka,
high levels of performance anxiety related to Sarva doshaharatva, Vrushya, Medhya;
their ED which serves to only worsen their Pushtikara[33]. Swarna Bhasma has qualities
prematurity. In the absence of a thorough like Ojodhatu vivardhana and balakara[34].
sexual history, these men may be incorrectly
diagnosed as suffering from PE and not the Most of the drugs having anti- stress, anti-
underlying ED. oxidant properties; which is helpful in
relieving anxiety which is major factor of PE.
In Ayurveda this clinical condition can be
Most of the vajikaran bastis are rich in amino
correlated with Shukragata Vata[27]. Few
acid, lipid, and sugar, enzymes which are very
research works had been done under the title
essential in the production of steroidal
of Shukragata Vata. Whereas some scholar
hormones and provide nourishment to whole
correlate PE with Shukra avruta Vata.
body.

Indian Journal of Ancient Medicine and Yoga

 Prasad V. Kulkarni & Chandola HM / Systemic Review and Critical Analysis of 199
Research Work on Premature Ejaculation

By all these facts, further studies need to Thesis; Dept. of Kayachikitsa; I P G T & R A,
include biomarkers and other latest Gujrat Ayurved University, Jamnagar, 1992.
parameters for proper assessment of Ayurvedic 12. P K Godatwar et al. Shukra- A Clinical and
management in Premature Ejaculation. experimental study on the role of Swarna Bhasma
Dipana, Pachana, and Shodhana should be given in Normozoospermia, M.D.(Ayu.) Thesis;Dept.
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and its management by certain Ayurvedic drugs;
M.D.(Ayu.) Thesis;Dept. of Roga Nidan & Vikruti
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