Premature Ejaculation Causes and Treatment

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Sex is a basic and fundamental human need. Throughout the ages, the majority of societies considered sex to be of vital importance and regulated it strictly. The concept of no necessity for regulation, however, has not been thought of in recent years.

Premature ejaculation, a sexual disorder which affects as high as 40% of the population, has become common in present-day society. This common sexual disorder poses certain social, psychological, and economic problems.

Ejaculation starts after the ejaculation reflex, which is stimulated in the lumbar region of the spinal cord and is formed by the sympathetic nervous system and the bulbospongiosus muscle, takes place. Ejaculation dysfunction becomes recurrent and common in society, especially as a person grows older. According to investigations, 40% of the adult male population has ejaculation dysfunction.

Furthermore, the lack of social acceptance of the health condition and the hesitation of male patients in applying to a healthcare profession have led to further problems. Therefore, bulbospongiosus and related counseling interventions have become notably vital.

Definition and Prevalence

Premature ejaculation (PE) is the most common male sexual problem affecting men and their partners. It is more common than erectile dysfunction. PE is also known as anejaculation, ejaculatio praecox (MP), or “1-minute man,” which refers to unwanted, voluntary rapid ejaculation during sexual intercourse with minimal penile stimulation after the start of the relationship.

PE is diagnosed using either internal or external standard criteria. Despite causing distress, married PE men may father healthy children. Men requiring PE treatment should undergo careful medical and sexual consultation to exclude organic and unwanted psychogenic causes. Group therapy provides education about normal male sexual response, unmet life expectations, and healthy sexual satisfaction.

PE is a subjective diagnosis that reflexively affects penile tactile sensitivity. The most common etiology is fear and anxiety. The fear can be caused by regret, which makes men perform quickly out of fear. Associated drugs and alcohol misuse exacerbate ejaculatory behavior.
Rapid ejaculation in men receiving impotence 50 mg as needed either failed or deteriorated during a month of treatment. A synergic theory proposed by psychologists and psychiatrists suggests that their ejaculation threshold should be increased. The problem is that rapid ejaculation occurs quickly when men are close to ejaculating.

There are many definitions and underlying reasons for PE. PE is thought to be lifelong if it has been present since the first sexual event. It affects many countries and diverse treatments, but only a handful of scientific publications debate the impact of lifelong PE on general well-being. It does not behave like long-term and treatable PE. The criteria for diagnosis vary, with experts and patients having different perspectives. However, 1 minute is generally acceptable for most men. Men usually do not begin to worry unless their ejaculation takes less than 4 minutes.

Men are aware of PE and are disappointed with the severity, control, and consequences of PE. Men and their partners report personal distress during sexual activity. Such a time relationship has the most promise for meeting the unmet needs of men, partners, and their partners in challenging the dysfunction.

Only men seeking help from a doctor or mental health care provider for themselves or their sexual relationship will benefit from currently available medical treatment that helps improve satisfaction. Ninety-five percent of men with PE are affected by the activities of specialists who are interested in another sexual activity and not concerned with their sexual individualities.

Impact on Quality of Life

Premature ejaculation may result in a significant decrease in sexual satisfaction in affected men. It negatively impacts interpersonal relationships and interactions, leading to decreased overall quality of life. Furthermore, it can decrease self-esteem and self-confidence, and increase depressive symptoms, anxiousness, and stress levels.

On the partner’s part, preoccupation, personal sacrifice, and overall dissatisfaction with the sexual relationship may develop. The impact of PE on an individual is not necessarily linked to the severity of the condition, but more to the perception and reaction to the underlying problem.

However, the diagnostic process of PE (especially lifelong PE) and the requirement of measuring intravaginal ejaculation latency time (IELT) in the clinical setting, as well as potential privacy violations and ethical concerns in some populations, also need to be taken into account for men with PE.

What You Need to Know About Premature Ejaculation Surgery

Even though sexual dysfunctions are not life-threatening, they lead to many different problems in the male and in his partner’s life. Premature ejaculation is one of these sexual dysfunctions, affecting not only the PE patient but also his female partner.

Surgical techniques have been suggested in the treatment of this condition due to its organic nature. Although its benefits with higher compliance, medical prophylaxis has lower efficacy for lifelong PE patients. The last two decades literature reports the two main approaches for the surgery of PE.

New studies are still investigating PE further, but the benefits and follow-up results from the surgeries are promising when both approaches are handled by experienced uroandrology surgeons. Though the ongoing surgeries results are promising, the surgical treatment of lifelong PE should still be mastered. The risks and tasks for the surgery should be well-informed.

Premature ejaculation is the most common sexual dysfunction and has higher rates than other sexual dysfunctions. LPE is also a very important topic since it reflects the duration of male copulation during sexual intercourse. This condition can also be observed only from the beginning of the sexual act, but lifelong PE is more important in terms of male sexuality. The surgical interventions are only suggested for long-lasting PE forms.

