The Holistic Management of Premature Ejaculation Through Ayurveda - A Case...

[Full title: The Holistic Management of Premature Ejaculation Through Ayurveda - A Case Report]

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Journal of Ayurveda and Integrated Medical Sciences 2025 Volume 10 Number 3 MARCH E-ISSN:2456-3110 Case Report Premature Ejaculation Publisher www.maharshicharaka.in The Holistic Management of Premature Ejaculation Through Ayurveda - A Case Report Panja S 1* , Yadav N 2 , Bhaduri T 3 , Khan SK 4 DOI:10.21760/jaims.10.3.54 1* Soumya Panja, Second Year Post Graduate Scholar, Department of Kayachikitsa, Institute of Post Graduate Ayurvedic Education and Research at Shyamadas Vaidya Shastra Pith (SVSP), Kolkata, West Bengal, India 2 Neha Yadav, Second Year Post Graduate Scholar, Department of Kayachikitsa, Institute of Post Graduate Ayurvedic Education and Research at Shyamadas Vaidya Shastra Pith (SVSP), Kolkata, West Bengal, India 3 Tapas Bhaduri, Reader and Head, Department of Kayachikitsa, Institute of Post Graduate Ayurvedic Education and Research at Shyamadas Vaidya Shastra Pith (SVSP), Kolkata, West Bengal, India 4 Subir Kumar Khan, Reader, Department of Kayachikitsa, Institute of Post Graduate Ayurvedic Education and Research at Shyamadas Vaidya Shastra Pith (SVSP), Kolkata, West Bengal, India Premature ejaculation is a very common male sexual disorder, affecting on an average 40 % in worldwide. Premature ejaculation is a recurrent ejaculation that occurs with minimal stimulation and earlier than desire, before or soon after penetration, which bothers or distress, and upon which the sufferer has little or no control. Most common cause of premature ejaculation are psychological factors like depression, performance, anxiety, stress, distorted thinking, lack of confidence with or without other physical etiological factors. In this case study, a 28 years old male came to Kayachikitsa outpatient department (OPD) of IPGAE & R at SVSP complaining of recurrent ejaculation with minimal stimulation & earlier than desire for past 6 months. In Ayurveda it’s sign & symptoms resembles with Sukragata Vata in which Vata Dosha is involved. Management was planned according to the principle of Vajikarana in the inpatient department (IPD) of Kayachikitsa. Brihatyadi Panchamoola Niruha Vasti was administered. After completion of 45 days treatment, significant improvement was noted in IELTS (Intravaginal Ejaculatory Latency Time), VCOE (Voluntary control over ejaculation), Patients Satisfaction, Partner’s Satisfaction & GRISS questionnaire Keywords: Vajikarana, Brihatyadi Panchamoola Niruha Vasti, Snehana, Swedana, Shirodhara Corresponding Author How to Cite this Article To Browse Soumya Panja, Second Year Post Graduate Scholar, Department of Kayachikitsa, Institute of Post Graduate Ayurvedic Education and Research at Shyamadas Vaidya Shastra Pith (SVSP), Kolkata, West Bengal, India Email: Panja S, Yadav N, Bhaduri T, Khan SK, The Holistic Management of Premature Ejaculation Through Ayurveda - A Case Report . J Ayu Int Med Sci 2025;10(3):357-363 Available From https://jaims.in/jaims/article/view/4190/ Manuscript Received Review Round 1 Review Round 2 Review Round 3 Accepted 2025-02-12 2025-02-25 2025-03-05 2025-03-15 2025-03-25 Conflict of Interest Funding Ethical Approval Plagiarism X-checker Note None Nil Not required 11.42 © 2025 by Panja S, Yadav N, Bhaduri T, Khan SK and Published by Maharshi Charaka Ayurveda Organization. This is an Open Access article licensed under a Creative Commons Attribution 4.0 International License https://creativecommons.org/licenses/by/4.0/ unported [CC BY 4.0] J Ayu Int Med Sci 2025 ; 10 ( 3 ) 357

