Premature Ejaculation

What is premature ejaculation?

Premature ejaculation, or PE for short, is defined as the “[p]ersistent or recurrent ejaculation with minimal sexual stimulation that (1) occurs before, upon or shortly after penetration and before the person wishes; (2) is associated with marked distress or interpersonal difficulty; and (3) is not a direct effect of substance abuse…”.¹
In 2001, Aschka et al. estimated that up to 60% of men in the U.S. experience premature ejaculation. More conservative estimates put prevalence closer to 27-40% of men.² Prevalence of PE is higher in men with benign prostatic hyperplasia (BPH) and chronic prostatitis than in men in the general population.
Generally speaking, premature ejaculation is not considered a disease in its own right, but rather a side effect of anxiety, other psychological causes or lack of sexual experience. More and more commonly, practitioners are considering PE to be a neuro-biological condition.
In an effort to take the pressure off, I usually remind the men who come to me for treatment of premature ejaculation that time until orgasm is typically between 3 and 7 minutes according to research done by Corty and Guardiani in 2008. Men who are able to have intercourse for a longer period of time have to teach themselves techniques to restrain their orgasm. Men have to learn orgastic control through trial and error. You’re not born with this ability. Additionally, the first Chinese medicine text to mention PE was published in 610 BCE, so this particular scourge on men has been around for quite some time.

What are the symptoms of premature ejaculation?

Premature ejaculation is characterized by ejaculation that occurs too early — before a man or his partner wants — during a majority of sexual encounters and/or masturbation. PE is uncontrolled and occurs with a very low level of sexual stimulation.

What causes premature ejaculation?

The exact causes of premature ejaculation are not understood. It is probably caused by a combination of physiological and psychological factors, which could include:

• Anxiety, depression, stress, and/or guilt
• Hormone or other chemical imbalances
• Abnormal thyroid function
• Inflammation or infection
• Erectile dysfunction
• Medications
• Genetic factors
• Early sexual encounters that involved the need to rush through intercourse

Male genito-urinary anatomy

How is premature ejaculation diagnosed by a physician?

A diagnosis of premature ejaculation can be made by interviewing the patient and/or his partner(s). Other medical tests can be performed to determine the underlying cause of premature ejaculation in a male patient.
These tests include:

• A psychological analysis will reveal if premature ejaculation is psychological/mental in nature or caused by stress, anxiety, or overstimulation
• Blood and urine laboratory tests can detect if premature ejaculation is caused by a hormone imbalance
• Specific tests of thyroid function can determine if premature ejaculation is caused by a thyroid problem

How is PE diagnosed by an acupuncturist?

When I am evaluating premature ejaculation in a patient in the clinic, I rely on the main diagnostic methods of Chinese medicine – looking, listening, palpating. No, that doesn’t require me to see or touch your genitals. I will ask you a lot of questions, look at your tongue, and palpate your pulse and abdomen. These are our traditional diagnostic modalities, created in a time before X-rays and blood tests. The questions an acupuncturist asks help determine your mental/stress state, your general wellbeing, and to better understand exactly how PE is affecting you.

How is premature ejaculation treated medically?

Treatment for premature ejaculation may include one or all of the following:

• Sexual therapy: masturbation, non-penetration forms of sex, the squeeze technique, distraction methods, different sex positions, condom use
• Medications: no drug has been FDA approved to treat premature ejaculation, but antidepressants and anesthetic creams have had shown some success
• Counseling: talk therapy focusing on underlying psychological causes of premature ejaculation
• Mechanical devices such as penile constriction rings
• Relaxation exercises

How is PE treated by acupuncture?

Acupuncturists use what is called pattern diagnosis to explain the various health complaints of our patients. These patterns are usually named after internal organs that we know from biology class, but they don’t necessarily directly correspond to the literal organs in our bodies. By asking a lot of questions during your visit, I will decide what pattern best fits your symptoms. This pattern will then guide the treatments through the selection of acupuncture points and herbal medicines.
In addition to acupuncture and herbal medicine, I often recommend dietary modification, Qigong exercises and self-massage. Of course, you’re welcome to do these massage techniques with your sexual partners, too, as an intimacy building experience.

To make an appointment with me for treatment, please go to the Rdmenik Acupuncture. If you have further questions, feel free to ask me through the Contact person : +62 81916190029 / +62 361 768249

Enlarged Prostate (BPH)

What is an benign prostatic hypertrophy (BPH)?

