This week, we will begin a series of articles on male sexual dysfunction. Today's article is on premature ejaculation (PE).Around 30 per cent of men experience PE at sometime in their life. In October 2007, the International Society for Sexual Medicine (ISSM) gathered the world's leading sexual health experts to develop an evidence-based definition of premature ejaculation. The ISSM has 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; and, negative personal consequences, such as distress, bother, frustration and/or the avoidance of sexual intimacy".
In a four-week study appearing in the May issue of The Journal of Sexual Medicine, 1,587 men were evaluated. The researchers reported that men who suffer from premature ejaculation had an average intravaginal ejaculatory latency time (IELT) of 1.8 minutes, compared to 7.3 minutes in men who did not.
Premature ejaculation is classified as either primary - if you've had the problem for as long as you've been sexually active - or secondary - if you developed the condition after having had satisfying sexual relationships in the past.
Causes
Primary premature ejaculation can have genetic or psychological origins.
The rapidity of ejaculation in men was found to be genetically determined by neuropsychiatrist Dr Marcel Waldinger and Pharmacological Researcher Paddy Janssen of the Utrecht University who studied 89 Dutch men with premature ejaculation. They discovered that those who climaxed too soon during intercourse had a version of a gene that controls the hormone serotonin, which determines the rapidity of ejaculation. They also discovered that premature ejaculating fathers had a higher probability of having sons with that problem too.
Psychological causes
Conditioning - many doctors believe that early sexual experiences influence future sexual behaviour. So, if a teenager conditions himself to ejaculate quickly, to avoid being caught while masturbating, or having sex, it might be difficult to break this habit.
Medical problems - If you have a medical concern that causes you to feel anxious during sex, such as a heart problem.
Guilt - This may increase your tendency to rush through sexual encounters.
Trauma - A traumatic sexual experience, such as carnal abuse, at an early age may lead to lifelong performance anxiety.
Upbringing - Some men, who have had a conservative upbringing where sexual activity is only considered appropriate in certain circumstances, such as after marriage, may find it difficult to relax during sex.
Secondary premature ejaculation can be caused by psychological or physical factors:
Psychological causesConflicts, or sexual incompatibility in relationships.
Performance anxiety is often the main issue at the start of a new sexual relationship, or where a man has had previous problems with sexual performance.
Physical causes
Diabetes, hypertension, an underactive thyroid gland, excessive drinking, inflammation and infection of the prostate or urethra, nervous system damage due to surgery or trauma and withdrawal from narcotics or a drug called trifluoperazine (Stelazine) used to treat anxiety and other mental health problems.
Very early ejaculation, occurring prior to entry into the vagina, may be the cause of infertility and marital disharmony.
Your doctor will diagnose premature ejaculation based on a comprehensive sexual history, a thorough physical examination and appropriate laboratory investigations.
Treatment options for premature ejaculation include self-help techniques, sexual therapy, medications and psychotherapy.
Self-help techniques
Masturbating an hour or two before sex.
Using a thick condom to help decrease sensation.
Taking a deep breath in order to briefly shut down the ejaculatory reflex.
Having sex with your partner on top.
Contraction of your PC muscles when you think you are a bout to ejaculate.
Couples therapy
If you are in a long-term relationship, you may benefit from couples therapy. Couples are encouraged to explore any issues that may be affecting their relationship and receive advice on how to resolve them. They are also shown techniques that can help the man 'unlearn' the habit of premature ejaculation. The two most popular techniques are the 'squeeze' and 'stop-and-start' techniques.
Squeeze technique
This technique involves sexual stimulation until the man recognises that he is about to ejaculate. At that point, the man or his partner gently squeezes the end of the penis for several seconds, withholding further sexual stimulation for about 30 seconds, and then resuming stimulation.
Stop-and-start method
This involves sexual stimulation until the man recognises that he is about to ejaculate. The stimulation is then stopped for about 30 seconds and then resumed. The sequence is repeated until ejaculation is desired.
Topical anaesthetic creams
Topical anaesthetic creams containing lidocaine or prilocaine will dull the sensation on the penis to help delay ejaculation. It is applied a short time before intercourse; these creams are wiped off when your penis has lost enough sensation to help you delay ejaculation.
Antidepressants
Your doctor may prescribe one of several antidepressants such as sertraline (Zoloft), paroxetine (Paxil) or fluoxetine (Prozac) to help delay ejaculation. Recently, University of Minnesota researchers have shown that the drug dapoxetine is a safe and effective drug treatment.
If the timing of your ejaculation doesn't improve, your doctor may prescribe the tricyclic antidepressant clomipramine (Anafranil).
Psychotherapy
This is also called talk therapy and is a useful adjunct to the above approaches, especially in patients with severe emotional and relationship difficulties.
Dr Alverston Bailey is a medical doctor and immediate past president of the Medical Association of Jamaica. Send comments and questions to editor@gleanerjm.com or fax 922-6223.
Sources:
Utrecht University (2008, October 10). Premature Ejaculation? Not Your Fault: Gene Determines Rapidity Of Ejaculation In Men. Science Daily . Retrieved October 28, 2008 , from http://www.sciencedaily.com?/releases/2008/10/081007132509.htm
P.K.C. Janssen, M.D et al. Serotonin Transporter Promoter Region (5-HTTLPR) Polymorphism is Associated with the Intravaginal Ejaculation Latency Time in Dutch Men with Lifelong Premature Ejaculation. Journal of Sexual Medicine, October 7, 2008.
