Premature ejaculation is a problem which plagues up to 30% men depending upon the definition. There is no uniform cut-off defining "premature", but a consensus of experts at the International Society for Sexual Medicine endorsed a definition including "ejaculation which always or nearly always occurs prior to or within about one minute". However, it is important to recognize that premature ejaculation is a subjective diagnosis and totally depends on the satisfaction of the partners.
Incorrectly, the following were listed as possible causes of premature ejaculation:
- Men are too excited to focus on bodily sensation.
- Some men's first experience with intercourse was in a tense situation where hurrying was beneficial, like in a car, and then learned a bad habit.
- Being so concerned about performance they didn't pay attention to their own sensations.
- Guilt about enjoying sex or pleasure of any kind.
- Worrying about maintaining erections.
- Unresolved relationship issues.
- General life stress.
Through the years many physical causes were possibly linked to premature ejaculation. However, there are very few medical reasons that have been documented as causing premature ejaculation.
In the early 1990's, information was presented at the International Society for Impotence Research that indicated that the pelvic muscles, specifically the muscles that surround the penis, are in a hyperactive state in men with premature ejaculation. Furthermore, it is known that during the ejaculation process premature ejaculation have hyperactive muscles that are already on their way toward the threshold to producing ejaculations. Over the past few years that we have been evaluating and treating men with impotence and premature ejaculation, we have found that it may be due to a combination of hypersensitivity of the penis and hypersensitivity of the pelvic muscles.
Here is a partial list of treatments that have NOT been shown to be beneficial.
- Long term psychoanalysis
- Getting drunk
- Using one or more condoms
- Concentrating on something other than sex or having intercourse, like one's bank balance for example
- Biting one's cheek as a distraction
- Frequent masturbation
- Testosterone injections
Masters and Johnson in the 60's popularized the start/stop, and squeeze techniques. In some cases this has been associated with delayed ejaculation. Dr. Helen Kaplan described in her book, Premature Ejaculation, certain exercises that she claimed when performed and practiced regularly prolonged in at least 70-80% of men the time to ejaculation. Unfortunately, few men and their partners are motivated to perform the exercises as necessary to obtain beneficial results. For a period of time we attempted to use biofeedback (where control of the bodily functions is mastered) through the use of a rectal plug and home teaching monitor. We were able to obtain excellent results with this technique, although our patients were reluctant to stimulate themselves with something in the rectum (certainly no surprise).
Currently, our approach to premature ejaculation consists of a history, physical examination specifically geared towards neurological problems and the amount of sensitivity of the penis. Rarely have we found a physical abnormality with the exception of hypersensitivity of the penis as previously mentioned.
There have been numerous reports in the urology literature of successful treatment of premature ejaculation through the use of low dose antidepressants including Anafronil, Prozac and Zoloft. One of the known side effects of these medications when used for depression is significantly delayed ejaculation. In the studies,low doses of the antidepressant medication have prolonged ejaculation by at least 5-10 minutes. It should be pointed out that this medication is not approved by the FDA for treatment of premature ejaculation. We have found that combining the medication with the exercises in Dr. Kaplan's book, potentially can result in a man obtaining control over his ejaculation time. However, these antidepressants typically must be taken daily and are often accompanied by a variety of side effects including, ironically, lose of sexual desire.
Recently, there has been some advances in topical medications for premature ejaculation that are showing great promise. Topical anesthetics applied directly to the penis have always been able to help men delay ejaculation. However, they have been accompanied with two significant side effects that have made them unpopular. These traditional "numbing" sprays and creams reduce sexual pleasure for the man and transfer to his female partner resulting in reduced sensation and inability for a woman to achieve orgasm.
A new class of topical anesthetic medications has been developed recently which have absorption technology. This enables the mild anesthetic to absorb through the skin's surface to the nerves below the surface that control ejaculation. The result is good sensory feeling for the man and virtually no transfer to his partner. In clinical trials, PSD502 - currently unavailable in the U.S. - achieved positive results. Patients are reporting a high level of satisfaction with Promescent, which is available over-the-counter.
Although premature ejaculation is a common and frustrating problem, we are prepared and willing to be of whatever assistance we can for you and your partner. Frequently, marital and relationship issue may be an underlying cause of premature ejaculation. These differences should be addressed in order to improve the success of the therapy.
Reprinted with permission from Dialog Medical, dialogmedical.com.
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