The prostate gland is a reproductive gland just below the bladder of a man. It encircles the urethra, the tube in the penis through which urine and semen pass. The prostate contributes fluids and nutrients to the semen.

Comparison of normal and hyperplastic prostate

Benign prostatic hypertrophy, or more simply an enlarged prostate, is generally considered a normal part of the aging process. The prostate gland grows bigger, and can cause problems with urination when it begins to squeeze the urethra or press on the bladder.
The reason an enlarged prostate is called benign prostatic hypertrophy (that last ‘H’ sometimes stands for hyperplasia) is this condition is not cancer and does not contribute to cancer risk.

What are the symptoms of an enlarged prostate?

Less than half of all men with an enlarged prostate show symptoms. Those who do have symptoms of BPH, usually have one or more of the following symptoms:

• Urinary dribbling following the end of urination
• Inability to urinate (urinary retention)
• Feeling of incomplete urination
• Incontinence
• Nocturia, or the need to urinate more than 2 times at night
• Pain with urination or bloody urine (these may indicate infection)
• Slowed or delayed start of the urinary stream (hesitancy)
• Strong and sudden urge to urinate (urgency)
• Weak urine stream

What causes BPH?

The cause of BPH is unknown, but the prostate does seem to become enlarged as part of the normal course of aging.
Additionally, doctors have noticed that men who have had their testicles removed at a young age do not develop BPH. If the testicles are removed after the onset of BPH, the prostate will return to its original size. So, it is suspected that some process happening in the testicles plays a roll in the development of an enlarged prostate.
According to the National Institutes of Health, here are some additional BPH facts (quote):

• BPH is so common that it has been said all men will have an enlarged prostate if they live long enough.
• A small amount of prostate enlargement is present in many men over age 40 and more than 90% of men over age 80.
• No risk factors have been identified other than having normally functioning testicles.

How is an enlarged prostate diagnosed by my doctor?

Your doctor’s primary tools for diagnosis are taking a medical history and a digital rectal exam to feel your prostate gland for any inflammation. Additionally, your doctor might perform the following tests:

How a digital rectal exam is performed

• Urine flow rate
• Post-void residual urine test (checks to see how much urine is left in your bladder after urination)
• Urinalysis to check for any abnormalities in the urine (i.e., infection, blood)
• Urine culture to check for bacteria
• Prostate-specific antigen (PSA) blood test to rule out prostate cancer
• Cystoscopy, a test that allows the doctor to see inside the urethra and bladder

Your doctor might also use a survey to evaluate the severity of your symptoms. A commonly used survey is this one:the American Urological Association BPH Symptom Score Index Questionnaire. Click here to view it. Feel free to bring this to share with me during your first visit.

How does acupuncture diagnose BPH?

Acupuncture and the theories behind it were developed thousands of years ago, and so do not rely on the same tests a doctor would perform. Rather, as an acupuncturist, I will ask you all about what your subjective experience of having an enlarged prostate is, like the frequency of urination or the sensations and discomfort you may be feeling. I will also collect some objective information – pulse, tongue and abdominal diagnosis – by looking at how you present to me in the clinic.
I then put all of this information to create a Chinese medicine diagnosis, or pattern of disharmony. This guides your treatments.

How will my doctor treat an enlarged prostate?

Since the prostate of most men becomes enlarged as they age, and because about half of men have no symptoms of this enlargement, doctors often take a wait-and-see approach. There are some self-care remedies a doctor might recommend during this waiting period. They are:

• Don’t hold it, and urinate when you have the chance even if you don’t feel you have to
• Don’t drink alcohol or caffeine after 5pm
• Evenly space drinks throughout the day rather than drinking all of your fluids at once
• Don’t drink anything within 2 hours of bedtime
• Keep warm and get regular exercise (This is spot-on from an acupuncture perspective)
• Do Kegel exercises
• Reduce stress

More active interventions by a doctor might include:

• Medications (Alpha-1 Blockers, like doxazosin, prazosin, or tamsulosin, to relax the neck of the bladder and prostate; Finasteride and dutasteride to lower levels of hormones produced by the prostate (but these also reduce sex drive/libido))
• Surgery (Transurethral resection of the prostate (TURP), Transurethral incision of the prostate (TUIP) or Simple prostatectomy)
• Prostatic stent

How will acupuncture treat an enlarged prostate?