Since it was suggested that lifelong PE has an organic background, the number of surgery options has started to increase. Ideally, lifelong PE patients should be well-informed about both of the most preferred medical and surgical treatments before deciding which type of therapy they will use.

The Options

Before beginning treatment of PE, it is necessary to ask a number of questions and do a full medical history to determine if any medical condition or other factor is the possible cause of the PE. The questions could be set out as the following: Is the symptom lifelong or acquired?

Does the patient feel anxious when thinking about sexual intercourse? Is there a trauma in the patient’s life that may have affected sexual performance? Is there a history of sexual abuse as a child or adult? Is there a history of other sexual disorders, for example, erectile dysfunction, impotence, incest, and/or history of sexual performance disorder with other partners?

Does the patient drink alcohol? Is the patient taking medicines for depression or high blood pressure? Does the patient ejaculate before the penis enters the vagina, immediately after insertion, during foreplay, when direct pressure is applied, or within 10 s after penetration? Has it always been like this? Does the penis become flaccid straight after ejaculation? Has there been any previous result from medical consultation?

The initial approach to treatment is always based on a discussion with the patient, explaining the types of available treatment and who will be involved in the treatment—possibly including the sexual partner; anxiety should be mentioned and its possible influence on performance; we only offer or suggest treatment (medication) if the patient insists (i.e., in general we do not offer medications); self-help strategies are suggested in conjunction with or before drug treatment begins.

The self-help therapies are listed in Table 1 and some have been found highly effective, especially when aiming for a natural approach. It has been suggested that men suffering from premature ejaculation should think about all the unpleasant things that they will be doing after sex, or they can try the “stop and start” or the “squeeze” technique. Unfortunately, there are no drug treatments that have been approved and boast high efficacy at the moment.

The remaining pharmacological and non-pharmacological treatments are unlicensed medically or involve surgical intervention. The diagnosis of sexual dysfunction is mostly based on statements from the patient and a physical examination could be included and reassurance provided; often the reassurance offer can have a marked effect on outcome.

Reasons for Getting Premature Ejaculation Surgery

Premature ejaculation surgery, or, as it’s professionally called, penile prosthesis implantation, is an option when treatments like the squeeze technique or numbing sprays don’t work. But it’s important to know why you need to go the extra mile. Prosthetic penile implants are designed to provide elasticity to the penis when patients cannot achieve or maintain erections on their own.

The good results with drug therapy have rendered the use of 3-piece implantable penile prostheses in patients with severe erectile dysfunction discretionary rather than compulsory. The numbers needed to treat to get one additional man cured of PE with fluoxetine, sertraline, paroxetine, or clomipramine were 4, 4, 4, and 6, respectively. In a preliminary, proof-of-concept study, prostatic inflammation was consistently associated with self-reported PE, and records of Anglo-Saxon medicine have identified a variety of treatments which mirror many of the therapies currently used for self-diagnosis and self-treatment of PE.

To be sure of the accuracy of the penile prosthesis, men must meet the following criteria: he is diagnosed with biologically based severe ED with recognized severity on oral medication; failed prior erectile function and medication are invert or laser ablation therapy; motivated with implant surgery and has realistic goals with the penile prosthesis; awareness of positive and negative aspects if penile prosthesis is required; willing to sign informed allowed consent and can accept therapy results evaluation; a member of the professional team and insurance company approved the implant.

There are 15 patients seeking all help from keratosis or Peyronie’s disease who have not responded to previous conservative treatment that have indicated that penile prosthesis is the next logical treatment option. The median number of unsuccessful attempts that patients report with their ED treatments is 32. Each patient has tried and not been successful with at least two times prior or true PDE5 inhibitors of therapy. Large patient choices of penile prostheses can achieve the potential to have three-piece penile implants with 54% of 10 codes. The rest needs successful salvage or primary placement of penile implants.

Surgery for Premature Ejaculation

Surgery for premature ejaculation is only useful in individuals who have long intravaginal ejaculation to start with and have a very brief refractory period. They must also know the chances of its effectiveness and the surgical risks included.

The easiest and most safe approach used to be removal of the penile frenulum alone or combined with a z-plasty. Other methods include dorsal neurectomy with or without resection of accessory nerve fibers of the dorsal nerve or intravaginal absorption of a muscle relaxant or Tramadol residues.

Would you like to place your head on a chopping block rather than try more proven methods of ejaculation delay for the male, or would you like that to be your partner’s choice? If the former is the only way of reducing PE despite medical therapy, surgical options have nevertheless been developed. Such procedures might be indicated in a male who has a very brief refractory period combined with a long ejaculation time.

