Premature ejaculation can be a distressing condition for men and their partners. Premature, early or rapid ejaculation are all terms used to describe the event whereby men are unable to control ejaculation during sexual arousal and/or activity. The control of ejaculation is thought to be related to changes in serotonin and dopaminergic neurotransmission,1 specifically 5-hydroxytryptamine (5-HT)2C receptor hyposensitivity and/or 5-HT1A receptor hypersensitivity, but the precise mechanism controlling ejaculation has yet to be determined.
Recently, premature ejaculation (PE) has become characterised by ejaculating within few minute or before partner or self-satisfaction. The time between vaginal penetration and ejaculation is referred to as intra-vaginal ejaculatory latency time (IELT), although ejaculatory latency time (ELT) may be a more appropriate term as it acknowledges other forms of sexual activity. Normal ejaculatory latency has been cited as being six to thirteen minutes after vaginal penetration.
Recently, premature ejaculation (PE) has become characterised by ejaculating within few minute or before partner or self-satisfaction. The time between vaginal penetration and ejaculation is referred to as intra-vaginal ejaculatory latency time (IELT), although ejaculatory latency time (ELT) may be a more appropriate term as it acknowledges other forms of sexual activity. Normal ejaculatory latency has been cited as being six to thirteen minutes after vaginal penetration.
Definition - PE has been defined as persistent ejaculation with minimal stimulation, which is not a result of withdrawal of opiates, and that results in marked distress. This definition assumes regular sexual activity with the same person for around six months. Some definitions - inability to delay ejaculation (no self controle) on all or most vaginal penetrations; and negative consequences (eg distress, bother, guilt / depression, avoidance of intimacy).
The prevalence of PE:- Based on epidemiological data, PEis estimated to be 22.7 per cent, which is higher than the estimated prevalence of erectile dysfunction.
The causes of PE are not precisely known. This is due partly to the different types of PE and partly to a lack of consensus on definition. There are four proposed types of PE. Lifelong PE is thought to be caused by neurobiological or genetic factors, whereas acquired PE might be caused by hormonal or vitamin deficiency, poor neurological co-ordination, infection, withdrawal of opiates, performance anxiety or other psychosexual or relationship concerns. The remaining categories are not thought to have any biological causation.
Type of premature ejaculation: 1- Lifelong. 2- Acquired. 3- Natural variable. 4- Situational.
The nature of the problem needs to be established, as PE may be caused by prostatitis (more commonly subclinical prostatitis), necessitating an examination of the prostate on USG. It is also essential to know what the patient wants out of the consultation, as some men expect sexual activity to be mutually orgasmic and have unrealistic expectations of normal ejaculatory latency. If the prostate is tender on examination, treatment with 500mg ciprofloxacin twice daily for four weeks may resolve the problem. It is also important to determine whether the man has erectile dysfunction rather than PE.
No further examinations are needed, although the opportunity can be taken to look at testosterone, lipid and glucose levels.
Treatment of premature ejaculation
The most common treatment options for PE are treatment of basic cause that is leading to PE. Behavioural therapies; local anaesthetics, and selective serotonin reuptake inhibitors (SSRIs) or equivalent medication. Phospho-diesterase type 5 inhibitors (PDE5Is) have been used, but their precise mechanism of action is unclear.
A man who fears that he will lose an erection before ejaculating may well increase the speed of intercourse, thus giving himself PE. The underlying problem in these circumstances is loss of tumescence related to the narrowing of the pudendal artery, in which case a PDE5I may be a more appropriate prescription.
While SSRIs have not been found to maintain ejaculatory delay in all men after cessation of treatment, some with acquired PE have been able to sustain ejaculatory delay. Where possible, appointments should involve both partners, as the solution involves a couple rather than a solitary approach.
Sensate focus
Each couple will have their own ‘rules’ for sexual activity and intimacy, and negative feelings, eg pressure to perform, tiredness, pain, upset, guilt or worry, can affect both partners' desire for sexual activity. These feelings need to be articulated and discussed for PE to resolve. If the relationship has deteriorated to the point where no intimacy is present, or where no sexual activity is attempted, relationship counselling rather than sex therapy is needed. Behavioural therapy, Squeeze technique, Stop/start technique have their limitations. Kegal exercise helps.
New treatments
Recently, two further treatments have been investigated, with promising results:
topical eutectic mixture for PE (TEMPE)27 – an aerosol delivery of lidocaine-prilocaine;
dapoxetine – a serotonin transport inhibitor and the first SSRI licensed for treatment of PE.The potential advantages of dapoxetine are that it is a short-acting SSRI with few side-effects. It has been found to be effective on first dose, rather than after seven to ten days, as with other SSRIs.
