E-ISSN:2456-3110

Case Report

Shirodhara

Journal of Ayurveda and Integrated Medical Sciences

2023 Volume 8 Number 3 March
Publisherwww.maharshicharaka.in

Effect of Shirodhara in Situational Anejaculation: A Single Case Study

S. Khandalikar S.1*
DOI: http://dx.doi.org/10.21760/jaims.8.3.36

1* Sandeep S. Khandalikar, Associate Professor, Department of Sanskrit Samhita, Government Ayurved College, Baramati, Pune, Maharashtra, India.

Anejaculation is a type of male sexual dysfunction that can affect one’s ability to enjoy sex. It can also lead to male infertility. The process of ejaculation has important meanings not only for its association with orgasm but also for the timing to ejaculate in the context of sexual activity. Healthy sexual behaviour plays an essential role in maintaining the harmony and happiness of marital life.

Keywords: Shirodhara, ejaculation, infertility, Disorders of Ejaculation

Corresponding Author How to Cite this Article To Browse
Sandeep S. Khandalikar, Associate Professor, Department of Sanskrit Samhita, Government Ayurved College, Baramati, Pune, Maharashtra, India.
Email: 		Sandeep S. Khandalikar, Effect of Shirodhara in Situational Anejaculation: A Single Case Study. J Ayu Int Med Sci. 2023;8(3):188-191.
Available From
https://jaims.in/jaims/article/view/2006

Manuscript Received Review Round 1 Review Round 2 Review Round 3 Accepted
2023-01-28 2023-01-30 2023-02-06 2023-02-13 2023-02-19
Conflict of Interest Funding Ethical Approval Plagiarism X-checker Note
Nil Nil Yes 16%

© 2023by Sandeep S. Khandalikarand 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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Khandalikar S: Effect of Shirodhara in Situational Anejaculation

Introduction

Dharma, Artha, Kama and Moksha are four objectives (Purusharthas) of life mentioned in Ayurveda. Ejaculation is the release of semen from the penis. It occurs when a person reaches sexual climax (orgasm) during intercourse or masturbation.

People who experience anejaculation are unable to ejaculate semen when they have an orgasm. The condition can affect sexual enjoyment and the ability to conceive. The term delayed ejaculation (DE) (also called retarded ejaculation, or inhibited ejaculation) has been used to describe “a marked delay in or inability to achieve ejaculation. The man reports difficulty or inability to ejaculate despite of the presence of adequate sexual stimulation and the desire to ejaculate”.[1] Vajikarana (aphrodisiac therapy) is one of the eight branches of Ayurveda that deals with the preservation and amplification of the sexual potency of a healthy man and conception of healthy progeny as well as management of defective semen, disturbed sexual potency and spermatogenesis, along with treatment of seminal-related disorders in man.[2]

Causes of delayed ejaculation

Psychological causes of delayed ejaculation can occur due to a traumatic experience. Cultural or religious taboos can give sex a negative connotation. Anxiety and depression can both suppress sexual desire, which may result in delayed ejaculation as well. Relationship stress, poor communication, and anger can make it worse. Disappointment in sexual realities with a partner compared to sexual fantasies can also result in delayed ejaculation. Often, men with this problem can ejaculate during masturbation but not during stimulation with a partner. Certain chemicals can affect the nerves involved in ejaculation. This can affect ejaculation with and without a partner. Some medications can all cause delayed ejaculation like Antidepressants, antipsychotics, diuretics, alcohol.

Surgeries or trauma may also cause delayed ejaculation. The physical cause may include damage to the nerves in the spine or pelvis, certain prostate surgeries that cause nerve damage, heart disease that affects blood pressure to the pelvic region, infections, especially prostate or urinary infections, neuropathy or stroke, low thyroid hormone, low

testosterone levels, birth defects that impair the ejaculation process.[3]

Delayed ejaculation can be correlated with Shukra Gata Vata or Klaibya.

Types of delayed ejaculation

Some people are never able to ejaculate (primary anejaculation). Others lose the ability to ejaculate for various reasons (secondary anejaculation).

Types of anejaculation include:

Situational: Person can ejaculate in certain situations, like while masturbating, but not during intercourse or he may be able to ejaculate only at home, but not at other places.

Total: Person is unable to ejaculate while masturbating or having sex, regardless of the location or situation.

Orgasmic: Person can’t ejaculate while having an orgasm. Orgasmic anejaculation is often due to a physical problem like nerve damage.

Differential diagnosis: Anejaculation is when orgasm occurs but no fluid leaves the body. Anorgasmia is when orgasms are absent or less intense even after plenty of sexual stimulation.

Retrograde ejaculation is a condition in which orgasm occurs, but semen goes back into the bladder instead of coming out from penis.

Lakshana (Symptoms): The male reproductive system makes semen. It contains sperm, which fertilizes eggs for conception and pregnancy. The semen is ejaculated during intercourse or masturbation when a person reaches sexual climax (orgasm).

Delayed ejaculation occurs when a man needs more than 30 minutes of sexual stimulation to reach orgasm and ejaculate. Some men can only ejaculate with manual or oral stimulation. Some cannot ejaculate at all.

Some men have a generalized problem in which delayed ejaculation occurs in all sexual situations. For other men, it only occurs with certain partners or in certain circumstances. This is known as situational delayed ejaculation. In rare cases, delayed ejaculation is a sign of a worsening health problem such as heart disease or diabetes.


