Premature Ejaculation : Causes, Symptoms and Treatment

Posted by tom sterling on May 19th, 2018

It has been claimed that premature ejaculation (PE) is one ofthe most commonly reported male sexual complaints, withprevalence ranging between 20% and 30% in the malepopulation according to several epidemiological studies[1]. PE may have a detrimental impact on quality of life forpatients and their partners. According to the ISSM, lifelong PE is ‘‘an ejaculationwhich always or nearly always occurs prior to or withinabout one minute of vaginal penetration, and the inabilityto delay ejaculation on all, or nearly all vaginal penetrations,along with negative personal consequences, such asdistress, bother, frustration and/or the avoidance ofsexual intimacy.’’ Acquired PE is characterized by gradualor sudden onset over the lifetime of the individual, whodescribes previous normal ejaculatory performance andejaculates within approximately 3 min after vaginalpenetration. As a result of heterogeneous data and poorly clarifiedphysiology of ejaculation and pathophysiology of ejaculatorydisorders (including a mixture of organic, psychogenic,and iatrogenic etiologies), the appropriate approach for PEmanagement was long considered related to the psychosexologyfield.

What Causes Premature Ejaculation?

Numerous causes are involved behind PE which can be biological, chemical and/or emotional. The working of the neurotransmitters that regulate sexual excitement might be problematic.

Serotonin

Serotonin is a neurotransmitter that helps control the mood, emotion, sleep and sexual desire. High amounts of serotonin in the brain can provoke feelings of pleasure and thus cause an ejaculation last longer; in contrast low amounts can lead to PE. However, the role of neurotransmitter serotonin in PE is unclear. Aging is not a direct cause of PE as it can happen at any age. Yet, advancing agecan lead to alterations in erections and ejaculation. Erections may not be as firm or as large for older men and they may not last as long as before ejaculation occurs. Occasionally, ejaculation may be delayed or anorgasmia (inability of a man to reach climax with an erection) may develop. Lifelong PE patients might never have a control of ejaculation.  

Psychological Issues

• Negative feelings influence sexual desire and can cause PE.

• Managementof emotional stress can help.

• Men with PE may also feel:

• Temporary depression

• Stress

• Guilt

• Unrealistic expectations about sex

• Sexual repression (blocked or bottled-up sexual feelings)

• A lack of confidence

• Relationship problems

Treatment modalities of PE

Mainstay of treatment for PE includes psychological therapy, behavioral therapy (sexual exercises) and drugs. Best treatment plan can be developed after a thorough doctor and patient interaction. Combination of one or more treatments can be useful in many cases.

Medical management of PE

Nevertheless, pharmacologic researchwith selective serotonin reuptake inhibitors (SSRIs) has ledto a neurobiological-genetic vision of PE as postulated byWaldinger and colleagues in 1998. After the first placebo-controlled study of paroxetine, several other SSRIs were investigated and have been used for off-label clinical treatment of PE. SSRIs, topical anesthetics (TAs), and, more recently, tramadol represent the most common on- and off-label pharmacotherapeutic approaches for PE management.There are no FDA approved drugs which specifically treats PE. Still, some drugs, numbing creams and sprays, and condoms can be used to help slow ejaculation. Antidepressants have the side effect of delayed orgasms. Some patients may even develop anorgasmia as antidepressants affect serotonin levels. Examples of these drugs are:

• Paroxetine

• Sertraline

• Dapoxetine

• Fluoxetine

• Clomipramine

Some doctors use them “off-label” to treat PE. Other medicines used for the treatment of PE are as follows:

1) Topic anesthetics

Anesthetic creams and spray like lidocaine and prilocaine creams can be used to delay ejaculation by reducing sensation in the penis which may help delay ejaculation.

2) Oral Medications

i. Antidepressants

ii. Analgesics

iii. Phosphodiesterase-5-inhibitors

3) Counselling

Counselling might come in handy by reducing ones stress and anxiety which may in some way help to delay ejaculation time of an individual.

4) Alternative methods

i. Yoga

ii. Meditation

iii. Acupuncture