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Introduction Premature ejaculation [1] is a most common male sexual dysfunction. Ejaculatory response [2 ] is the efferent (motor) component of a spinal reflex that typically begins with sensory stimulation to the glans penis. However, much less is known about this disorder than erectile dysfunction [3] and there is a lack of a commonly accepted definition for this complaint A specific ejaculatory latency was not defined because of the absence of normative data. It is a complex, poorly understood condition and is the most common type of ejaculatory dysfunction which is very difficult to cure. The global prevalence [4] of premature ejaculation is estimated as 20 - 40% among general population and in India [5] among the 21.15% of sexual disorders reported, 8.76% was premature ejaculation. However, several definitions exist for PE the current 5 th revision of DSM [6 ] cleared much of earlier ambiguity defining Premature Ejaculation as a persistent or recurrent pattern of ejaculation occur during partnered sexual activity within approximately 1 minute prior to or after vaginal penetration and before individual wishes it. It is to be diagnosed only if the primary symptom persists at least for 6 months in most of the encounters. It should not be also associated with another medical causes or substance abuse. In Ayurveda it can be clinically co-related to Sukragata Vata , where Vata vitiates the Sukra & dismantle its proper action It causes premature expulsion of semen & undue retention of semen. All the therapeutics introduced are Vata Samak (which reduces Vata ) in action, started from Snehana with Ashwagandha Taila, Shirodhara with Bramhi Taila followed by Swedana by Dasamoola Kwath all having the Vata Samak properties as well as Brishya which gives nutrition to the genitalia. Shirodhara with Bramhi Taila is very much effective in reducing the anxiety & stress. Stress & anxiety are the main concern of early ejaculation. Main therapeutics administered was Brihatyadi Panchamoola Niruha Basti having the Vata Samak as well as Balya, Brishya, Sukra Janana Guna & Deha Pusti Vardhana Guna . Anuvasana Vasti with Ashwagandha Taila enhances the libido & strengthen the pelvic floor muscles whose relaxation & contractions are the driving force of smooth firm & long-lasting penile erection Case Report This was a single case study conducted at our Institute. A 28 years old male came to the Kayachikitsa OPD of I.P.G.A. E & R at SVSP, complaining of early ejaculation during sexual intercourse which didn’t lasts more than 2 minutes along with general weakness for past 6 months On occupation he was a daily worker & coming from lower socio-economic condition. He was well built, weighted 74 kg & having 5-foot 8-inch height, dark complexion & anxious facies. OPD no- AYUR/RG 240001 XXXX. Previously took allopathic medications but didn’t get significant relief. Further on admission in Kayachikitsa in-patient department (IPD), management was scheduled according to the principle of Vajikarana. IPD no -GA 4 XX/2024 Treatment Schedule Treatment plan included Deepana- Pachana, Snehana, Swedana, Virechana, Shirodhara followed by Brihatyadi Panchamoola Niruha Basti mentioned in Astanga Samgraha Siddha Basti Kalpa Adhyaya along with Samana Ausadhis Baseline Findings Table 1: Rogi Pariksha Blood Pressure 120/80 mm of hg Pulse 82 Beats Respiratory Rate 18 breaths / min Temperature 97-degree Fahrenheit Anaemia / Jaundice / Cyanosis / Clubbing / Oedema Not Present Mental State & Intelligence Alert and conscious Decubitus Normal Systemic Examination Urogenital System: Loin pain / Symptom of Uraemia / Painful micturition / Haematuria / Urethral discharge Not Present Oedema of ankles / hands / face Not Present Frequency & urgency of micturition Normal Quantity of urine Normal Haematuria Not Present Problems with sexual intercourse Premature Ejaculation during sexual intercourse Dyspareunia Not present Local Examination: Soumya P et al. Holistic Management of Premature Ejaculation Through Ayurveda On clinical examinations no scar marks, no deformity was observed over the penis J Ayu Int Med Sci 2025 ; 10 ( 3 ) 358