They should preferably occur before the man becomes sexually active in a monogamous relationship and should certainly be performed prior to scarring of the frenulum after coitus.

Surgical Treatments

A high incidence of dissatisfaction and complications with surgeries motivated the search for less invasive, pharmaco-therapeutic treatments for premature ejaculation. Concerns with safety and efficacy, as a result of the non-specific site of action, the pharmacokinetics of the drugs, and experience in sexual medicine led to the development of less systemic treatments using creams, gels or sprays that delay the ejaculatory event after topically applied local anesthetic agents.

Painless and uncomfortable coitus are reported by 20% and 70% of the men, respectively, 1-2 hours after application of a lidocaine-prilocaine cream compared to that experienced by 60% and 20%, respectively, following 5 minutes of intercourse after placebo. The relatively high incidences of unsatisfactory durations of action, penile hypo-anesthesia, and lack of improved erectile function by phosphodiesterase type-5 inhibitors explained the negative and inconclusive responses in clinical trials in those men with premature ejaculation comorbid with erectile dysfunction.

Physical endurance with positive constraints and negative feedback from the receiver and an alprostadil hydroalcoholic gel, which promoted more satisfactory results and duration of the effect, with no penile hypo-anesthesia, no erectile dysfunction, and sexual satisfaction improvements.

Men classified with two types of premature ejaculation (primary and acquired) profited equally from treatment. Selective pharmacological stimulation by Oxytocin A1 peptide, known to facilitate sexual, ejaculatory reflexes, and place-criterion experiments and the mesolimbic reward pathway, may represent a future promising treatment that carries no side effects. Children and young adolescents, despite the vast majority engaging in sexual activity, are not good candidates for current remedies on account of safety considerations.

Selective Dorsal Neurectomy (SDN)

The dorsal nerve of the penis (DNP) contains the primary afferent nerve fibers from the penis and is the largest sensory nerve of the penis. The nerve fibers pass through Alcock’s canal, then pierce the perineal membrane to enter the pelvis.

It is because the sensory nerve fibers of the penis pass through Alcock’s canal that finasteride was suggested to have a role in premature ejaculation. An injection of anesthesia, either to the selectively identified DNP in Alcock’s canal with B design needle guidance or a single puncture of the first branch of the pudendal nerve, was no less efficacious. The above anatomical explanation is the logical substrate explaining better results obtained after newer SDN techniques than the classical open ligature that interrupts all interneurons of the nervous bundles.

Selective Dorsal Neurectomy (SDN) is an adaptable surgical technique for medically refractory or recurrent premature ejaculation. has traditionally been the scope of andrology, but lately, it has far-reaching implications in men’s sexual medicine. We have studied the effects of osmotic minipump infusion of the above peptides and drugs, direct intracerebroventricular administration, on males of several rabbit and rodent animal species.

During the last two decades, more PE pathogeneses have been discovered, and new effective treatments such as short-acting selective serotonin reuptake inhibitors, tramadol, phentolamine, and the like have been introduced. Emerging neuroscience can be transplanted from several fields to PE research. SDN is a facile, minimally invasive outpatient intervention with a high satisfaction rate, very low complication rate, quick recovery, and hardly visible consequence.

Inner Condom Technique

The use of a condom seems to make ejaculation less intense, thus preventing PE to occur in some males. This technique uses a retraction band instead of the IC to prevent complete ejaculation. This band should be applied when the penis is about half its size.

After ejaculation, some sperm will collect between the internal and external condoms. The two condoms are then taken out, and the sperm-containing external condom is discarded. The condom technique has a reported success rate of 81%.

However, it is not very comfortable to use and is recommended only for partners who do not fear STDs. Not only is any sort of pregnancy protection avoided, but the discomfort of ejaculating inside a condom increases the sensation of lack of control over the ejaculation time, which can lead some men to ejaculate even quicker.

Cryoablation and Radiofrequency

In a 2003 study, Rafaelsen et al. presented a pilot study showing that temperature-dependent ablation technology may have the potential for becoming a minimally invasive spatial therapy for dysfunction of the male genitourinary system such as BPH (benign prostatic hyperplasia) and PE (premature ejaculation), and the results are encouraging.

In 2006, Rafaelsen et al. used cryoablation intermittently for three boys with anejaculation from adrenergic cryotherapy. This treatment is becoming more and more popular and may become a new minimally invasive or non-invasive spatial treatment for some forms of sexual dysfunction in the male genitourinary system. This might be a new, fascinating area for sexual medicine. This therapy gives hope for success with the adverse side effect and negative feature that threatens the sexual function during and after adrenergic cryotherapy.

RF (radiofrequency) has several potential advantages over other therapeutic options for BPH, including lower power deposition requirements, limited thermal damage outside the vessel, and endovascular application. For the treatment of PE, an RF device may be inserted into the corpora, such as along the Buck’s fascia.

