Premature Ejaculation
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What is premature ejaculation?
Premature ejaculation (PE) is when during sexual intercourse, there is too rapid achievement of climax and ejaculation occurs in the male relative to his own or his partner's wishes. In this state, ejaculation occurs during the early stages of sexual excitement or soon after the insertion of the penis into the vagina.
Premature ejaculation is one of the most common male sexual problems negatively impacting sexual life leading to worry, stress, or serious concern. About 1 in 3 men are affected by PE at some point in their life.
Premature Ejaculation can be differentiated between two types. Primary PE, which is present from the time a man attains puberty, and Secondary PE which is acquired later in the man's life.
Premature Ejaculation can be further divided between
· Global Premature Ejaculation, which occurs with all partners and in all circumstances, and
· Situational Premature Ejaculation which occurs in certain situation or with specific partners.
How is PE measured?
There is presently no medical standard that exists to indicate how long a man should take to ejaculate. Therefore, it’s almost impossible to get an accurate description of premature ejaculation, because what some couples consider a satisfactory length of intercourse would be very inadequate for others.
A study reported the average intravaginal ejaculation latency time (IELTs)-that is the time it takes a man from vaginal penetration to when he ejaculates- of 6.5 minutes in 18 – 30 year old.
While this could be considered standard, it is possible that men with very low IELTs, of say about 2 minutes could be happy and satisfied with their performance, while men with higher IELTs of even up to 20 minutes may consider themselves to have premature ejaculation.
So how is PE measured? Since there seem to be no agreed gold standard for classifying PE, it may therefore be based on both partners satisfaction with the length of time the man stays before coming.
How common is PE?
Premature Ejaculation is a very common form of male sexual dysfunction. As a matter of fact, it is the most common instance of sexual dysfunction for men under 40 years of age.
Recent estimates conclude that up to 1 in 3 sexually active men are affected by the problem to some degree. Most men experience premature ejaculation at least once in their lives.
What are the symptoms of premature ejaculation?
Premature ejaculation is characterized by the following:
· The inability of a man to control his ejaculation that interferes with optimal sexual or psychological well-being in either partner.
· Ejaculating before he is ready to, or has satisfied his partner.
· Ejaculating before penetration, upon penetration, or shortly thereafter.
What causes PE?
Some cases of premature ejaculation do not have a clear cause. However, for most cases, combinations of factors have been identified, these include:
· Oversensitive glans penis ( head of the penis)
· Intercourse with a new partner
· Nervousness or performance anxiety
· Long time since the last ejaculation
· Temporary depression
· Sense of guilt
· Side effect of medications
· Financial and emotional stress
· Unrealistic expectations about performance
· History of sexual repression
· Hormonal imbalances
· Thyroid issues
· Genetic abnormalities
· Neurotransmitter abnormalities
· Abnormal reflex activity of the ejaculatory system
· An overall lack of confidence
· Inflammation and infection of the prostate or urethra
· Nervous system damage from surgery or trauma
How is premature ejaculation diagnosed?
There are two major types of PE, which is Primary (which is present from the time a male attains puberty), or Secondary (which is acquired later in the man's life). The type should be determined before treatment is commenced.
In order to determine the causes, the doctor may do the following:
· Take a medical and sexual history of the patient
· Conduct thorough medical examination
· Require some specific laboratory tests and analysis to rule out some medical problems
How is premature ejaculation treated?
Treatment for mild cases
For men who last between 4-5 minutes but would like to last longer can practice some techniques such as:
Relaxation/Distraction technique: This method helps to delay ejaculation.
This means turning your mind to something else when you sense that climax is near, like thinking about something totally unconcerned with sex.
Lifestyle changes: For some men, stopping or cutting down on the use of alcohol, tobacco, or illegal drugs may improve their ability to control ejaculation.
Use of condoms: Other options include using a condom to reduce sensation.
Another kind of condom contains a local anaesthetic (benzocaine or lidocaine) inside it. This has been shown to be effective in a couple of men with premature ejaculation, though some men may react to the local anaesthetic.
Local anaesthetic gel: A local anaesthetic gel that's applied to the shaft of the penis shortly before intercourse can help reduce sensitivity of the penis and help in PE.
This method has some disadvantages of dulling the partners’ sexual sensation as well as producing side effects such as intense itching, redness and soreness.