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Personal History: Drug History No relevant drug history regarding the disease Family History No relevant family history in father / siblings found Addiction No such Marital history Married for four years Sexually transmitted disease’s history No such Other Co-morbidities No such Investigations Before the starting of treatment hormonal tests were done which includes Serum TSH level, Serum FSH level & Serum Testosterone level (at 8-10 am) which came with in normal limit Test Result Serum Testosterone 9.01 ng/ ml Serum FSH 5.04 mIU/ ml Serum TSH 1.02 uIU/ ml Diagnosis Ayurvedic diagnosis - Sukragata Vata Modern diagnosis - Premature Ejaculation Treatment Assessment parameter Treatment Plan Treatment Protocol: Samsodhana Chikitsa Purvakarma Treatment Name Duration Treatment Procedure Deepana - Pachana 12-06-2024 to 16-06-2024 Panchakola powder twice a day before meal with lukewarm water Snehapana 17-06-2024 to 22-06-2024 Brihat Chagaladya Ghrita in increasing dosing form starting from 25 ml at empty stomach at first day of Snehana goes upto 150 ml on 6 th day till appearance of Sneha Siddha Lakshana Day 1 - 25 ml, Day 2 - 50 ml, Day 3 - 75 ml, Day 4 - 100 ml, Day 5 - 125 ml, Day 6 - 150 ml Abhyanga 23-06-2024 to 25-06-2024 Then 30-06-2024 to 15-07-2024 Abhyanga in the lower part of the body with Ashwagandha Taila Swedana 23-06-2024 To 25-06-2024 Then 30-06-2024 to 15-07-2024 Nadi Swedan with Dasamoola Kwath, duration of 15 min for each session Shirodhara 23-06-2024 to 25-06-2024 Then 30-06-2024 to 15-07-2024 Shirodhara with Bramhi Taila, duration of 15 min for each session Soumya P et al. Holistic Management of Premature Ejaculation Through Ayurveda Penis was normal in length and also in breadth, meatus normal in size, testicles were normal in shape and size Patency of urinary tract was also checked by doing urinary catheterization GRISS Questionnaire IELT (Intravaginal ejaculatory latency time) Voluntary control over ejaculation Patient’s & partner’s satisfaction Nidan Parivarjana Deepana- Pachana Samsodhana Chikitsa Samshamana Chikitsa J Ayu Int Med Sci 2025 ; 10 ( 3 ) 359

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Shamana Chikitsa He was given discharge from hospital with Shamana Aousadhi for a duration of 45 days. (16-07-2024 to 29-08-2024) Pathya & Apathya Pathya Apathya Aahara - Sali-Sastika, Dhanya, Godhuma, Masura, Chanaka, Navanita, Dugdha Aahara - Guru, Viruddha, Asuchi , Vidahi, Puti Aahar Vihara - Bhaya Mukta, Sangkalpa Praban, Abhyanga, Utsadana, Snana Vihara - Kshuda, Trishna, Vegabarodha Midpoint and Progress Endpoint findings The combined treatment protocol showed significant improvement in parameters like Intravaginal Ejaculation Latency Time, voluntary control over ejaculation, patient’s and partner’s satisfaction & GRISS Questionnaire BT AT Comparison: Parameter Before Treatment After Treatment Intravaginal Ejaculatory Latency Time (IELT) ++ (2 Min) ++++ (4 Min) Voluntary Control Over Ejaculation + +++ Patients’s Satisfaction + +++ Partner’s Satisfaction + ++++ Pradhana Karma Treatment Name Duration Treatment Procedure Virechana Karma 26-06-2024 Virechana was performed after proper Snehana and Swedana with Trivrit Avaleha 60 gm, Triphala Kwath - 100 ml and Abhyadi Modak - 2 gm (4 tablets) Total Virechana Vega - 20 Samsarjana Karma 27-06-2024 