E-ISSN:2456-3110

Case Report

Premature Ejaculation

Journal of Ayurveda and Integrated Medical Sciences

2025 Volume 10 Number 3 MARCH
Publisherwww.maharshicharaka.in

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

Panja S1*, Yadav N2, Bhaduri T3, Khan SK4
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].

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Soumya P et al. Holistic Management of Premature Ejaculation Through Ayurveda

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 5th 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/RG240001XXXX. 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 4XX/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 Pressure120/80 mm of hg
Pulse82 Beats
Respiratory Rate18 breaths / min
Temperature97-degree Fahrenheit
Anaemia / Jaundice / Cyanosis / Clubbing / OedemaNot Present
Mental State & IntelligenceAlert and conscious
DecubitusNormal

Systemic Examination

Urogenital System:

Loin pain / Symptom of Uraemia / Painful micturition / Haematuria / Urethral dischargeNot Present
Oedema of ankles / hands / faceNot Present
Frequency & urgency of micturitionNormal
Quantity of urineNormal
HaematuriaNot Present
Problems with sexual intercoursePremature Ejaculation during sexual intercourse
DyspareuniaNot present

Local Examination:

  • On clinical examinations no scar marks, no deformity was observed over the penis.

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  • 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.

Personal History:

Drug HistoryNo relevant drug history regarding the disease
Family HistoryNo relevant family history in father / siblings found
AddictionNo such
Marital historyMarried for four years
Sexually transmitted disease’s historyNo such
Other Co-morbiditiesNo such

Investigations

Before the starting of treatment hormonal tests were done which includes Serum TSH level, Serum FSH level & Serum Testosterone level (at 8-10am) which came with in normal limit.

TestResult
Serum Testosterone9.01 ng/ ml
Serum FSH5.04 mIU/ ml
Serum TSH1.02 uIU/ ml

Diagnosis

Ayurvedic diagnosis - Sukragata Vata
Modern diagnosis - Premature Ejaculation

Treatment Assessment parameter

  • GRISS Questionnaire
  • IELT (Intravaginal ejaculatory latency time)
  • Voluntary control over ejaculation
  • Patient’s & partner’s satisfaction

Treatment Plan

  • Nidan Parivarjana
  • Deepana- Pachana
  • Samsodhana Chikitsa
  • Samshamana Chikitsa

Treatment Protocol:

Samsodhana Chikitsa Purvakarma

Treatment NameDurationTreatment Procedure
Deepana - Pachana12-06-2024
to 16-06-2024		Panchakola powder twice a day before meal with lukewarm water.
Snehapana17-06-2024
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 6th 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.
Abhyanga23-06-2024
to 25-06-2024
Then
30-06-2024
to 15-07-2024		Abhyanga in the lower part of the body with Ashwagandha Taila.
Swedana23-06-2024
To 25-06-2024
Then
30-06-2024
to 15-07-2024		Nadi Swedan with Dasamoola Kwath, duration of 15 min for each session.
Shirodhara23-06-2024
to 25-06-2024
Then
30-06-2024
to 15-07-2024		Shirodhara with Bramhi Taila, duration of 15 min for each session.

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Pradhana Karma

Treatment NameDurationTreatment Procedure
Virechana Karma26-06-2024Virechana was performed after proper Snehana and Swedana with Trivrit Avaleha 60gm, Triphala Kwath - 100ml and Abhyadi Modak - 2 gm (4 tablets).
Total Virechana Vega - 20
Samsarjana Karma27-06-2024
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 Karma30-06-2024
to
15-07-2024		Brihatyadi Panchamoola Niruha Vasti & Ashwagandha Taila Anuvasana Vasti was given in Kala Vasti schedule (6N + 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

Shamana Chikitsa

He was given discharge from hospital with Shamana Aousadhi for a duration of 45 days. (16-07-2024 to 29-08-2024).

  • Ashwagandha Powder - 3gm twice daily after meal with milk.
  • Gokshura Powder - 3gm twice daily before meal with luke warm water.

Pathya & Apathya

PathyaApathya
Aahara - Sali-Sastika, Dhanya, Godhuma, Masura, Chanaka, Navanita, DugdhaAahara - Guru, Viruddha, Asuchi , Vidahi, Puti Aahar
Vihara - Bhaya Mukta, Sangkalpa Praban, Abhyanga, Utsadana, SnanaVihara - Kshuda, Trishna, Vegabarodha

Midpoint and Progress

  • Improved pelvic muscles contraction.
  • Increased voluntary control over ejaculation.

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.

  • 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

BT AT Comparison:

ParameterBefore TreatmentAfter Treatment
Intravaginal Ejaculatory Latency Time (IELT)++ (2 Min)++++ (4 Min)
Voluntary Control Over Ejaculation++++
Patients’s Satisfaction++++
Partner’s Satisfaction+++++

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jaims_4190_01.jpg
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]

QuestionBTAT
1. Are you able to delay ejaculation during intercourse if you think you may be coming too quickly?NoYes
2. Can you avoid ejaculation too quickly during intercourse?NoYes
3. Do you ejaculate without wanting to almost as soon as your penis enters your partner’s vagina?NoYes
4. Do you ejaculate by accident just before your penis is at least to enter your partner’s vagina?NoYes

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 anti-stress 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.


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Soumya P et al. Holistic Management of Premature Ejaculation Through Ayurveda

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 well-known 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.

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