Local anaesthetic spray: This is a spray that contains a local anaesthetic, which is sprayed on the penis within 15-20 minutes of initiation of sexual intercourse. This has been shown to be effective in many men presenting with ED.
Treatment for more severe cases
If PE is causing you significant problems, it is best to consult an expert for treatment. For more severe cases, the following may be used.
The “penis grip” method
This technique is based on a special 'penis grip' and has been shown to cure the majority of men with premature ejaculation. It involves adequate co-operation from their partners and works like this:
1. Your partner places her hand so that her thumb is on one side of the man's erect penis
2. Her index and middle fingers are on the other side
3. The index finger is just above the ridge of the glans (the 'head'), while the middle finger is just below the ridge
4. When the man feels that he's near to a climax, he tells his partner
5. She then squeezes his shaft firmly between her thumb and the other two fingers
This is continued until the man is then able to control his own ejaculation.
Use of medications
Antidepressants:
A group of antidepressant medicines called selective serotonin reuptake inhibitors (SSRIs) are sometimes used to treat premature ejaculation. These medicines are used because a side effect of SSRIs is inhibited orgasm, which helps delay ejaculation.
Antidepressants that are commonly used for this purpose include
· Clomipramine
· Fluoxetine
· Sertraline
· Paroxetine
Tramadol
This belongs to the group of drugs called analgesics, and used for the treatment of pains. Tramadol, to a reasonable extent exhibit some characteristics of an anti-depressant in that it increases levels of serotonin and norepinephrine. Tramadol also has few side effects, and safe to use.
In management of premature ejaculation, it is shown to be very effective, having the potential to cause an increase in intravaginal ejaculation latency time (IELT) of 4-20 folds in greater than 90% of men.
Dapoxetine
This drug is a short-acting selective serotonin reuptake inhibitor (SSRI) that is used to treat premature ejaculation.
A study using dapoxetine showed it significantly improved all aspects of PE. It is taken by mouth, in tablet form. The dose is either 30 mg or 60 mg. Dosage depends mainly on your body weight.
Possible side-effects of dapoxetine include:
· Dizziness
· Nausea
· Insomnia
· Headaches
· Diarrhoea
Intracavernous pharmacotherapy
This is another method of treating PE. This is a method of injecting a drug known as a vasodilator directly into the penis to help men control premature ejaculation and maintain their erection. It has been proven to be effective in over seventy percent of test patients
A special constriction device
This is another technique that is potentially useful for treating premature ejaculation. It involves wearing a slightly constricting ring below the head of the penis for 30 minutes each day. The assumption is that it would make the organ less sensitive.
This method was developed over a decade ago but there is yet to be more convincing study on the efficacy. It is advisable that such technique should only be used when prescribed by an expert.
Cognitive behaviour treatment (CBT)
This is another method of treating PE.
The CBT method focuses firstly, on addressing thought patterns that are detrimental to sexual performance and satisfaction.
This method also aims to alter the man’s behaviour. In this instance the man is encouraged to masturbate using the stop-start technique to gain more control over his responses and his urge to ejaculate quickly.
The stop-start technique
1. The man is encouraged to masturbate alone.
2. He is asked to set time aside to be private and to masturbate with dry hands.
3. The man is encouraged to masturbate almost to the point of ejaculation and then stop.
4. He should do this three times.
5. On the fourth time, he is permitted to ejaculate
After he has achieved this measure of control, he can try masturbating with a wet hand, which will feel more like the inside of a vagina. He is encouraged to do the stop-start technique as before.
This method can be practiced at home, or preferably with the help of a sex therapist.
Herbal medicines
Some of herbal products have been shown to help in premature ejaculation.
A product that has been shown to be very useful is panax ginseng, especially the red ginseng. These are actually useful in treating secondary PE.
References:
· The Turek Clinic, male ejaculatory disorders http://www.theturekclinic.com/ejaculatory-disorder.html accessed 15 October 2012
· Netdoctor.com, premature ejaculation, http://www.netdoctor.co.uk/sex_relationships/facts/prematureejaculation.htm
· Waldinger MD, Quinn P, Dilleen M, Mundayat R, Schweitzer DH, Boolell M (2005). "A multinational population survey of intravaginal ejaculation latency time". The journal of sexual medicine 2 (4): 492–7.
· PubMed Health, Premature ejaculation http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0002492/
· NHS Choices, Ejaculatory problems http://www.nhs.uk/conditions/ejaculation-problems/Pages/Introduction.aspx