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Khandalikar S: Effect of Shirodhara in Situational Anejaculation

Vata especially Apan Vayu is responsible for generation of Shukra and ejaculation of semen. Qualities of semen are impaired when the vitiated Vata afflicts the functional characteristics of Shukra. When Vata affects these characteristics, Shukra Dushti is explained as Phenila, Tanu, Rooksha[4], Grathita, Vivarnadi Yukta,[5] Vatika Shukra, Granthishukra (Vata-Kaphaja), Ksheena (Vata-Paittika),[6] Alpa Retas, Ksheena Retas and Vishushka Retas[7] occurs.

The male sexual dysfunctions have been elaborately described as Klaibya.[8] In clinical practices Klaibya is the most common psychosexual disorder. It refers to a problem during any phase of the sexual cycle that restricted the man from experiencing satisfaction from the activity.

Clinical findings & history

Name - ABC

Age - 28 years, Male

Occupation - Engineer in an IT Company

Complaints - Unable to ejaculate during intercourse but could ejaculate while masturbating.

Pules - 82/ min

BP - 110/80 mmHg, Nondiabetic.

Past history of illness - No significant illness

No history of psychiatric disorder,

No history of surgery, trauma, accident

No habits (tobacco, alcohol)

Marriage - Married before 1 year 3 months

CBC - Within Normal Limits.

Testosterone and T3, T4, TSH - Within Normal Limits.

Semen analysis - Volume 2.5ml /ejaculation and sperm count 20 mil/ml

Internal Medicine

Kapikacchu Beej (Shodhit) Churna 3 gm before meal twice a day with milk (for 1 month)

Kapikacchu (Mucuna pruriens Linn.) is the most famous drug for its powerful aphrodisiac action. It is well known to increase the sperm count[9] and to increase testosterone levels in the body as

well. Kapikacchu is an agent that helps the body in building up the mass as well as endurance and also helps the body to increase muscular strength. It promotes the mood for sexual indulgence thereby increasing the libido power and is also beneficial for people who are undergoing depression.

It has Guru, Snigdha Guna; Ushna Virya; Madhura Vipaka; Vatahara and Pittahara Karma. Pharmacological actions are, Hypoglycemic Activity, Aphrodisiac Activity, Antioxidant Activity, Antimicrobial Activity, Antiparkinson’s Activity etc. Kapikacchu Churna effectively raised the sperm count. The results on sperm count were found highly significant. It also showed good improvement in other seminal parameter like volume of semen, Ph of semen, motility of sperms etc.[10]

Shirodhara: The patient was advised to cut hair as small as possible. Shirodhara with Til Tailam (Sesame oil) was performed for 40 minutes for 28 days. During Shirodhara the patient was given instructions to relax his body and mind. Then he was advised to think and create a scenario of pleasurable reaction to touching and progression toward orgasm and ejaculation. Psychological counselling was done at every sitting of Shirodhara.

Shirodhara is a unique non-invasive technique of Ayurveda. Its non-invasive approach has been shown good or even better for the treatment of insomnia, anxiety, stress, headache, hypertension.[11] Shiro means head and Dhara means dripping. Shirodhara is the procedure in which oil or any liquid dripping on the forehead in a steady stream or flow for 36 min to 1 h 12 min.[12] Total treatment duration in terms of days is not specified in classical texts, based on various practices in India Shirodhara is done for 3, 7, 14, or 28 days.[11]

Assessment criteria

Lakshana Nil Alpa Madhya Uttam
Confidence 0 1 2 3
Pleasure of orgasm 0 1 2 3
Quantity of semen ejaculated 0 1 3 3

Before and after treatment

The Patient experienced marked improvement in confidence and performance during sexual intercourse. Patient felt better and felt marked improvement in weakness and increased level of sexual desire.

The patient experienced ejaculation during intercourse after 20 days of treatment.


Journal of Ayurveda and Integrated Medical Sciences 2023;8(3)190
Khandalikar S: Effect of Shirodhara in Situational Anejaculation
Lakshana After 7 days After 14 days After 21 days After 28 days
Confidence 1 2 2 3
Pleasure of orgasm 0 0 1 2
Quantity of semen ejaculated 0 0 1 2

Discussion

Different clinical presentations of the same pathological process occur according to the effect of the vitiated Vata on various structural and functional attributes of Shukra. In delayed ejaculation, although intravaginal ejaculation eventually occurs, it requires a long time and strenuous efforts at coital stimulation and sexual arousal may be sluggish. It may be caused when the vitiated Vata loses its Drutatva or Chalatva after the enlodgement, which leads to lack of sufficient stimulation (Prerana) for ejaculation. It may also happen when the vitiated Vata causes diminution of Shukra Dhatu by Shoshana Svabhava and quantitatively less amount of Shukra is ejaculated after a long effort.[13] The most common treatment for anejaculation is psychological counselling to address underlying causes and sexual therapy. Sexual therapy can involve sex education for a clearer understanding of the arousal process by the affected person.

Conclusion

Shirodhara reduces performance anxiety and improves the pleasure of the sexual act. Shirodhara along with psychological counselling is very effective in the treatment of Shukra Gata Vata. Anxiety and Stress are the triggering factors of Delayed Ejaculation. Therefore, while treating a patient with Delayed ejaculation, psychological counselling is a must. Psychological counselling could impart confidence and self-esteem in the subject, help him to think positively, and to indulge in the sexual act enthusiastically by reducing performance anxiety. Guru, Snigdha Guna; Ushna Virya; Madhura Vipaka; Vatahara Karma of Kapikacchu is useful in vitiated Vata involved in delayed ejaculation.

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