I use a combination of acupuncture, herbal medicine, dietary therapy and nutritional supplements to decrease urinary urgency and night urination, stop discomfort and decrease hesitancy. This is done by using the pattern diagnosis mentioned above to treat the symptoms I see before me. There is no one-size-fits-all treatment. It’s about treating You the Individual, and the whole you, too. Every treatment is fully customized for your specific constellation of symptoms. And relief awaits.

To make an appointment with me for treatment, please go to the Rdmenik Acupuncture. If you have further questions, feel free to ask me through the Contact person : +62 81916190029 / +62 361 768249

Prostatitis

What is prostatitis?

Prostatitis is swelling of the prostate gland, a gland about the size of a walnut just below a man’s bladder. The prostate contributes to the liquid portion of semen (ejaculate). Prostatitis has a number of causes, but the primary signs are pain and difficult urination. Prostatitis can be acute or chronic.

What are the symptoms of prostatitis?

Prostatitis is when the prostate gland becomes inflamed or swollen. Prostatitis symptoms may include:

• Abnormal urination: painful, burning, difficult, dribbling/hesitant, or frequent
• Pain: back, groin, abdominal, perineum (area between the scrotum and the rectum), penis, testicles, during orgasm
• Flu-like symptoms

What causes prostatitis?

Chronic and acute bacterial prostatitis are caused by bacterial infections. The exact causes of non-bacterial prostatitis — chronic pelvic pain or chronic abacterial prostatitis — are unknown. Other causes of prostatitis may include:

A normal versus enlarged prostate

• Immune or nervous system problems
• Direct injury to the prostate
• Defective nerve and/or muscle function
• Blockage of the urinary tract
• Build-up of toxic chemicals in the urine

How is prostatitis diagnosed by my doctor?

A diagnosis of an inflamed prostate can be made based on the medical history and physical exam of a patient. These tests can identify several possible risk factors of prostatitis, including:

• Being young or middle aged
• Not drinking enough liquids
• Being under a lot of stress
• Genetic predisposition
• Nerve problems
• Stroke
• Parkinson’s disease
• Multiple sclerosis
• Diabetes
• Radiation from cancer treatments

Your doctor will perform a digital rectal exam, which can detect inflammation and tenderness of the prostate. Further tests are required to identify the specific type of prostatitis: urine, blood, and semen tests can detect an acute or chronic bacterial infection. These medical tests for an inflammation of the prostate gland can also rule out conditions that cause similar symptoms:

• Overactive bladder
• Benign prostatic hyperplasia (BPH)
• Post-bladder cancer
• Urethral stricture
• Narrowing of the penis meatus

How does an acupuncturist diagnose prostatitis?

An acupuncturist’s main mode of diagnosis is inquiry. Basically, we ask a lot of questions to figure out what’s going on. I never perform digital rectal exams in my clinic. Men who seek treatment will either already have a diagnosis by a doctor, or will have symptoms that fit the bill. If symptoms persist, and a patient has not been to a doctor, I will refer to a urologist to make a diagnosis and rule-out other problems. More recently, urologists have begun to refer their patients out for acupuncture to help treat the symptoms of prostate inflammation, like problems with urination.
As part of an intake interview with an acupuncturist, we will discuss not only the symptoms you are having related to inflammation of prostate, but also about your health in general, lifestyle and diet, so I can get a better understanding of the whole you. I treat people, not diseases.

How is prostatitis treated by a doctor?

Treatment of prostatitis depends on the underlying cause. Treatments may target the cause or the symptoms of an inflamed prostate (like problems with urination) and may include:

• Antibiotics—oral or intravenous—to treat prostatitis caused by a bacterial infection
• Drugs called alpha blockers relax the area where the prostate and bladder meet and help alleviate painful urination
• Over-the-counter pain relievers also help with pain
• Prostatectomy is surgery to remove all or part of the prostate

How does acupuncture treat prostatitis?

By piecing together the signs and symptoms, I identify a pattern of disharmony. Patterns are how Chinese medicine quantifies and qualifies illness. The names of patterns often have words we recognize from high school biology class about internal organs. This isn’t a direct correlation, so don’t get caught up in the name or what it might mean.
Acupuncturists use the pattern diagnosis to dictate the treatment plan. The treatment will involve acupuncture and herbs to unwind the disharmony of the pattern to restore balance to the body. I also use dietary therapy and tui na massage to support these modalities. I often give patients a bit of homework in the form of self-massage to be used as a treatment between acupuncture appointments.

