Premature Ejaculation
How does ejaculation occur?
v Sexual stimulation (physical and/or mental) causes nerves in the
penis to send chemical messages to the spinal cord and the brain. Brain
chemicals help relay messages of stimulation throughout the brain, while nerve
signals from the brain carry these messages to the rest of the body through the
spinal cord to the male reproductive organs. When a man reaches a certain level
of excitement during this process, chemical and nerve messages sent to the
pelvis cause ejaculation. While not completely understood, it is believed that
the chemical serotonin plays a major role in this process.
v Ejaculation is the release of semen from the penis. Ejaculation
involves mainly two phases. The first process through which the components of
semen are released from the male reproductive organs (prostate, seminal
vesicle, vas deferens) is called emission. During this process semen is
deposited into the urethra (urine channel). The second phase (ejaculation
proper, evacuation) is a reflex that causes rhythmic contractions of the
muscles around the urethra, which propels the semen through the urethra and
from the penis.
Components of semen
¬ Semen is the fluid releases from the penis upon ejaculation.
Semen is made up of two parts: 1) sperm from the vas deferens and 2) seminal
fluid which contains fluid from mainly the prostate gland and seminal vesicles.
¬ Each time a male ejaculates, normally between 50- to 500-million
sperm are released. However, they make up only about 2-5% of the volume of
semen. The bulk of the semen is composed of the ejaculate fluid portion of
semen. Men produce between 1 ml and 5 mls of semen during each ejaculation.
What is mean by premature ejaculation
(PE)?
Ø Premature ejaculation is repeated ejaculation in response to
minimal stimulation before, at the time of, or shortly after penetration, but
before the man wishes it, and over which the man feels he has little or no
control. It is important to recognize that premature ejaculation is a
subjective diagnosis and totally depends on the satisfaction of the partners.
Ø Epidemiology
How
common is PE
ü PE is the most common sexual dysfunction reported by men but is
still under-diagnosed and under-treated. Estimating the prevalence of PE is
difficult since many men do not want to talk about it, while others may not
even perceive that they have PE.
ü However, recent research indicates that 25-30% of men struggle
with PE.
ü PE can happen at any age and its prevalence is consistent across
all ages.
ü Is there variation in incidence between countries?
ü Global studies consistently report that 20-30% of men experience
PE worldwide. This means that PE is experienced at similar rates across the
globe.
Difference between life-long and acquired
PE
¬ Primary PE refers to men who have experienced this sexual problem since
first having sex.
¬ Secondary PE refers to men who had ejaculatory control at some point but
began experiencing PE later in life, sometimes even after years of satisfying
sex, without explanation.
PE and man's psychology
v PE can have a broad impact on many aspects of a man's life. Men
experiencing PE can suffer anxiety, embarrassment, inadequacy, depression,
anger and guilt.
v PE can cause both personal stress, and stress to a relationship.
In one study, men with PE were less satisfied with sexual intercourse and their
sexual relationship, and suffered more problems with sexual anxiety and arousal
compared to non-sufferers.
v Some men with PE have trouble staying in relationships or may be
scared to begin new ones.
PE affect the partner of the man with PE
ü PE is a problem for the couple as a whole. Partners sometimes
experience frustration and anger. Also, many couples do not discuss the problem
with each other or with friends and family and there can be a breakdown of
intimacy between them.
Premature Ejaculation - Conditions
¬ Unfortunately, the cause of PE is generally unknown.
Historically PE was seen as a psychological disorder, but researchers now
suggest that most cases are multi-factorial with a contribution from both
psychological and physical factors.
¬ PE is categorized as either primary or secondary.
¬ Primary PE applies to men who have experienced this sexual
problem since they were able to function sexually (post-puberty) essentially
since the first time he had sex.
¬ Secondary PE refers to men who were able to experience an
acceptable level of ejaculatory control previously but, inexplicably, began
experiencing PE later in life, sometimes even after years of satisfying sex.
¬ Many researchers believe that premature ejaculation, at least in
some men, may be due to a chemical imbalance or changes in receptor sensitivity
in the brain or spinal cord.
