Disease / Premature Ejaculation

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Although premature ejaculation is a common problem that causes significant distress, there is no way of having a complete cure of premature ejaculation though it can be managed to a certain extent by using the measures mentioned above. Please seek help from your doctor or your urologist.

What is premature ejaculation?

There are different definitions for premature ejaculation, as defined by various organisations. World Health Organisation’s international classification of disease defined premature ejaculation as the inability to delay ejaculation sufficiently to enjoy love making which is manifested by either an occurrence of an ejaculation before or very soon after the beginning of intercourse (if a time limit is required before or within 15 seconds of beginning the intercourse) or if the ejaculation occurs in the absence of sufficient erection to make intercourse possible. International Society for Sexual Medicine defined Premature ejaculation as a male sexual dysfunction characterised by ejaculation which always or nearly always occurs prior to or within about one minute of vaginal penetration and inability to delay ejaculation on all or nearly all vaginal penetrations. The main point in all of the definitions is ejaculation occurring very soon, before or immediately after vaginal penetration and causing significant bother to the patient and the partner.

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What are the types of premature ejaculation?

Premature ejaculation can be life long (primary) or it could be acquired (secondary).

How prevalent is premature ejaculation?

The prevalence rate of premature ejaculation is about 20-30%. The highest prevalence rate was found in a study in the USA ‘NHSLS Study’ to a level of 31%.

What are the risk factors for premature ejaculation and how does it occur?

The exact cause of premature ejaculation is unknown. High levels of performance anxiety that is presented in patients with erectile dysfunction may worsen premature ejaculation. Premature ejaculation is more common in certain racial groups (Black and Hispanic men and men from Islamic backgrounds). It may be higher in men with lower educational levels. Other risk factors include poor overall health status and obesity, prostate inflammation, thyroid hormone disorders, emotional problems, stress and traumatic sexual experience.

How is premature ejaculation diagnosed?

The diagnosis of premature ejaculation is purely based on the patient’s medical and sexual history. Your doctor will ask questions to explore the duration of the time of ejaculation and degree of sexual stimulus and how this impacts on your sexual activity and quality of life. The time to ejaculation after vaginal penetration is assessed by measuring the time intervaginal ejaculatory latency time. However estimation of this time does not clearly diagnosis premature ejaculation as it is hugely variable among male population.

How is premature ejaculation treated?

Variable Behavioural strategies are used to treat premature ejaculation.

  • Stop/start programme: This means the partner stimulates until the patient feels the urge to ejaculate at this point he instructs his partner to stop and wait for the sensation of pass and then stimulations resumed.
    The Squeeze technique: is similar but the partner applies manual pressure to the glans just before ejaculation until the patient loses his urge.
    Basically these behavioural techniques allows men to learn and recognise the signs of increases sexual arousal and how to keep this level of arousal excitement below the intensity that results in ejaculation. Overall success rates of such strategies were 50-60% on a short term.
  • Topical anaesthetic medications are the use of a local anaesthetic medications by a cream at the tip of the penis may reduce the sensitivity of the glans penis and this may help to increase the time interval between ejaculation and vaginal penetration.
  • There are other medications available from a group called selective serotonin reuptake inhibitors. These medications are used to treat mood disorders but can also delay ejaculation and there are very selective medications within this group for use for premature ejaculation. Since these medications are used as antidepressants, there are side effects related to these medications.
  • PDE5 type inhibitor medications like Viagra and Cialis may also help premature ejaculation by treating the erectile dysfunction and also by reducing the performance related anxiety. Other underlying conditions like genitourinary infections (prostatitis) should be treated first as prostate inflammation can cause premature ejaculation.