PREMATURE EJACULATION

Description

Premature ejaculation is the most commonly reported sexual complaint of men and couples. The highest number of complaints is among teenage, young adult, and sexually inexperienced men. Premature ejaculation occurs when male sexual climax (orgasm) occurs before a man wishes it, or too quickly during intercourse to satisfy his partner.

Causes and symptoms

There are several reasons why a man may ejaculate prematurely. For some men, the cause is due to an innate reflex or psychological predisposition of the nervous system. Sometimes it can be caused by certain drugs, such as non-prescription cold medications. Psychological factors, such as stress or fear, or guilt can also play a role. Examples of psychological factors include guilt that the sexual activity is wrong or sinful, fear of getting caught, or stress from problems at work or home.

In general, symptoms are when a male reaches climax in less than two minutes or when it occurs before the male or couple want it to occur.

Treatment

Sexual therapy involves addressing the personal as well as the sexual relationship between the two people who come for treatment. A plan can be developed that requires dedication, patience, and commitment by both partners. It necessarily begins by prohibiting intercourse for an extended period of time—at least a week, often a month. This is very important to the man because "performance anxiety" is the greatest enemy of performance. If he knows he cannot have intercourse he is able to relax and focus on the exercises. The first stage is called "sensate focus" and involves his concentration on the process of sexual arousal and climax. He should learn to recognize each step in the process, most particularly the moment just before the "point of no return." At this point the techniques diverge. The original "squeeze technique" requires that the partner gently squeeze the head of the penis at intervals to prevent orgasm. The modified procedure, calls upon the man to instruct the partner when to stop stimulating him to give him a chance to draw back. A series of stages follow, each offering greater stimulation as the couple gains greater control over his arousal. This whole process has been called "outercourse." After a period of weeks, the man’s response will have been ‘retrained’. With either technique, the emphasis is on the mutual goal of satisfactory sexual relations for both partners.

In the 1990s medicines became available which were shown to have a beneficial effect upon premature ejaculation. Clinical studies have shown that a class of antidepressants called selective seratonin reup-take inhibitors (SSRIs) can be very effective in prolonging the time to ejaculation. The individual drugs and the average amount of time they delay ejaculation are fluoxetine, one to two minutes with doses of 20-40 milligrams per day (mg/day) and eight minutes with 60 mg/day; paroxetine, three to 10 minutes with doses of 20–40 mg/day; and sertraline, two to five minutes with doses of 50–200 mg/day.

There are several alternative products, such as local anaesthetic agents designed to be sprayed or rubbed on the penis to delay ejaculation. Although the products promise results, there are no valid clinical studies to support the claims. The "squeeze technique" has elicited a 95% success rate, whereby the patient is able to control ejaculation. Treatment with SSRIs is effective in 85–90% of cases. However, the effectiveness begins to decrease after five weeks of daily administration. Although more studies are needed, this suggests the SSRIs are more effective when used on an as-needed basis.

Prevention

The best prevention is obtaining adequate information on normal sexual responses of men before having sex. It is also helpful to have sex in a comfortable, relaxed, private setting, free of guilt, stress, and fear.

Ejaculation Disorders

There are two main types of Ejaculation Disorders. The links below will guide you to the correct information:
Delayed Ejaculation
Premature Ejaculation