Diagnosing Premature Ejaculation
Although
there are no specific diagnosis or treatment guidelines for PE, the diagnosis
of PE is based mainly on a detailed sexual history that establishes:
ü The patients' perception of his control over ejaculation. Is it
poor, fair or good?
ü The time frame within which he ejaculates. Less than a minute?
More than 2 minutes?
ü The majority of men who self-identify themselves as having PE
will ejaculate in less than 2 minutes.
ü The majority of men who self-identify as NOT having PE will
ejaculate in longer than 2 minutes.
ü PE is considered to be the occurrence of ejaculation prior to the
wishes of both sexual partners, (which can vary widely from couple to couple);
no clear time cut-offs have been set as to the appropriate duration for sexual
contact before reaching orgasm, although the FDA in its assessment of drugs for
PE uses 2 minutes as the guideline. Patient self-report time to ejaculation
(known as ejaculatory latency time) has been shown to be surprisingly accurate.
ü That the short ejaculatory latency time is a source of distress
for him or for his partner.
ü That the short ejaculatory latency time is interfering with the
satisfaction of sexual relations for him or the couple.
ü If this condition has been life-long or if it has occurred more
recently. Life-long PE is known as primary PE and recently acquired PE is known
as secondary PE. If the onset of the problem is more recent, are there
precipitating factors?
ü Frequency of PE. An occasional instance of PE might not be cause
for concern, but if the problem happens more than 50% of the time, a pattern
usually exists for which treatment may be appropriate.
ü While a physical examination is often conducted (involving an
abdominal and genital examination and possibly a prostate examination) it
generally aids little in the diagnosis of PE.
PE and ED
¬ ED is a man's inability to attain or sustain an erection for the
duration of sexual intercourse. Whereas PE is when a man and/or his partner
perceives that he reaches orgasm and ejaculates too quickly and with little
control.
¬ In other words, PE is ejaculation before a man and his partner
wants it to happen. There are men however who develop PE as a result of poor
erection sustaining capability. In this situation, they condition themselves to
reach orgasm/ejaculation quicker so they can do so before they lose their
erection. The treatment of this begins by treating the erection problem first.
With treatment many men can resolve the PE problem. Differentiating between the
two conditions is a very important step for patients and physicians. An
experienced physician should be able to define the real problem relatively
easily.
Treating Premature Ejaculation
Types
of treatment are available for PE
v Medications
v Physical
& Psychological Treatment
Which doctor takes care of PE
Many
different types of specialists are interested in sexual medicine and PE. The first
resource would be the members of this society as they are all committed to
excellence in sexual medicine and have a significant part of their practices
devoted to this area. But if not possible, generally sex therapist,
psychologist, would be the primary specialists to go to for the treatment of
PE.
Medications for PE
There
are currently a number of treatments types used to manage PE.
The
risks and benefits of all of the below treatment options should be discussed
between the caregiver and the patient, as patient and partner satisfaction is
the primary goal in the treatment of PE.
¬ Desensitization
treatments: these are aimed at
reducing the sensitivity of the penis immediately before sexual relations. It
is noteworthy to mention that there is no evidence that men with PE have any
difference in penis sensitivity than men without PE. Although these techniques work
for some men with mild PE, they can cause a reduction in sensitivity so that
sexual satisfaction during intimacy is also reduced. Little research has been
done on these techniques and their true benefit. Techniques that are employed
by some men include:
¬ Using
condoms: the use of a single condom
may reduce sensitivity enough to make a difference in ejaculatory control for
some men. Using multiple condoms, however, reduces sensitivity, potentially to
the point where the sensation during relations is less than satisfactory for
men.
¬ Using
desensitization ointments: local
anesthetics like lidocaine/prilocaine creams can be applied to the undersurface
of the head of the penis (the glans) 30 minutes before sex. Desensitization
ointments are best applied and then washed off 5-10 minutes before sexual
relations, otherwise they will cause a numbing effect for the partner also.
Some men use these creams underneath a condom.