to 29-06-2024 (3 days) On the day of Virechana Karma - Only Mudga Yusa in a quantity of 650 ml 27-06-2024 = Mudga Yusa 650 ml at morning & 650 ml at evening 28-06-2024 = Liquid Khichrdi, 350 ml at lunch & 350 ml at dinner On 29-06-24 = Semisolid Khichrdi, 350 ml at lunch & 350 ml at dinner Vasti Karma 30-06-2024 to 15-07-2024 Brihatyadi Panchamoola Niruha Vasti & Ashwagandha Taila Anuvasana Vasti was given in Kala Vasti schedule (6 N + 10 A) The contents of Brihatyadi Panchamoola Niruha Vasti are Laghu Panchamoola Kwath, Mamsa Rasa of Chaga Mamsa, Egg albumin of chicken eggs, Sitapala, Madhu, Saindhav & Prakshepa Dravya : Sali-Godhuma, Yava & Sasthika. During Vasti he was advised to take light digestive veg diet & also to do KEGEL exercise Before Vasti Karma patency of urinary tract also checked by foley’s catheter Vasti Schedule: Day 1 - Anuvasana Day 2 - Anuvasana Day 3 - Niruha Day 4 - Anuvasana Day 5 - Niruha Day 6 - Anuvasana Day 7 - Niruha Day 8 - Anuvasana Day 9 - Niruha Day 10- Anuvasana Day 11 - Niruha Day 12 - Anuvasana Day 13 - Niruha Day 14 - Anuvasana Day 15 - Anuvasana Day 16 - Anuvasana Soumya P et al. Holistic Management of Premature Ejaculation Through Ayurveda Ashwagandha Powder - 3 gm twice daily after meal with milk Gokshura Powder - 3 gm twice daily before meal with luke warm water Improved pelvic muscles contraction Increased voluntary control over ejaculation After completion of treatments hormonal tests were carr. out which came with in normal limit Sr Testosterone - 3.5 ng/ml, TSH - 2.1 uIU/ ml, DHEA - 291.9 ug/dl J Ayu Int Med Sci 2025 ; 10 ( 3 ) 360

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IELT - Intravaginal Ejaculatory Latency Time, VCOE - Voluntary Control Over Ejaculation, P.A.S - Patients’s Satisfaction, P.R.S - Partner’s Satisfaction Griss Questionnaire [7 ] Question BT AT 1. Are you able to delay ejaculation during intercourse if you think you may be coming too quickly? No Yes 2. Can you avoid ejaculation too quickly during intercourse? No Yes 3. Do you ejaculate without wanting to almost as soon as your penis enters your partner’s vagina? No Yes 4. Do you ejaculate by accident just before your penis is at least to enter your partner’s vagina? No Yes Discussion Powder Panchakola constitutes Pippali [8 ] , Pippalimoola, Chavya [9 ] , Chitraka [10] & Sunthi [11 ] , all of them are having Usna (Hot), Tikshna (Sharp), Sukshma (Minute) properties which enhances Jatharagni (Digestive enzymes). Pervading through Sukshma Srotas (minute channels) they nullify ‘Ama’ and makes easy passage of nutrition. Brihat Chagaladya Ghrita [12 ] comprises of Aja Mamsa (Goat meat) , Murchita Ghrita (processed clarified butter) , Ridhi, Vriddhi, Meda , Mahameda, Jeebakha, Rishabakha, Kakoli & Kshirakakoli, all of them are having Balya (Strength promoter), Mamsakara (Builds musculature), Vrishya (Libido enhancer) and Agni Sandeepana (Booster of metabolism) properties. Ashwagandha Taila consists of Ashwagandha, Padmaka roots , Padmaka Kantaka , Saluka, Sugandhabala , Mulethi, Sariba, Padmaka Puspa, Nagakesara, Meda, Punarnava, Draksha, Manjistha, Brihati-Dwaya (two types of Brihati ), Triphala & Tila Taila etc. All of them are Vata Samaka ( Vata alleviating) with chief ingredient Ashwagandha [13 ] which is Vajikarak having aphrodisiac property Local application of Ashwagandha Taila nourishes the Vata Vahini Srotas enhancing the action of Shookshma Shrotas (minute channels). It also pacifies the Adho-Vata ( Vata localised in the lower region of the body). Dasamoola [14 ] constitutes of Brihat Panchamoola & Laghu Panchamoola . Brihat Panchamoola [15 ] comprises of Bilwa, Agnimantha, Shayonaka, Patala, Gambhari & Laghu Panchamoola consists of Gokshura, Brihati, Kantikari, Salaparni, Prisniparni. Together