Premature Ejaculation

ERECTION PHYSIOLOGY

For something that appears so natural, an erection is a rather complicated process involving the coordination of the psychological, neurological and cardiovascular systems.

No matter what the nature of the stimulus, be it visual, mental or physical, the brain coordinates the following series of events:

Nerve impulses transverse the length of the spinal cord to the pudendal nerve and on to the penis. Smooth muscle within the walls of the penile arteries respond by relaxing. Subsequently, the penile arteries dilate allowing up to eight times more blood to flow into the corpora cavernosum (two parallel cylinders that transverse the length of the penis).

The cavernosum becomes engorged with blood which expands and lengthens the penis. The expanding tissue then exerts a positive pressure that compresses the veins that normally empty the blood from the penis, which maintains the blood in the penile tissue. When ejaculation occurs or when arousal is discontinued the penis returns to its non-erect state. There are many theories concerning the cause of premature ejaculation whether the condition is psychological and/or physiological.

DEFINITION OF PREMATURE EJACULATION

The medical definition of premature ejaculation is the persistence of recurrent ejaculation with minimal sexual stimulation before, on, or shortly after penetration, and before the person wishes it to occur.

In common terms, PE is defined as:

• The inability to control your ejaculation.

• Ejaculating before you are ready to, or, have satisfied your partner.

• Ejaculating before or within several minutes after penetration.

HOW COMMON IS PREMATURE EJACULATION (PE)?

Premature ejaculation is very common. Recent studies show that up to 1 out of 3 sexually active men (33%) are affected by this problem. Premature ejaculation occurs in men of all ages (more common in younger men) and of all socioeconomic backgrounds.

Premature ejaculation has been identified in men who have been diagnosed without psychological conditions, as well as, in those men who are experiencing extreme stress and anxiety.

Men who experience premature ejaculation frequently question their masculinity and will often lose confidence concerning their sexual performance. This lack of sexual performance can result in a low self-esteem that affect existing relationships.

Secondary to their fear of ejaculatory control, sometimes men will also isolate themselves and refrain from dating or engaging in meaningful relationships.

CAUSES, INCIDENCE AND RISK FACTORS OF PE

Premature ejaculation is a common complaint. It is rarely caused by a physical or structural problem. Premature ejaculation is essentially caused by an oversensitive glans (or head of the penis), as well as nervousness or tension during lovemaking. This is often due to the fear of ejaculating rapidly and not satisfying your partner due to previous episodes of PE.

The fear of ejaculating rapidly can exacerbate the problem. Premature ejaculation can also occur in association with erectile dysfunction. Treating the latter will often provide a solution to the former.

IS PE A SERIOUS PROBLEM?

Most patients with PE have no underlying medical problems. However, it is important to solve the problem of PE for two reasons:

It is difficult to fully enjoy your sex life to its fullest with premature ejaculation because most of the time you are occupied with trying to delay ejaculation. Also, leading to frustrations in the partner who fails to achieve maximal sexual fulfillment.

Secondly, premature ejaculation tends to be a lifelong problem until treated. Although some lovemaking sessions may last a little longer than others, the problem is always there, limiting the full enjoyment of lovemaking. Consequently, there is a tendency to avoid lovemaking and other forms of intimacy. This problem may even affect your relationship, your confidence in every day life, or impair your ability to socialize.

PE TREATMENT OPTIONS

Before a treatment option is offered, your problem must be diagnosed correctly. In general, practice and relaxation will help you deal with the problem. Some men try to distract themselves by thinking non-sexual thoughts to avoid becoming excited to fast.

Some Helpful hints:

The "Start and Stop method"

This technique involves sexual stimulation until the man recognizes that he is about to ejaculate. The stimulation is then removed for about 30 seconds and then may be resumed. The sequence is repeated until ejaculation is desired, the final time allowing the stimulation to continue until ejaculation occurs.

The "Squeeze method"

This technique involves sexual stimulation until the man recognizes that he is about to ejaculate. At the point, the man or his partner gently squeezes the head of the penis for several seconds, withholding further sexual stimulation for about 30 seconds, and then resuming stimulation. The sequence may be repeated by the person or couple until ejaculation is desired, the final time allowing the stimulation to continue until ejaculation occurs. Condom use reduces the sensation during intercourse thus prolonging the time before ejaculation.

Antidepressants such as Duloxetine and Fluoxetine and other selective serotonin reuptakes inhibitors (SSRI's) may be helpful because they have a common side effect of prolonging the time it takes to achieve ejaculation.

Local anesthetic creams may be applied to the penis to decrease stimulation. Decreased feeling in the penis may prolong the time before ejaculation.

EXPECTATIONS AND PROGNOSIS

In most cases, the man is able to learn ejaculatory control through education and practice of the simple techniques outlines. Chronic premature ejaculation may be a sign of anxiety or depression, both of which could be helped by psychiatric intervention.

CALLING YOUR HEALTH CARE PROVIDER

Call for an appointment with your urologist if premature ejaculation is causing a problem and does not respond to techniques mentioned. There is no prevention for this disorder, though relaxation can reduce the likelihood of its occurrence.