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| Premature ejaculation Classification & external resources | |
| ICD-10 | F52.4 |
|---|---|
| ICD-9 | 302.75 |
| MedlinePlus | 001524 |
| eMedicine | med/643 |
Premature ejaculation (PE), also known as, rapid ejaculation, rapid climax, premature climax or early ejaculation, is the most common sexual problem in men, affecting 25%-40% of men. It is characterized by a lack of voluntary control over ejaculation. Masters and Johnson stated that a man suffers from premature ejaculation if he ejaculates before his sex partner achieves orgasm in more than fifty percent of their sexual encounters. Other sex researchers have defined premature ejaculation as occurring if the man ejaculates within two minutes of penetration; however, a survey by Alfred Kinsey in the 1950s demonstrated that three quarters of men ejaculate within two minutes of penetration in over half of their sexual encounters. Today, most sex therapists understand premature ejaculation as occurring when a lack of ejaculatory control interferes with sexual or emotional well-being in one or both partners.
Most men experience premature ejaculation at least once in their lives. Often adolescents and young men experience premature ejaculation during their first sexual encounters, but eventually learn ejaculatory control. Because there is great variability in both how long it takes men to ejaculate and how long both partners want sex to last, researchers have begun to form a quantitative definition of premature ejaculation. Current evidence supports an average intravaginal ejaculation latency time (IELT) of six and a half minutes in 18-30 year olds.Ejaculation delay: what\'s normal? [July 2005; 137-4]. Retrieved on 2007-10-21.Waldinger MD, Quinn P, Dilleen M, Mundayat R, Schweitzer DH, Boolell M (2005). "A multinational population survey of intravaginal ejaculation latency time". The journal of sexual medicine 2 (4): 492-7. doi:10.1111/j.1743-6109.2005.00070.x. PMID 16422843. If the disorder is defined as an IELT percentile below 2.5, then premature ejaculation could be suggested by an IELT of less than about one and a half minutes.Waldinger MD, Zwinderman AH, Olivier B, Schweitzer DH (2005). "Proposal for a definition of lifelong premature ejaculation based on epidemiological stopwatch data". The journal of sexual medicine 2 (4): 498-507. doi:10.1111/j.1743-6109.2005.00069.x. PMID 16422844. Nevertheless, it is well accepted that men with IELTs below 1.5 minutes could be "happy" with their performance and do not report a lack of control and therefore do not suffer from PE. On the other hand, a man with 2 minutes IELT could present with perception of poor control over his ejaculation, distressed about his condition, has interpersonal difficulties and therefore be diagnosed with PE.
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Psychological factors commonly contribute to premature ejaculation. While men sometimes underestimate the relationship between sexual performance and emotional well-being[attribution needed], premature ejaculation can be caused by temporary depression, stress over financial matters, unrealistic expectations about performance, a history of sexual repression, or an overall lack of confidence. Interpersonal dynamics strongly contribute to sexual function, and premature ejaculation can be caused by a lack of communication between partners, hurt feelings, or unresolved conflicts that interfere with the ability to achieve emotional intimacy. Neurological premature ejaculation can also lead to other forms of sexual dysfunction, or intensify the existing problem, by creating performance anxiety. In a less pathological context, premature ejaculation could also be simply caused by extreme arousal.
Recent research has also investigated the role of factors involving the female partner. One study of young married couples (Tullberg, 1999) reported that the husband\'s IELT seems to be affected by the phases of the wife\'s menstrual cycle, the IELT tending to be shortest during the fertile phase. Other studies suggest that young men with older female partners reach the ejaculatory threshold sooner, on average, than those whose partners are their own age or younger[citation needed].
Sympathetic motor neurons control the emission phase of ejaculation reflex and expulsion phase is executed by somatic and autonomic motor neurons. These motor neurons are located in the thoracolumbar and lumbosacral spinal cord and are activated in a coordinated manner when sufficient sensory input to reach the ejaculatory threshold has entered the central nervous system.deGroat WC, Booth AM (1980). "Physiology of male sexual function". Ann. Intern. Med. 92 (2 Pt 2): 329-31. PMID 7356224. Truitt WA, Coolen LM (2002). "Identification of a potential ejaculation generator in the spinal cord". Science 297 (5586): 1566-9. doi:10.1126/science.1073885. PMID 12202834.
Several areas in the brain, and especially the nucleus paragigantocellularis, have been identified to be involved in ejaculatory control.Coolen LM, Olivier B, Peters HJ, Veening JG (1997). "Demonstration of ejaculation-induced neural activity in the male rat brain using 5-HT1A agonist 8-OH-DPAT". Physiol. Behav. 62 (4): 881-91. PMID 9284512. Scientists have long suspected a genetic link to certain forms of premature ejaculation. In one study, ninety-one percent of men who suffered from lifelong premature ejaculation also had a first-relative with lifelong premature ejaculation. Other researchers have noted that men who suffer from premature ejaculation have a faster neurological response in the pelvic muscles. Simple exercises commonly suggested by sex therapists can significantly improve ejaculatory control for men with premature ejaculation caused by neurological factors[citation needed]. Often, these men may benefit from anti-anxiety medication or selective serotonin reuptake inhibitors (SSRIs), such as sertraline or paroxetine, as these slow down ejaculation times[1]. Some men prefer using anaesthetic creams, however, these creams may also deaden sensations in the man\'s partner, and are not generally recommended by sex therapists.