A cylinder CFR electrode was positioned around the Buck’s fascia. The thermal proliferation of new collagen fibrous and shrinkage of the connective tissue results in thickening and stiffening of the Buck’s fascia, reducing angiopathically venous return and the efficiency of the second erectile mechanism PC fibers, increasing latency of the return of excitability and PE.

Hyaluronic Acid (HA) Gel Glans Penis Augmentation

This technique is popular for medical men’s choosing of penile self-injection and sessions has specific hard surgical vascular techniques partner’s understanding. In this method, augmentation can be performed to widen the glans, which also lengthens the time taken to achieve ejaculation.

The main points of HA gel glans penis augmentation include administering an intramuscular injection of dextran 40 for glans decompression to reduce postoperative complications, administering a combination of natox and neurostil to protect the facial nerve, choosing the incision direction mainly according to the appearance of the glans, and performing layer-by-layer superimposed suturing. In almost all cases, the patients, the sexual partner, and the surgeons were satisfied with the final aesthetic results.

For more information, HA gel glans penis augmentation can also be combined with hyaluronic acid filler administration to the glans. According to the research letter by Cirus Humeau B, who underwent augmentation of the glans with hyaluronic acid, he performed a good decision of injecting an intramuscular injection of dextran 40 for glans decompression to reduce postoperative complications, administering a combination of natox and neurostil to protect the facial nerve, and performed layer-by-layer superimposed suturing.

According to this research, the patient, the sexual partner, and the surgeon were all nearly satisfied with the final aesthetic results. Overall, HA gel glans penis augmentation is an effective, safe, and reliable treatment approach for men with premature ejaculation, which can reduce the level of PE. It can be performed with a high satisfaction rate, suggesting that it confers a high level of satisfaction on both patients and sexual partners.

This report of HA gel glans penis augmentation from the patient’s sexual life was completely normal after follow-ups, and the authors believe that this technique can be an effective way to get patient stimulation, trust, and satisfaction back.

Risks of Surgical Treatments for Premature Ejaculation

Surgical treatments for PE can carry significant risks. Perhaps the most significant risk is that of worsening sexual function. One study indicates that around 10% of individuals who choose to undergo such procedures may experience diminished sexual function in the long term.

Specific complications such as penile shortening or decreased or absent ejaculation or orgasm can also have significant negative impacts on quality of life.

Possible physical complications for some surgical procedures for PE have also been reported. Most notably, pain, tightness, and infection resulting from subcutaneous penile transplants have been documented.

Multiple erogenous nerves, vascular tissues, and connective tissue may have been damaged in the upper incision of the connective tissue in the performance of penile subcutaneous transplantation, which could have impaired the ability to sense sexual excitement and then lead to ED or even impotence.

Symptoms reported by patients undergoing the procedure included a “scabby” appearance. The patients also noted that the food sucked from the partner would “wrap” the skin.

Non-Surgical Alternatives

Topical anesthetics

Topical anesthetics have been in use for over thirty years, and they have been shown to be effective in increasing IELT. Premature ejaculation often occurs with initial intercourse or in the early part of the reproductive period. Not infrequently, the use of one of the longer-acting topical anesthetics for the first two to six months is effective. When it is not, the patient may then be given a trial of one of the drugs specifically indicated for PE.

One of the original caveats to the use of topical anesthetics is that the patient should always be evaluated for STDs and properly treated. The anesthetics have been shown to increase the spread of HIV in the laboratory. However, in one study with the hypodermic needle application of prilocaine and lidocaine topical anesthetic applicators, diffusion into the glans was found to be insignificant.

Local irritation and the transfer of the topical anesthetic to the partner have been reported, but are not the most frequent side effects. The most frequent side effects are dissatisfaction with the anesthetic from one or both of the participants in intercourse.

The subcommittee agrees with the ISSM that the regimen used is important in consistently obtaining the most satisfying results. Either a punctual application of one of the creams approximately 10 minutes before intercourse or a self-injection into the frenulum of prilocaine or lidocaine delivered close to the time of intercourse as one would plan to use an oral medication is recommended.

Upon initial use, a conversation that lets both users know what to expect is important. However, absence of sensitivity leading to complete dissatisfaction in many subjects makes its use intermittent or not the primary treatment for a number of patients.

More recent disappointments in cohabitation studies indicate that the use of the suction approach described by Niggers to limit the transfer of the anesthetic may not provide the clear-cut advantage suggested by a very old study.

Topical PE Treatments

Topical PE treatments frequently bypass various psychological worries that may exacerbate premature ejaculation. These are pharmacokinetic issues associated with the application of local anesthetics. reported in 2016 that early ejaculation lidocaine wipes were effective and ensured both penile sensation and sexual fulfillment in males who lasted lower than a minute during the intravaginal ejaculation delay phase.

