Premature ejaculation: Wikis

  
  

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Premature ejaculation
Classification and external resources
ICD-10 F52.4
ICD-9 302.75
MedlinePlus 001524
eMedicine med/643

Premature ejaculation (PE) is a condition where a man ejaculates earlier than he or his partner would like him to. Premature ejaculation is also known as rapid ejaculation, rapid climax, premature climax, or early ejaculation.

Masters and Johnson defines PE as the condition where a man 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.[citation needed]. Self reported surveys report up to 75% of men ejaculate within 10 minutes of penetration. 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.[citation needed]

Most men experience premature ejaculation at least once in their lives. PE affects 25%-40% of men in the United States.[citation needed] 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 of six and a half minutes in 18-30 year olds.[1][2] 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.[3] 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 would not be defined as having PE. On the other hand, a man with 2 minutes IELT may have the perception of poor control over his ejaculation, distressed about his condition, has interpersonal difficulties and therefore be diagnosed with PE.

Contents

Possible psychological and environmental factors

Psychological factors commonly contribute to premature ejaculation. While men sometimes underestimate the relationship between sexual performance and emotional well-being, 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 caused simply by extreme arousal.

According to the theories developed by Wilhelm Reich, premature ejaculation may be a consequence of a stasis of sexual energy in the pelvic musculature, which prevents the diffusion of such energy to other parts of the body[4].

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].

Possible physical factors

Science of mechanism of ejaculation

The physical process of ejaculation requires two sequential actions: emission and expulsion.

Mechanism of Ejaculation

The emission phase is the first phase. It involves deposition of seminal fluid from the ampullary vas deferens, seminal vesicles, and prostate gland into the posterior urethra.[5] The second phase is the expulsion phase. It involves closure of bladder neck, followed by the rhythmic contractions of the urethra by pelvic-perineal and bulbospongiosus muscle, and intermittent relaxation of external urethral sphincters.[6]

It is believed that the neurotransmitter serotonin (5HT) plays a central role in modulating ejaculation. Several animal studies have demonstrated its inhibitory effect on ejaculation. Therefore, it is perceived that low level of serotonin in the synaptic cleft in these specific areas in the brain could cause premature ejaculation. This theory is further supported by the proven effectiveness of selective serotonin reuptake inhibitors (SSRIs), which increase serotonin level in the synapse, in treating PE.

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.[7][8]

Several areas in the brain, and especially the nucleus paragigantocellularis, have been identified to be involved in ejaculatory control.[9] Scientists have long suspected a genetic link to certain forms of premature ejaculation. In one study, ninety-one percent of men who have had premature ejaculation for their entire lives also had a first-relative with lifelong premature ejaculation. Other researchers have noted that men who have 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 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.

Premature Ejaculation Diagnostic Tool (Premature Ejaculation Test)

A diagnostic tool to help physicians and patients diagnose this condition has been developed. The methodology and results were published several times in medical congresses and peer reviewed medical journals[10][11]. The three different categories a patient can be classified to are: No PE; Probable PE; and PE.

Differential diagnosis

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.

Other ejaculation disorder types

Treatment

In mundane cases, treatments are focused on gradually training and improving mental habituation to sex and physical development of stimulation control. In clinical cases, various medications are being tested to help slow down the speed of the arousal response.

Masters and Johnson recommended a start and stop technique to increase the time until ejaculation. This requires a great deal of couple cooperation and communication, and may be difficult for some.

Another method is that of control instead of prevention. Performing routines such as Kegel exercises, which, as mentioned above, relate to gaining voluntary control of the PC muscle and thus give a person more control over ejaculation. When ejaculating, the control of this muscle is said to be lost, and thus, learning to maintain control of it can be of aid to some.

Medications

Serotonergic medications, such as SSRIs, can delay ejaculation.[13][14] SSRIs are commonly used as anti-depressants. Examples include Prozac, Zoloft, Celexa, and Lexapro. Clinical trials indicate that Paroxetine gives the largest increase in intravaginal ejaculation latency time.[15] Clomipramine often helps with serious cases that are related to the central nervous system (as opposed to psychological factors). The drug has the added benefit of also improving erection quality in some patients.[16]

Although serotonergic medications can delay ejaculation during administration, Post-SSRI sexual dysfunction, which can occur upon the cessation of treatment, may cause premature ejaculation even if it did not exist previously or may worsen an existing case.