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Most sex therapists and sex educators prescribe a series of exercises to enable the man to gain ejaculatory control. These are considered the first line of treatment, and are usually recommended to be tried before other methods.
One of the most common exercises is the “Start-Stop” technique in which during sex when he feels that he is getting too close to orgasm, he stops and does not move, to avoid more stimulation. He may withdraw his penis, or stay inside and request that his partner also not move. He waits seconds or minutes until his arousal lessens, and then resumes sex. He may stop and then re-start as many times as necessary. Locker, Sari, (2005) Overcoming Sexual Problems in The Complete Idiot’s Guide to Amazing Sex. Penguin: New York.
Another technique is the "Squeeze Technique", in which during sex (or masturbation if he wants to practice it) when he feels the urge to ejaculate, he would withdraw his penis and squeeze at the tip of the shaft below the glans of his penis near the frenulum of his penis, until the feeling subsides. To be more specific, the proper hand position for this technique is for him to place his thumb on the frenulum, and his index and middle fingers above and below the coronal ridge (which is on the other side of the head of his penis), and then squeeze his penis from front to back. He may consult a sex therapist for more directions to this technique. Masters, W.H.; Johnson, V.E. (1966). Human Sexual Response. Toronto; New York: Bantam Books. ISBN 0-553-20429-7..
The male\'s partner plays an essential role in enabling him to overcome premature ejaculation. Without understanding and emotional support, the male is unlikely to obtain the level of relaxation required for sexual satisfaction. Both the male and his partner should communicate their feelings openly and with sensitivity. The partner may also be integrated into the exercises to keep her involved. She can learn to deliver the squeeze technique, and she can encourage the stop-start technique.
Both partners should also be aware of the sexual positions that make the male most likely to ejaculate quickly. They should avoid those positions if they want to prolong sex. Some men ejaculate quickly in any position, however, so the other methods would be more effective.
In cases where the chief concern is reaching simultaneous orgasm, it is also possible to simply work around the premature ejaculation problem by changing positions frequently (which studies have shown delays male orgasm by a factor of 2-3), using lubrication to reduce friction (friction stimulates the male but is not as important in female orgasm), or switching to cunnilingus for awhile when close to ejaculation, and then switching back when ejaculation is no longer imminent.http://www.menshealthsa.co.za/index.php?cat=1186&art_id=908
SSRI antidepressants have been shown to delay ejaculation in men treated for different psychiatry disorders.Rosen RC, Lane RM, Menza M (1999). "Effects of SSRIs on sexual function: a critical review". Journal of clinical psychopharmacology 19 (1): 67–85. PMID 9934946. SSRIs are considered the most effective treatment currently available for PE. These include paroxetine, fluoxetine, sertraline and more. The use of these drugs, that require chronic therapy, is limited by the neuropsychiatric side effects. New SSRI drugs specifically targeted to treat premature ejaculation (e.g. dapoxetine) can be taken on an as needed basis and have been recently shown positive results in large phase III studies.Safarinejad MR (2007). "Safety and Efficacy of Dapoxetine in the Treatment of Premature Ejaculation: A Double-Blind, Placebo-Controlled, Fixed-Dose, Randomized Study". doi:10.1038/sj.npp.1301500. PMID 17625501. Nevertheless dapoxetine is not yet approved by any regulatory authority around the world. There is speculation that some of the associated effects are caused by lowered libido and blood pressure as well as lowered anxiety levels. Other pharmaceutical products known to delay male orgasm are; opioids, cocaine, and diphenhydramine.[citation needed]Local anesthetic creams (like lidocaine, prilocaine and combinations) have shown to be effective in clinical trials and are being used for the treatment of PE.Morales A, Barada J, Wyllie MG (2007). "A review of the current status of topical treatments for premature ejaculation". BJU Int. 100 (3): 493–501. doi:10.1111/j.1464-410X.2007.07051.x. PMID 17608824. Their use is limited by its own anesthetic effect that reduce sensation on the penis and vagina.
External latex rigid sheathes fastened to the body have been developed that cover all part of the penis during penetration so that the penis is protected from all the stimulation of the vagina. These help to gain control and to provide satisfaction to the partner. Masters and Johnson recommended the use of the Lateral coital position to help alleviate premature ejaculation.
Diagnostic criteria for Premature Ejaculation DSM-IV-TR (American Psychiatric Association)
A. Persistent or recurrent ejaculation with minimal sexual stimulation before, on, or shortly after penetration and before the person wishes it. The clinician must take into account factors that affect duration of the excitement phase, such as age, novelty of the sexual partner or situation, and recent frequency of sexual activity.
B. The disturbance causes marked distress or interpersonal difficulty.
C. The premature ejaculation is not due exclusively to the direct effects of a substance (e.g., withdrawal from opioids).
Premature ejaculation should be distinguished from erectile dysfunction related to the development of a general medical condition. Some individuals with erectile dysfunction may omit their usual strategies for delaying orgasm. Others require prolonged noncoital stimulation to develop a degree of erection sufficient for intromission. In such individuals, sexual arousal may be so high that ejaculation occurs immediately. Occasional problems with premature ejaculation that are not persistent or recurrent or are not accompanied by marked distress or interpersonal difficulty do not qualify for the diagnosis of premature ejaculation. The clinician should also take into account the individual\'s age, overall sexual experience, recent sexual activity, and the novelty of the partner. When problems with premature ejaculation are due exclusively to substance use (e.g., opioid withdrawal), a substance-induced sexual dysfunction can be diagnosed.
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