The administration of PSD502, a mixture of 2.5 percent lidocaine and 2.5 percent prilocaine, onto the penile skin area as found it has enhanced intravaginal ejaculation time before friction. The greatest time limit for PSD502 usage of 5 minutes indicated the almost simultaneous action of PSD502. In spite of the minor negative outcomes associated with the local administration of PSD502, a 2011 questionnaire of female acquaintances recognized PSD502 as slightly efficient.

The application of benzocaine 4% wipes onto the penile skin decreased the intravaginal ejaculation period and have direct impacts, as discovered in the segments of the coitus latency time and the premature ejaculation measure in a previous point study from 2013.

Another recent point research from 2013 discovered that it took men significantly longer to have an orgasm following the benzocaine 4% wiped alcohol than it did with the placebo pad. However, a questionnaire from the partner review pointed out that PSD502 and benzocaine enhanced the sexual timing activity of patients, which further indicates reasonable satisfaction with benzocaine.

About 30-60 percent of respondents exhibited an adverse reaction to topical agents. To increase the satisfaction-connected drawback of benzocaine 4% wiped alcohol in the premature ejaculation measure, one 2013 randomized double-blind trial suggested the benzocaine desensitized penis, whereas the other requested benzocaine to delay the male orgasm that eventually led to increased patient and partner satisfaction.

Refusal to place a slim condom after the drug administered sign between 2004 and 2006 suggested that the male would like a control photo. On the test day, the male organ and the inner surface of the condom’s suggestion were carefully soaked with the anesthetic cream (1.5 g) an hour before the contact, resulting in notable preterm resorption time postponement. The questionnaire outcomes showed that men were content with the drug’s usage.

Medications for PE

As a result of introducing SSRIs and certain psychotropic drugs, sexual dysfunctions due to medication are frequently observed. Again, there are specifications focusing on the sexual function which is relied on by blocking these drugs in the human body.

To give an example, SSRIs, which are efficient in the treatment of obsessive-compulsive disorder, depression, and panic attack disorders, have a reception before sexual intercourse if they are taken short-acting. Side effects, which are alarming, such as insomnia, etc. Short-acting SSRIs are generally taken in a dose to the extent of four times the treatment dosage. On the other hand, if the dosage is stabilized, it provides effects within six to eight hours.

Medications used before sexual intercourse today in the treatment of premature ejaculation are under the names of Dapoxetine, Asertin, and Prozac. Pharmacologically, they enable effecting an efficient treatment in the short term. Such drugs reveal their effects only throughout its period and require increasing in dose. Again, these drugs remove the periphery from concern in sexual function and leave them in a sexual escape position.

At present, as a result of the operation of five neurotransmitters discovered, it was proposed that the diagnostics of the diseases caused by these transmitters were examined through new-generation batteries. In this context, an operation of 5HT-1A appears that the ejaculatory performance, the ejaculatory process, and some specific parts of the ejaculation will be improved by specific agonistically elation. 5HT-1A agonists will make the diagnosis which will be performed once daily and chronic and physiological; however, their effects do not enable the creation of sanctioning when necessary after taking. Besides, inhibitors of selective re-capture progressing will also solve the problem.

Techniques for PE

There are a number of different techniques proposed for treating PE sensation. Many techniques focus on trying to modify the feelings sensed in the penile shaft at climax, in an attempt to try to induce detumescence and a delay to ejaculation. If voluntary contractions of the ischiocavernous and bulbocavernous muscles can be timed immediately pre-ejaculation, several minutes of ejaculatory retardation can be achieved. Various techniques have been used to try to achieve this desensitization of the penile shaft.

One of the easiest methods is to introduce and maintain a slight degree of penile anesthetization. It is popular in Latin America to use a condom with a slit in its tip, into which the anesthetic lubricant is squeezed and brought into contact with the penile shaft. The application of a 2% xylocaine gel on the penile shaft immediately before offering sexual relations can help delay ejaculation. The gel not only causes a decreased sensation during vaginal relations but also causes numbness by the time of ejaculation. There are no reported side effects using this reduction.

The original informally tested behavioral treat was condoms which were inside out and glued back over themselves to the reverse inside out state, with the outer surface of the condom purposefully coated with a numbing agent which can be carried to the wrong side of the condom.

Pelvic Floor Exercises

Pelvic floor exercises, often called Kegel exercises, have the advantage of being noninvasive and carry little to no risk. On the other hand, they can require several months to induce a significant therapeutic effect. According to a definition issued by the International Continence Society in 1990, they consist of voluntary exercises to strengthen the pelvic floor muscles.

