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PREMATURE EJACULATION (PE)

INTRODUCTION

There is usually no set time for a man to ejaculate during intercourse. But this becomes a problem if you experience an orgasm before or in less than a minute during intercourse. The condition is called  Premature Ejaculation (PE).

Most men have experienced it at some point in their life. So, keep in mind that it is not something to worry about if it happens occasionally.

Premature ejaculation occurs when a man ejaculates too soon during sexual intercourse than he or his partner would like. PE is a common sexual complaint amongst men. Approximately, 1 out of 4 men have experienced this problem at some time. As long as it happens on rare occasions, it is not a cause for concern.

Some factors such as psychological and biological factors play a major  role in premature ejaculation. Some men feel awkward discussing  about it, PE can be treated using medications, counseling and sexual skills that prolong ejaculation or a series of combination of these solutions— can help improve sexual intercourse for your partner and you.

premature ejaculation

CRITERIA FOR DIAGNOSIS OF PREMATURE EJACULATION

You can be diagnosed of premature ejaculation if you:

  • always or almost always ejaculate within one minute of penetration.
  • are unable to delay ejaculation during intercourse all or almost all of the time.
  • feel distressed and tend to abstain from sexual intercourse as a result.

CLASSIFICATIONS OF PREMATURE

Premature ejaculation can be classified on the following basis:

Based on severity of the PE

> Mild: occurs within 30 secs — 1 min of vagina penetration

> Moderate: occurs within 15 — 30 secs of vagina penetration

> Severe: occurs before sexual activity begins; or at the start of sexual activity; or within 15 secs of vagina penetration.

Based on duration of the dysfunction

> Lifelong (primary): this occurs all or nearly all of the time beginning with your first sexual intercourse.

Characteristics of patients with lifelong premature ejaculation can include:

  • Psychological problems and
  • Deep anxiety about sex that relates to one or more traumatic experiences encountered during development.

> Acquired (secondary): this occurs after you have had several sexual encounters without ejaculatory problems. Characteristics of patients in this group includes:

  • Erectile dysfunction
  • Performance anxiety
  • Psychotropic drug use (drugs that affects the mind, emotions and behaviour).

Based on the context in which the dysfunction occurs

> Generalized: when premature ejaculation is not limited to a particular type of stimulation, situation or partner.

> Situational: Occurs when PE is limited to a particular type of stimulation, situation or partner.

SYMPTOMS OF PREMATURE EJACULATION

The main symptom of premature ejaculation is the inability to delay ejaculation for more than one minute during sexual intercourse.

Some men may feel they have PE, but their symptoms may not meet the diagnostic criteria.

symptoms of premature ejaculation

CAUSES OF PE

The cause of premature ejaculation is not yet known. But some psychological and biological factors play a key role in causing it.

Most causes of PE is due to psychological factors like sexual abuse, depression, anxiety, overexcitement, disturbed body image, worrying over early ejaculation.

Also, rarely, some biological factors may contribute to one having premature ejaculation like imbalance in hormone levels, abnormal levels of brain chemicals called neurotransmitters, inherited traits, multiple sclerosis, excessive alcohol intake, inflammation of the urethra and prostate, etc.

RISK FACTORS FOR PREMATURE EJACULATION

Various factors can increase your risk for PE, including:

  • Erectile dysfunction: You risk having PE, if you consistently have trouble getting or maintaining an erection.
  • Stress: Any emotional or mental stressor in your life can play a major role in PE, causing inability to focus during sexual intercourse.

COMPLICATIONS OF PE

PE causes a lot of problems in your life,some of which  include:

  • Stress
  • Relationship problems: this is a common complication of PE. For fear of ejaculating early, you or your partner will not want to engage in sexual activity.
  • Fertility problems: it might be difficult for you to get your partner pregnant.

DIAGNOSIS OF PREMATURE EJACULATION

In addition to asking about your sex life, your doctor will ask about your health history and might do a physical exam. If you have got both PE and trouble getting or maintaining an erection, your doctor might order blood tests to test your male hormone (testosterone) levels or other tests.

In some cases, your doctor might suggest that you see a urologist or a psychologIst who focuses on sexual dysfunction.

PREMATURE EJACULATION TREATMENT

treatment of premature ejaculation

Treatment is most effective if both partners are involved. It can be divided into; Pharmacological and non-pharmacology therapies .

PHARMACOLOGICAL TREATMENT

TOPICAL ANESTHETIC AGENTS

Anesthetic creams and sprays that contain a desensitizing agent are sometimes used to treat PE. These products are applied to the penis 10 to 15mins before sex to cut back sensation and help delay ejaculation.

Although anesthetic agents are effective and well-tolerated, they have potential side effects, as an example; some men report temporary loss of sensitivity and decreased pleasure. Sometimes, female partners even have reported these effects.

ORAL MEDICATIONS

  • A lot of studies have shown that selective serotonin reuptake inhibitors (SSRIs) are safe and very effective in the treatment of PE. They are conventional antidepressants but many have been found to have a side effect of delaying ejaculation.
  • Some studies also have shown that the combination of phosphodiesterase-5- (PDE5) inhibitors with SSRIs gives better results in treatment of PE than just the use of SSRIs alone.
  • A side effect of some weak opioid analgesics is delayed ejaculation.

NON-PHARMACOLOGICAL TREATMENT

COUNSELLING

This approach involves talking with a mental health practitioner about your relationship and experiences. Sessions can be facilitated to reduce performance anxiety and find better ways of addressing stress. Counselling is presumably to assist when it is utilized in combination with drug therapy.

BEHAVIOURAL TECHNIQUES

  • In some cases, therapy for PE might involve taking simple steps, like masturbating an hour or two before intercourse in order to delay ejacualation during sex.
  • Condoms: might decrease penis sensitivity, which may help delay ejaculation. “Climax control” condoms are available over the counter. These condoms contain numbing agents or are fabricated from thicker latex to delay ejaculation.
  • Moderate physical activity between above 30mins at least 5 times a week has been show to delay ejaculation.

SEX THERAPY TECHNIQUES

Masters and Johnson popularised 2 methods:

  • Stop-start method: In the stop-start method, the man is sexually stimulated either by himself (masturbation) or by his partner. Once he has the feeling or the urge to ejaculate, the stimulation should be stopped, allowing the feeling or urge to subside and thereafter, sexual stimulation begins again.
  • Squeeze-pause method: In the squeeze-pause method, sexual stimulation is done and when the man has the feeling urge to ejaculate, his partner should squeeze the end of his penis (at the point where the head (glans) joins the shaft); maintaining the squeeze until the feeling or urge to ejaculate is gone; then the process is repeated again. Note that, squeezing of the penis should not be painful to the man but could make him uncomfortable.

As time goes on with more practice, it becomes a habit and a point where the methods are no longer needed to delay ejaculation. Most couples find these techniques to be very effective and successful.

PELVIC FLOOR EXERCISE

Also known as Kegel exercises; can help to strengthen the muscles of the pelvic floor thereby reducing the risk of PE.

REFERENCES

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