To make an appointment with me for treatment, please go to the Rdmenik Acupuncture. If you have further questions, feel free to ask me through the Contact person : +62 81916190029 / +62 361 768249

Erectile Dysfunction

What is erectile dysfunction?

Erectile dysfunction is the inability to get or maintain an erection to allow for satisfactory sexual intercourse. In both Chinese and Western medicine, there are many causes of erectile dysfunction, also known as ED. Both medical traditions accept that there can be both physiological and psychological causes for the change in the quality of your erection – that is to say a problem in the body or one in the mind.
While it is generally accepted that erectile dysfunction increases with age, Chinese medicine theory believes that through the employment of acupuncture, herbal medicine, and health maintenance exercises and practices, a strong and satisfactory erection can be achieved at any age. Generally speaking, Chinese medicine puts an emphasis on health maintenance rather than healing disease, though it certainly does that quite well. So, a key part of any treatment is going to emphasize this principle when working to improve the quality of a man’s erection.
It is important to note that other diseases, like diabetes and atherosclerosis, and some medications can cause ED and a decrease in man’s satisfaction with his erection.

What are the symptoms of erectile dysfunction?

Erectile dysfunction (ED) symptoms are:

• Inability to get an erection
• Inability to keep an erection
• Decreased sexual desire is commonly a related symptom

What causes erectile dysfunction?

The causes of erectile dysfunction can be both physical and psychological. An erection begins in the brain with sexual arousal. The brain releases chemicals to tell the nerves to relax the muscles that control the blood vessels leading into the penis. This increase in blood causes an erection. If this process is interrupted at any point, ED can result.

Anatomy of the male genitourinary system

The specific causes of ED include:

• Heart and vascular disease
• High blood pressure
• High cholesterol
• Obesity and metabolic syndrome
• Diseases, including diabetes, Parkinson’s disease, and multiple sclerosis
• Altered hormone levels (especially low testosterone)
• Medications, alcohol, tobacco, and other recreational drugs
• Depression, stress, and anxiety

How is erectile dysfunction diagnosed by a doctor?

A diagnosis of erectile dysfunction can be made by a health care professional. Usually, a physical exam and an interview about sexual and medical history are enough to diagnose erectile dysfunction. However, the following tests may also be performed when diagnosing ED:

• Blood and/or urine sampling for laboratory testing
• Ultrasound imaging
• Nocturnal erection test, also known as a nocturnal penile tumescence or NPT
• Psychological exam
• Neurologic tests

These tests for ED will identify the type of ED as either:

• Physiological: a breakdown somewhere in the arousal pathway between the brain and the penis
• Functional: the inability of the penis to become erect, even if the pathway is working properly
• Psychological/mental: caused by stress, anxiety, and/or depression

In 2007, Kasper et al. created three classifications your doctor may use to describe your specific kind of erectile dysfunction. They are:

• Failure to initiate erection
• Failure of the penis to fill with blood
• Failure to the penis to store blood

How is this different from Acupuncture and Chinese medicine diagnosis of ED?

Chinese medicine was created in a time before blood tests, x-rays and other medical diagnostic procedures, so we rely mainly on asking question and some observational techniques. I’m not going to look at your genitals or ask to see your erection. I am going to look at your tongue, take your pulse, and palpate your abdomen.
By finding out when you experience ED, what else is happening at that time, your stress level, how the quality of your erection differs from what your ideal erection is and the presence of other symptoms, I can diagnose the ED as one of the patterns of disharmony we expect to see with these symptoms. There are both modern and pre-modern Chinese medicine diagnoses for ED.

How is erectile dysfunction treated by Western medicine?

Western medical (allopathic) erectile dysfunction treatments include:

• Oral medications: Viagra, Cialis, Levitra are drugs that increase blood flow to the penis
• Injected medications: the drug alprostadil is available as an injection or suppository (Muse)
• Devices: penis pumps
• Surgery: penile implants, blood vessel surgery

How does acupuncture and herbal medicine treat ED?

Not surprisingly, acupuncture and herbal medicine are the key modalities I use. In the case of erectile dysfunction, we’re also going to talk about diet and exercise. Typically, I also teach my patients some short Qigong exercises and self-massage techniques for you to do at home (you can also do this kind of massage with an intimate partner).

To make an appointment with me for treatment, please go to the Rdmenik Acupuncture. If you have further questions, feel free to ask me through the Contact person : +62 81916190029 / +62 361 768249