Premature Ejaculation:
Premature
ejaculation (PE; also known as rapid ejaculation) is the most common type of
sexual dysfunction in men younger than 40 years. Most professionals who treat
premature ejaculation define this condition as the occurrence of ejaculation
prior to the wishes of both sexual partners.
Complex problem:
Premature ejaculation sometimes is confused with delayed orgasm in
female partner.
To explain,a male may reach climax after 5
minutes of sexual intercourse, but this is not premature ejaculation if his
partner regularly climaxes in 3 minutes and both are satisfied with the timing.
Another male might delay his ejaculation for a maximum of 30 minutes, yet he
may consider this premature if his partner, even with foreplay, requires 45
minutes of stimulation before reaching climax.
Because many females are unable to
reach climax at all with vaginal intercourse ;they sometime need foreplay
simultaneously or before , this situation may actually represent delayed orgasm
in the female partner rather than premature ejaculation in the male; the
problem can be either or both, depending on the point of view. This
highlights the importance of obtaining a thorough sexual history from the
patient (and preferably from the couple).
How to define premature
ejaculation?
The criteria for premature
ejaculation stated in the Diagnostic and Statistical Manual of Mental
Disorders, Fourth Edition, text revision (DSM-IV-TR) is as follows:
(1) persistent and recurrent ejaculation with minimal sexual stimulation
before, on, or shortly after penetration before the person wishes it; (2)
marked distress or interpersonal difficulty; and (3) not exclusively due to
direct effects.
Cauasative
Factors:
This can either be primary:senice
beginning or secondary: after having period of normal ejaculatory latency.Many
research aerticle are published regarding the causative factors for premature
ejaculation but at large it is
attributed to pyschological factor.These men have increased Intra Vaginal
Ejaculatory Latency Time.Hyperexcitability
many times are due to strict religeous upbringing,sexual taboo in family
and sciety,previous traumatic sexual experience,sexual abuse.Sometimes guilt of
previous sexual exposure also contributes to the premature ejaculation.
In a study done in 110 patients with life long premature ejaculation; 90% of the patients ejaculated within 1 minute and 80% ejaculated within 30 s.
Sometimes performace anxiety plays
important role in PE.The male often then give excuse that the female partner
excited him so much that he could not hold back.
Now-a-days underlying erectile
dysfunction also has been seen as cause for premature ejaculation.
Sometimes cardiac patients ejaculate
early having fear in mind that prolonged sexual act may precipitate heart
attcak.
Management:
Many times detailed sexual history
only suffices no other investigations are really necessary.
Sexual counselling plays important
role as to remove/allay previous fear/guilt from the minds of patients.
Step by step approach may help
patients many-a-times:
1) Engaging in a lot of foreplay thus
removing performace anxiety and avoiding actual insertional sex
2) squeeze-pause technique
popularized by Masters and Johnson where partner masturbates the patient and
before the climax squeezes the glans(the
pressure should be applied underneath the glans) to stop the ejaculate and
ceases to stimulate the organ.Once
the male organ is flaccid again,the female partner starts the technique
again.This is repeated to gradually increase the ejaculatory latency.
3)After that female should stride
across the male partner on his lap and repeat the same thing but only diffrence
is that the penis is rubbed to the vulva(NO
INSERTION AGAIN)
4)Finally they can engage in sexual
act with the female partner on the top.
5)Once this sets the sex right
normal conentional position can be tried.
Drugs : Novel drug:Dapoxetene
in Premature Ejaculation
Normally
Selective Serotonin Uptake Inhibitors are used for such patients along with
psychotherapy. The mechanism of action of SSRIs is linked to their inhibition
of neuronal uptake of serotonin in the CNS. Various animal studies suggest that
SSRIs have weak effects on norepinephrine and dopamine neuronal reuptake.They
prolong the sexual climax causing relief from early unwanted ejaculation.
These SSRI (Sertraline,Paroxetene.Fluoxitine)may
take until at least 3 weeks following
initiation of treatment to cause improvement in sexual latency.
It
has been seen that many patients with PE have undelying erectile dysfunction
also so adding PDE-5 inhibitors like Viagra(sildenafil),Tadalafil works well.
Dapoxetine is an SSRI developed specifically for the
treatment of premature ejaculation. Dapoxetine may be effective at first dose
(ie, on-demand) for premature ejaculation when given 1-3 hours prior to sexual
intercourse.
The optimal medical treatment for premature ejaculation has
not been established but single dosing
prior to sexual relations can work for many males.While raised blood levels through daily use of the
medication may be unnecessary resulting in many CNS side effects. Obviously, if
single dosing is successful, therapy is simpler and is associated with fewer
adverse effects. Therefore, this may be the preferred initial therapy.
Dapoxitine right now although is manufactured in India ;is
not available in market.But it soon expected after Food Drug Administration
approves it.
Certain other methods:
Wearing
condom,applying lignocaine jelly sometime are practised. These agents may
reduce penile sensitivity and excitability and delay ejaculation.
Some
andrologist give tramadol- centrally acting opioid drug (weak μ-opioid effect)
in addition to reuptake inhibition of 5-HT and norepinephrine.
Circumcision
practised thinking that keratinisation of the glans may help in reduction of
sensitivity of the glans is occasionally practised but it is a painful option
with seemingly doubtful benefit.Logically the circumcision will lead to thickening and keratinization of the glans and hence less hypersensitivity. But many studies have failed to demonstrate any positive benefit. But the PE rates have been found out to be low in countries following ritualistic circumcision.
Premature
ejaculation in most cases is psychological.Sexual counselling of both partners is necessary
(unlike in India -most of the times only male partner visits.The female partner
thinking it as HIS PROBLEM RATHER THAN
THEIR PROBLEM .
SSRIs
along with PDE-5 inhibitors in most cases along with Master and Johnsons
technique is helpful.Condom and Lignocaine jelly can complement for the delay in ejaculation.
Thanks for sharing the report on the premature ejaculation . It is most common problem with the man . Most of the male feel PE problem. There are so many technique by which male can increase their time period .
ReplyDeleteErection Problem Treatment,Men sexual disorder treatment,Sexual Dysfunction in Male,
Premature ejaculation (PE) also known as rapid ejaculation, premature climax and easy ejaculation affects 1 in 5 men between the ages of 18-59 years. Usually termed as a psychological problem, biology also plays a role in it.
ReplyDeletePremature Ejaculation (PE) Treatment in India