The anterior portion of pelvic floor muscles was shown to play an important role during the ejaculatory process in rats. Pelvic floor exercises will target these muscles and can be practiced at home without the need for any assistance from a specialist. Their beneficial effect could reside in the progressive enhancement of the voluntary control of these muscles, which is an acquired skill. A good awareness of the muscles needed for ejaculatory control may be harder to achieve with solo practices; however, it is not impossible.

Moreover, self-practices may also pose a risk of injury to these muscles. It has been reported that some healthy men overestimate the performance of voluntary pelvic floor muscle contractions. Taking also into account the ethical necessity to firstly identify the specific ejaculatory muscles in humans and then to demonstrate the beneficial effects derived from the enhanced strength of these muscles, either through instruments or through tests on patients with peripheral neuropathy, it may be better to suggest to patients that tests performed by a specialist are needed to increase confidence in the effectiveness of pelvic exercises.

Hence, although patients may benefit from the combination of at-home (noninvasive) practices and more invasive techniques, the use of only home-based techniques does not seem to be the best approach.

Determining Suitability for Premature Ejaculation Surgery

You must have discussed all the non-surgical options with your urologist prior to contemplating premature ejaculation surgery. There are many treatments for premature ejaculation and the majority benefit from these treatments.

Check the effectiveness of these treatments first. Are you unsatisfied with the outcome? If medication therapy is involved, is it effective? Are the medications associated with intolerable side effects? If yes to these, then you more than likely will not benefit from surgery. If you respond to the medications, then this will give an approximate idea of what can be achieved with surgery.

To wit, if you respond to the fast-acting SSRIs, then the STT can boost your ejaculatory lag time with minimal side effects. If you begin slowly to respond to the SSRI medication, this could indicate that you would not benefit from the STT due to your body processing the medications more slowly producing a smaller therapeutic window. If the medications seem to lose potency this could indicate the same, due to building tolerance.

Although you must consider SSRI tolerance influences both SSRI medications and premature ejaculation surgery. With a greater risk of tolerance and dependence from long-term SSRIs therapy, premature ejaculation surgery ‘cures’ a condition that the medication itself builds tolerance to.

Consultation with a Healthcare Provider

Epidemiological studies have described the high prevalence of PE. However, the actual prevalence of the disorder in a defined country or region is unclear. This situation is due to the use of different definitions, diagnostic criteria, and the absence of very large population studies aimed particularly to confirm the diagnostic criteria of the DSM IV classification of sexual disorders.

If a sexual disorder is suspected, it could be useful to make use of a sexual counseling clinic or a healthcare provider because health workers must make themselves increasingly available to dealing with sexual dysfunctions, in employing good communication skills, even nonverbal ones, regarding human sexuality, thus being able to influence the individual’s life and other health problems.

In the case of the suspicion of the presence of a sexual disorder, including that of PE, it is very important to remember that a medical examination characterized by an evaluation of general health, blood pressure, glucose level, and the existence of atherosclerotic disease and heart attack, and an andrological evaluation to evaluate the presence of a varicocele, phimosis, testicular hypofunction, or erectile disorder which, as noted in another part of this journal, should be considered discriminatory signs of aminergic disorder of the ejaculation process, could identify the possible presence of a sexual disorder and other comorbidities which could affect health or sexual life.

On the other hand, it is to be considered that, at present, many men are self-medicating (often incorrectly) in search of a resolution of their disorder. For these reasons, more objective epidemiological studies should be performed to provide clear data.

Evaluating Individual Needs

One of the hallmarks of modern medicine is the recognition that individual patients have individual needs. This principle is especially relevant in the area of sexual medicine. It is clear that not all patients with premature ejaculation are alike.

Although patient and partner self-reporting (estimated intravaginal ejaculation latency times (IELTs)) are an excellent first step to diagnose premature ejaculation, it is clear that the intensity of subjective sexual sensations per se increase with elevated emotional excitability. Research has shown that men with “hypersexual” syndromes (satyriasis, compulsive masturbation, “suicide”) had IELTs similar to those of patients with erectile difficulties and far below the thresholds used to define premature ejaculations.

When we dissect the roles of physiologic sexual response from psychophysiological symptoms predictive of premature ejaculation in these patients, we can show first, the distress and anxiety in premature ejaculation patients are more related to high emotional excitability, which mediates the patients’ perception of their respondent behavior. It is this increased sexual excitation that amplifies their treatment-seeking behaviors – not the IELT, or, for that matter, the intensity of the stimuli causing the excitation. After the physician validates the patient’s feelings, the next logical question should be, “rewind the videotape of your typical sexual experiences back and tell me how these feelings arise.”

Frequently Asked Questions

What is Premature Ejaculation?