they possess Vata-Samak action. Nadi Swedana by Dasamoola Kwath clears channels (Vata Vahani Srotas) which further enhances blood circulation in genital organ. Continuous flow of Bramhi Taila over the ‘ Bramha Talu’ (forehead) during Shirodhara Karma [16] (Pouring of medicated oil into the forehead) is very helpful to keep the mind in calm state, having antistress activity. It helps to regulate the parasympathetic action of central nervous system. Parasympathetic nerves are group of nerve which are beneficial to control the erection. Its precise action over the sympathetic nerve controls the erection time of penis Bramhi [17] is a potent nootropic agent which enhances the action of brain & also fasten the action of neurotransmitters. Shirodhara with Bramhi Taila regulates the action of central nervous system & helps to get smooth erection of penis & increases the erection time by reducing stress & anxiety Virechana is very helpful to ward off the vicious materials from the body, which purifies the Annavaha Srotas (carries nutrients) and enhances perfect absorption of nutrition through the gut Brihat Panchamoola Niruha Vasti consisting of Laghu Panchamoola Kwath, Mamsa Rasa of Chaga Mamsa, Kukkta Anda Rasa - albumin of chicken eggs, Sitapala, Madhu, Saindhav with Prakshepa Dravya : Sali-Godhuma, Yava & Sasthika. In context of Brihat Panchamoola Niruha Vasti, Astanga Samgraha mentions “ Panchamoola Brihatyadi Prati Dravyam Palonmitam ” here ‘ Panchamoola Brihatyadi’ is correlated to Laghu Panchamoola [18] which includes Gokshura, Brihati, Kantikari, Salaparni, Prisniparni. These together used in Sukra Vikara enhances serum testosterone in blood. Chaga Mamsa (goat’s meat), Murchita Ghrita (Potentised clarified butter) and all the drugs of Jeevaniya Mahakasaya - Jeebaka, Rishabhaka, Meda, Mahameda, Kakoli, Ksheerkakoli, Ridhi, Vriddhi simultaneously enhance Ojas, Mamsa, Sukra thereby increasing vitality and strength Soumya P et al. Holistic Management of Premature Ejaculation Through Ayurveda J Ayu Int Med Sci 2025 ; 10 ( 3 ) 361

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Due to this beneficial effect these drugs can be used to promote health which is “Swasthasyaswasthyarakshnama” with its foremost aim of Ayurveda thus, in cumulative action all are good strength promoter, muscle bulk enhancer & spermatogenic in nature. Niruha Vasti is having a potent role over anal sphincter, by its application it maintains proper sphincter control. It regulates pituitary hormones and maintains smooth action of HPA (Hypothalamus-Pituitary-Adrenal) axis. Among Ayurvedic Rasayana (Immune-modulator) herbs, Ashwagandha [19 ] holds most prominent place. It is having adaptogenic and anti-stress property Ashwagandha is commonly available as a Churna (A fine sieved powder) that can be taken with water, Ghee (Clarified butter) or honey. It enhances function of nervous system along with improvement of memory. It improves function of reproductive system promoting a healthy sexual and reproductive balance. Being a powerful adaptogen, it enhances body's resilience to stress. It improves body's defence against disease by improving cell-mediated immunity. It also possesses potent antioxidant properties which protect us against cellular damage due to free radicals. Gokshura [20] has Madhura Rasa (Sweet), Guru (Heavy) and Snigdha Guna (Unctuous and Heavy quality), Vrishya (Aphrodisiac), Rasayana (Rejuvenator) & Brimhana (Nourishing) properties. However, Madhura Rasa , Snigdha , and Guru Guna increases Sukra Dhatu qualitatively and quantitatively. Gokshura is a wellknown drug in context with Mutravaha Srotas . It regulates Apana Vata , and also governs action on Sukra along lines similar to