The choice of whether to start medication or refer to a sex therapist can be difficult. A two-month course may be sufficient to help alleviate the pressure on men to perform in their sexual relationships. At the end of two months, a re-assessment of whether the man has been able to delay and control ejaculation can be undertaken. If there is no improvement, alternative pharmacological therapies and sex therapy may help.
PREMATURE EJACULATION TIPS
The prevalence of PE:- Based on epidemiological data, PEis estimated to be 22.7 per cent, which is higher than the estimated prevalence of erectile dysfunction.
The causes of PE are not precisely known. This is due partly to the different types of PE and partly to a lack of consensus on definition. There are four proposed types of PE. Lifelong PE is thought to be caused by neurobiological or genetic factors, whereas acquired PE might be caused by hormonal or vitamin deficiency, poor neurological co-ordination, infection, withdrawal of opiates, performance anxiety or other psychosexual or relationship concerns. The remaining categories are not thought to have any biological causation.
Type of premature ejaculation: 1- Lifelong. 2- Acquired. 3- Natural variable. 4- Situational.
The nature of the problem needs to be established, as PE may be caused by prostatitis (more commonly subclinical prostatitis), necessitating an examination of the prostate on USG. It is also essential to know what the patient wants out of the consultation, as some men expect sexual activity to be mutually orgasmic and have unrealistic expectations of normal ejaculatory latency. If the prostate is tender on examination, treatment with 500mg ciprofloxacin twice daily for four weeks may resolve the problem. It is also important to determine whether the man has erectile dysfunction rather than PE.
No further examinations are needed, although the opportunity can be taken to look at testosterone, lipid and glucose levels.
Treatment of premature ejaculation
The most common treatment options for PE are treatment of basic cause that is leading to PE. Behavioural therapies; local anaesthetics, and selective serotonin reuptake inhibitors (SSRIs) or equivalent medication. Phospho-diesterase type 5 inhibitors (PDE5Is) have been used, but their precise mechanism of action is unclear.
A man who fears that he will lose an erection before ejaculating may well increase the speed of intercourse, thus giving himself PE. The underlying problem in these circumstances is loss of tumescence related to the narrowing of the pudendal artery, in which case a PDE5I may be a more appropriate prescription.
While SSRIs have not been found to maintain ejaculatory delay in all men after cessation of treatment, some with acquired PE have been able to sustain ejaculatory delay. Where possible, appointments should involve both partners, as the solution involves a couple rather than a solitary approach.
Sensate focus
Each couple will have their own ‘rules’ for sexual activity and intimacy, and negative feelings, eg pressure to perform, tiredness, pain, upset, guilt or worry, can affect both partners' desire for sexual activity. These feelings need to be articulated and discussed for PE to resolve. If the relationship has deteriorated to the point where no intimacy is present, or where no sexual activity is attempted, relationship counselling rather than sex therapy is needed. Behavioural therapy, Squeeze technique, Stop/start technique have their limitations. Kegal exercise helps.
New treatments
Recently, two further treatments have been investigated, with promising results:
topical eutectic mixture for PE (TEMPE)27 – an aerosol delivery of lidocaine-prilocaine;
dapoxetine – a serotonin transport inhibitor and the first SSRI licensed for treatment of PE.The potential advantages of dapoxetine are that it is a short-acting SSRI with few side-effects. It has been found to be effective on first dose, rather than after seven to ten days, as with other SSRIs.
The choice of whether to start medication or refer to a sex therapist can be difficult. A two-month course may be sufficient to help alleviate the pressure on men to perform in their sexual relationships. At the end of two months, a re-assessment of whether the man has been able to delay and control ejaculation can be undertaken. If there is no improvement, alternative pharmacological therapies and sex therapy may help.
PREMATURE EJACULATION TIPS
Oil massage or Inject-able preparation do not help in PE. Treatment and medicines do not cost more, Vigra and other preparations are not used for PE(used for ED).. Over counter preparations should not be taken..
New advances n treatment of premature ejaculation has taken place in India. Drug which was available in USA, also approved by US FDA, is available in India now......
It is very effective , safe, and improve performance significantly. Get your sexologist opinion today.
New advances n treatment of premature ejaculation has taken place in India. Drug which was available in USA, also approved by US FDA, is available in India now......
It is very effective , safe, and improve performance significantly. Get your sexologist opinion today.
Dr Deshmukh MD Sexologist & Psychiatrist
9923291312