Premature ejaculation (PE) is the most common form of sexual dysfunction that affects men. There are many reasons why a man might develop premature ejaculation. Some of the most common include depression, stress, poor body image, sexual guilt, relationship problems, anxiety, excessive alcohol use, physical injury, and certain medications.

Even though PE is a common complaint, many men and their partners struggle to understand PE and the factors that cause it. Research has shown that engaging in sexual activities too quickly, avoiding open dialogue with the behavior, issues of control in and out of sexual activities, movement, muscle tension, sexual cycle, rapid penile stimulation, relationship issues, and history of passive sexual experiences may all contribute to PE.

Research has also shown that once a man experiences PE, it is easy for him to get stuck in the problem and to experience it more and more often. Part of the reason for the problem is that PE can lead to feelings of disappointment and a lack of sexual satisfaction. After experiencing repeated instances of PE, many men feel defeated and reject the idea of engaging in sexual activities or going along with a partner’s sexual needs.

Often, PE is also associated with guilt, shame, and a sense of worthlessness. Such negative thinking may prevent men from seeking help for the behavior. Not seeking help can make the situation worse. In short, it appears that PE creates a problematic cycle in which symptoms of PE cause the very conditions that lead men to engage in the behavior. Therefore, it is clear that an open and honest dialogue between men and their healthcare providers is important when treating PE.

Is Premature Ejaculation same as Erectile Dysfunction?

While most awareness programs and patient and healthcare provider discussions involve erectile dysfunction as the most common type of male sexual dysfunction, it is important to recognize that premature ejaculation is also a very frequent condition.

Upon clinical evaluation for either erectile dysfunction or premature ejaculation, it is imperative to distinguish between them to ensure the precise treatment is provided. In that regard, it is notable that difficulties exist when contrasting the two dysfunctions on the grounds of symptoms reported by the patient.

As noted previously, a decrease in the frequency and quality of erections coupled with maintainable rigidity is the primary manifestation of erectile dysfunction. Premature ejaculation shares some equivalent attributes, such as performance frustration for both partners, emotional, physical, and financial stress, an inadequate sexual experience for one or both partners, and absence of physical closeness and intimacy.

However, additional attributes require further evaluation, since the patient may have a normal time to ejaculation with sufficient rigidity and require ED-related treatment. However, features indicating the likelihood of premature ejaculation include: penile hypersensitivity; the partner plays a significant and supportive role; the partner experiences a warm-up attitude; and engorgement and erection progress smoothly and quickly during the prelude to penetration. While an acceptable interval for sexual activity may exist, normalization of the ED disorder usually results in increased symptoms.

Should I see a doctor if I ejaculate too soon?

Premature ejaculation, commonly referred to as PE, can potentially affect the vast majority of men at varying points in their lives. Research has repeatedly shown that ejaculation within a few minutes of penetration is experienced by 50% of men at some point in their lives and affects a reasonable percentage of men on a recurring basis.

Clearly, PE then is fairly common among men. Yet, only a small percentage of men with PE seek help from their healthcare professionals. With the increasing availability of direct-to-consumer advertising by pharmaceutical companies, such as Viagra and Levitra, men are gradually realizing that they can get help for their problem through the usual routes of counseling and medications. Even so, men may be too embarrassed to go to a doctor for a sexual problem and may not even know to ask about the specifics of what treatments are available for treating PE.

Nonetheless, men with PE should be reassured that there are effective treatments that can help them reach their sexual potential, including counseling, medications, and a combination of treatments. They should be reminded that there is no single treatment for PE that works for everyone. For this reason, close follow-up with healthcare providers who have experience in treating PE is needed to understand the best treatment and treatment schedule for each individual.

The take-home point is that men with PE should have the moral courage to seek medical help from a healthcare provider, no matter how impersonal managed healthcare has made medicine in the modern age. A caring health professional will always provide a private and personalized experience, especially to men who suffer from the problematic sexual issue of PE.

How many men suffer from Premature Ejaculation?

Historically, the relative insensitivity to the concerns of the male regarding dissatisfaction with the duration of sexual relations has made treating PE a lower clinical priority for both medical experts and for public policy. As a first step toward understanding the relative importance of PE, it is relevant to briefly consider the prevalence of this condition.

The relative prevalence of ejaculatory disorders has been ranked, in males presenting to andrologists, as follows: NOE, the most prevalent; POE, the second most prevalent; anorgasmia, the third most prevalent; and DM because it has been neglected. However, POE is epidemiologically the most common of ejaculatory disorders, and the rank of DM is likely second. Depending upon the national population and the criteria used to define just what qualifies as POE, which are generally poorly reported, the lifetime prevalence of PE is reported to range from 21 to 94% in community surveys.

At any point in time, the prevalence of PE in our satisfaction-based definition is quite high: over 260 million are believed impaired at any point in time. A value of men are diagnosed with the syndrome at the time of birth, and over 21 are classified in middle childhood. Clinicians generally view this environment with amusement; the patients do not. In lifelong cases, POE is identified shortly after a male starts to engage in sexual relations.