how Sukra Visarga is governed by Apana Vata. Conclusion The presented paper provided an opportunity for standardization of Ayurvedic assessments and treatment procedures which are therapeutically safe and effective. The following treatment protocol consists of Deepana - Pachana with powder Panchakola , Snehana with Brihat Chagaladya Ghrita , Abhyanga with Ashwagandha Taila , Nadi Swedana with Dasamoola Kwath , Shirodhara with Bramhi Taila , Niruha Vasti with Brihatyadi Panchamoola & Anuvasana Vasti with Ashwagandha Taila which are very much effective in the treatment of Sukragata Vata . This approach may be taken into consideration for further treatment and research work for Premature Ejaculation References 1. Parnham A, Serefoglu EC. Classification and definition of premature ejaculation. Transl Androl Urol. 2016 Aug;5(4):416-23. doi: 10.21037/tau.2016.05.16. PMID: 27652214; PMCID: PMC 5001991 [Crossref][PubMed][Google Scholar] 2. McKenna KE. Central nervous system pathways in the control of penile erection. Annu Rev Sex Res. 1999;10:157–83. [Crossref][PubMed][Google Scholar] 3. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 4 th ed. Washington, DC: American Psychiatric Press; 1994 [Crossref][PubMed][Google Scholar] 4. Kalejaiye O, Almekaty K, Blecher G, Minhas S. Premature ejaculation: Challenging new and old concepts [version 1; referees: 2 approved]. F 1000 Res [Internet]. 2017 Dec 04;6(F 1000 faculty review):2084. Available from: doi: 10.12688/f 1000 research.12150.1 [Crossref] [PubMed][Google Scholar] 5. Rao TS, Darshan MS, Tandon A. An epidemiological study of sexual disorders in South Indian rural population. Indian J Psychiatry [Internet]. 2015 Apr-Jun;57(2):150–157. Available from: [Article][Crossref][PubMed][Google Scholar] 6. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5 th ed. Arlington, VA: American Psychiatric Association; 2013. p. 443-444, 4226 [Crossref][PubMed][Google Scholar] 7. Rust J, Golombok S. The Golombok-Rust Inventory of Sexual Satisfaction (GRISS). Br J Clin Psychol. 1985 Feb;24(Pt 1):63-4. doi: 10.1111/j.2044-8260.1985.tb 01314.x. PMID: 3971070 [Crossref][PubMed][Google Scholar] 8. Sastry JL. Dravyaguna Vijnana. Vol. II. Reprint ed. Varanasi: Chaukhambha Orientalia; 2016. ISBN:978-81-7637-093-6. p. 452-458 [Crossref] [PubMed][Google Scholar] 9. Sastry JL. Dravyaguna Vijnana. Vol. II. Reprint ed. Varanasi: Chaukhambha Orientalia; 2016. ISBN:978-81-7637-093-6. p. 574-575 [Crossref] [PubMed][Google Scholar] Soumya P et al. Holistic Management of Premature Ejaculation Through Ayurveda J Ayu Int Med Sci 2025 ; 10 ( 3 ) 362

[Find the meaning and references behind the names: De Jager, Chavan, Shukla, Double, Chaudhari, Singh, Thakar, Unique, Prajapati, Evidence, Life, Marathe, Afr, Gilca, Trend, Mar, Prakash, Root, Blind, Gowda, Linn, Rege, Vyas, Kuldeep, Ideas, Amit, Bark, Jul, Dev, Bhalla, Aparna, Jager, Sethi, Baghel, Jan]

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Ayurveda, Snehana, Shirodhara, Ashvagandha, Vajikarana, Niruhavasti, Anuvasanavasti, Mental disorder, Sexual activity, Sexual satisfaction, Panchakarma Therapy, Virechana Karma, General population, Case report, Swedana, Shirodhara therapy, Chaukhambha Orientalia, Deepana Pachana, Experimental evaluation, Dravyaguna Vijnana, Nadi Swedana, Double blind study, Premature ejaculation, Dashamoola, Oligozoospermia, Holistic management, Samsodhana chikitsa, American Psychiatric Association, Ejaculatory Dysfunction, Early Ejaculation, Diagnostic and Statistical Manual, Global prevalence, Annavaha Srota, Ashwagandha powder, Ashwagandha Taila, Tribulus terrestris Linn, Indian J Psychiatry, Kayachikitsa Outpatient Department, Sexual disorder, Patient's Satisfaction, Vata Samak, Laghu Panchmool.