Tramadol has been shown to be effective in delaying ejaculation.[17]

William Francis Ganong cited dietary 5-HTP as an alternative source to raising serotonin levels.[citation needed]

External links

References

  1. ^ "Ejaculation delay: what's normal? [July 2005; 137-4"]. http://www.medicine.ox.ac.uk/bandolier/band137/b137-4.html. Retrieved 2007-10-21. 
  2. ^ 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. 
  3. ^ 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. 
  4. ^ See for example Body of knowledge: an introduction to body/mind psychology by Robert L. Marrone, SUNY Press, 1990, ISBN 0791403874, 9780791403877, p. 104
  5. ^ Böhlen D, Hugonnet CL, Mills RD, Weise ES, Schmid HP (2000). "Five meters of H(2)O: the pressure at the urinary bladder neck during human ejaculation". Prostate 44 (4): 339–41. doi:10.1002/1097-0045(20000901)44:4<339::AID-PROS12>3.0.CO;2-Z. PMID 10951500. 
  6. ^ Master VA, Turek PJ (2001). "Ejaculatory physiology and dysfunction". Urol. Clin. North Am. 28 (2): 363–75, x. doi:10.1016/S0094-0143(05)70145-2. PMID 11402588. 
  7. ^ deGroat WC, Booth AM (1980). "Physiology of male sexual function". Ann. Intern. Med. 92 (2 Pt 2): 329–31. PMID 7356224. 
  8. ^ 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. 
  9. ^ 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. doi:10.1016/S0031-9384(97)00258-8. PMID 9284512. 
  10. ^ Symonds T, Perelman MA, Althof S, Giuliano F, Martin M, May K, Abraham L, Crossland A, Morris M (2007). "Development and validation of a premature ejaculation diagnostic tool". Eur Urol. 52: (2): 565–73. PMID 17275165. 
  11. ^ Althof S, Rosen R, Symonds T, Mundayat R, May K, Abraham L (2006). "Development and validation of a new questionnaire to assess sexual satisfaction, control, and distress associated with premature ejaculation.". J Sex Med 3 (3): 465–75. PMID 16681472. 
  12. ^ "Premature Ejaculation". Premature Ejaculation and Male Orgasmic Disorder. Armenian Medical Network. 2006. http://www.health.am/sex/premature-ejaculation/. Retrieved 2007-09-19. 
  13. ^ Safarinejad, M. R., & Hosseini, S. Y. (2006). Pharmacotherapy for premature ejaculation. Current Drug Therapy, 1, 37-46.
  14. ^ SadeghiNejad, H., & Watson, R. (2008). Premature ejaculation: Current medical treatment and new directions. Journal of Sexual Medicine, 5, 1037-1050.
  15. ^ Bandolier (2004). Premature ejaculation treatments reviewed. pp. 128–3. http://www.medicine.ox.ac.uk/bandolier/band128/b128-3.html. 
  16. ^ http://mayoclinic.com/health/drug-information/DR602715#89DB9B50-CC99-270F-FF4D198198E465E1
  17. ^ Safarinejad MR, Hosseini SY, Safety and efficacy of tramadol in the treatment of premature ejaculation: a double-blind, placebo-controlled, fixed-dose, randomized study. J Clin Psychopharmacol. 2006 Feb;26(1):27-31.

Simple English

Premature ejaculation (also known as PE) is a condition affecting many men. It is when during sexual intercourse (sex) the male can not stop from ejaculating after about two minutes.[needs proof]

Treatment exercises

The condition is usually curable or at least treatable by a few exercises. (There are more exercises than these, however, these are the most common.)

Stimulation treatment

One exercise is to create an erection and begin to lose it, then stimulate it again. This exercise is best done alone at first and then with a partner. Thrusting should not be used with a partner until very near the end of treatment. This treatment may take several weeks to fully cure the problem if it is used properly.

Muscular treatment

Another treatment involves using the muscle which stops urine. To locate the muscle, simply begin urinating and stop quickly before emptying the bladder. Doing that, will demonstrate how to use the muscle. Then whenever convenient use the muscle. You do not need to be urinating to use the muscle and it is suggested you are not. After a few weeks of both these treatments, the PE will become more like traditional ejaculation and after about one and a half through two and a half months, it should be absolutely normal.








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