Such men, who have never functioned normally from the very first sexual experience, report high levels of distress and low levels of relationship satisfaction. Accordingly, lifelong POE is viewed as a sexual anxiety disorder, often associated with an array of additional complaints about romance. The notion of performance anxiety, in this view, extends to the need to demonstrate sexual prowess and to satisfy one’s partner by providing a normally timed climax.

What causes Premature Ejaculation?

Given that PE can be organic or non-organic, PE secondary to organic causes may also stem from underlying physical or organic health conditions. Despite organic PE being infrequent, most organic EJD cases occur symptomatic of erectile dysfunction, particularly of ED issues involving a high risk of CV diseases. It is essential to differentiate organic EJD from lifelong PE or acquired PE, considering the condition causing orgasm trouble.

The disturbed central serotonergic neurotransmitter pathway is thought to be the main cause of lifelong PE. Acquired PE is frequently post-psychiatric illness, sexual failure, erectile dysfunction, and occasionally may be due to physical reasons. Hormonal abnormalities such as hyperthyroidism, urinary tract infection treatments, and urethritis can often lie behind acquired PE. PE due to premature testosterone medications often occurs.

Men afflicted with PE can engage in either anticipated or repeated experiences of anxiety or exposure to novelty. Anticipating concerns about PE will be at the forefront of issues, particularly sexual success, as men with PE may dissociate from their partner during sex, as the connection of consciousness is necessary for awareness of ejaculation urgency.

Although some men may lose erection upon experience of anxiety at penetration, others are not subjected to the emotion until the first vaginal penetration of the anxiety. Women who want to conceive, as the conflict between creating and sexual pleasure contradictions, are at particular risk of PE. There are worries from both men and women about PE in the face of inadequate fulfillment, often developing into relational fear.

The expectation of failure will predispose the men to just showing the erotic desire of the body while retreating emotionally, while the women are facing challenges concentrating on the physical qualities of the act.

What happens if I don’t get my PE problem treated?

Mental health consequences of untreated PE include feelings of guilt or shame about experiences, relationships, and body, and diminished self-esteem and confidence. Relationship quality is also affected by untreated PE.

Couples often report feeling disconnected during sex when the male ejaculates prematurely, which can create distress, disappointment, and relationship conflicts. In addition, avoidance of sexual activity may contribute to social isolation, elevated marital problems, decreased satisfaction, and increased divorce.

Couples may also seek out sexual activities other than vaginal intercourse to compensate for incomplete vaginal intercourse in an attempt to restore or maintain sexual connection and relationship satisfaction.

The indirect mental health consequences for couples who are desiring a pregnancy are unique. Women’s reproductive decisions may be influenced by the male’s PE. Men with PE may prevent conception and fatherhood to prevent recognizing partner distress and dissatisfaction due to experiences with PE. Women may also avoid or delay seeking contraceptive education and counseling behaviors to avoid experiences with PE.

In contrast, couples may decide to accelerate planned time to conceive to resolve relationship dissatisfaction. The bias, shame, negative self-esteem, and relationship difficulties associated with PE may also delay new relationship formation for single men with untreated PE.

Physicians should work to mitigate the various consequences of untreated PE, such as emotional distress, interpersonal relationship problems, and reproductive pain, anxiety, depression, relationship conflicts, marital distress, diminished sexual satisfaction, and infertility.

What are the other ways to treat Premature Ejaculation?

Nonmedical or non-pharmacological treatments for premature ejaculation include psychological and behavioral therapeutic approaches, techniques to abuse the ejaculatory reflex and delay ejaculation, manual pressure on the perineum, and specialized condoms. The main non-pharmacological approach is the association of educational developmental techniques such as the stop-start technique and the squeeze technique.

In the stop-start technique, the man starts the sexual act without entering his partner. Whenever he feels he is close to ejaculating, he simply stops the stimulus by pulling out or ghosting of the vagina so that no distal stimulus is exercised. He stops the sexual act and breathes deeply; after a time, the couple can initiate the procedure again.

The squeeze technique involves stopping the masturbation or penile stimulation when the individual feels that he is about to ejaculate, squeezing the frenulum for several seconds, and then releasing and resuming the procedure. Both techniques are associated with individual psychosexual therapy, individual or couple methods, or any other educational resource that aims at the man’s control and management of sudden ejaculation, arousing sensations differently to experience more prolonged periods of mutual sensuality and orgasms.

They are non-pharmacological and directly affect sexual performance, positively affecting the man’s self-esteem and the man-woman relationship. With so much interaction in the partnership, the couple feels increasingly confident and has a greater physical and emotional interaction.

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