¬ Masturbating
prior to intercourse: many men
with PE, even those with primary (life-long) PE, have much better ejaculatory
control if they have sexual relations a second time within a short period of
time after the initial encounter. Some men use masturbation in the hours before
anticipated intimacy as a means to improve ejaculatory control.
¬ Non-FDA
approved treatment options: a number of
over-the-counter and prescription 'medications' have been used for PE:
Psychological Treatments
Distraction techniques:
Ø Distracting mental exercises during sex can be used to help PE
(such as thinking of mundane things like baseball, work, etc.). These
techniques are probably most useful for men with occasional PE or men who
experience PE in the initial stages of a new sexual relationship. For men with
long-standing PE, the consistent use of these techniques usually interferes
with spontaneity and satisfaction.
Psychological Therapy:
Ø These treatments have been utilized for decades and are
associated with success in many people. However, it is questionable for how
long these treatments work. For example, for a man who has derived benefit from
the techniques described, how long-lasting are the beneficial effects? It is
estimated that 25% of men helped by such techniques retain the benefit for 2
years after starting the treatments.
Ø PE can be both due to, and the cause of, psychological stress or
other mental health and personal issues. Psychological treatments often involve
counseling or sexual therapy that can include talking about relationships and
experiences with a mental health professional and/or learning practical tools.
By investigating relationships and individual issues that may be causing or
compounding PE, mental health professionals can help find effective ways of
coping with and solving problems that may be causing PE. For many couples
affected by PE, working with a therapist together may produce the best results.
Ø Some psychological therapies also focus on helping the
individual find ways in which they can control ejaculation. Healthcare
practitioners may provide instruction about distraction techniques, and
"stop-start" and "squeeze" techniques that allow the
patient to develop a sense of ejaculatory control.
Ø The stop-start method works to help the individual identify ways
of controlling their sexual stimulation and ejaculatory response. This method
requires the man to engage in sexual stimulation, either with or without his
partner, until he realizes that he is about to ejaculate. At this point he
stops for about thirty seconds, reducing his urge to ejaculate, and then begins
the sexual stimulation again. These steps are repeated until ejaculation is
desired. In the final step of the sequence, stimulation is continued until a
climax is achieved.
Ø The squeeze method also involves sexual stimulation until just
prior to the "point of no return". Once the man senses that he is
about to ejaculate, his partner stops sexual stimulation and gently squeezes
the tip or the base of the penis for several seconds. Further stimulation is
withheld for 30 seconds and then resumed. The couple may choose to repeat the
sequence as many times as they like, or continue stimulation until ejaculation
is desired. These exercises have little benefit if conducted by the man himself
and require the participation of partner.
How do I find a psychologist experienced
in treating PE?
There
are all kinds of psychologists available in field, so seeing a sex psychologist
(as opposed to an addiction, family therapy or depression specialist) is
recommended.
Homeopathy Medication
Symptomatic
Homeopathy works well for Premature Ejaculation,, So its good to consult a
experienced Homeopathy physician as well as Psychologist without any
hesitation.
For
More details Please contact,
Whom to contact for Premature Ejaculation Treatment
Dr.Senthil
Kumar Treats many cases of Premature Ejaculation In his medical professional experience with
successful results. Many patients get relief after taking treatment from
Dr.Senthil Kumar. Dr.Senthil Kumar visits Chennai at Vivekanantha
Homeopathy Clinic, Velachery, Chennai 42. To get appointment please call
9786901830, +91 94430 54168 or mail to consult.ur.dr@gmail.com,
For
more details & Consultation Feel free to contact us.
Vivekanantha Clinic Consultation Champers
at
Chennai:- 9786901830
Panruti:- 9443054168
Pondicherry:- 9865212055 (Camp)
For appointment please Call us or Mail Us
For appointment: SMS your Name -Age – Mobile Number - Problem in Single word -
date and day - Place of appointment (Eg: Rajini – 30 - 99xxxxxxx0 – Premature
Ejaculation – 21st Oct, Sunday - Chennai
), You will receive Appointment details through SMS
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