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Premature Ejaculation
Premature Ejaculation
Premature Ejaculation (PE) is rapid ejaculation. There is no set time when a man should ejaculate during sex. It has been defined in various ways:
- Having an orgasm before penetration.
- Having an orgasm less than a minute after sexual intercourse.
- Ejaculation that occurs sooner than desired, either before or shortly after penetration, causing distress to either one or both partners.
- Short ejaculatory latency that causes personal distress and is beyond the ability to control.
- The inability of a man to delay ejaculation long enough for his partner to reach orgasm on 50% of intercourse attempts (Masters and Johnson, 1970).
Obviously, there is an incomplete fulfillment of the sexual encounter, and associated feelings of frustration on the part of both partners.
Fast Ejaculation
How fast is fast.
Well, in one study, the median intravaginal ejaculatory latency time (IELT) was measured by using a stopwatch held by the partner. For men without PE, the median time was 7.3 minutes from penetration to ejaculation. For men with PE, median time was reduced to 1.8 minutes.
Prevalance of PE
No matter what the definition, some studies report Premature Ejaculation of one of the most common sexual dysfunction. Some studies report a prevalance of 30 % occuring at sometime in men's life.
Causes of PE
No one has clearly defined the cause of Premature Ejaculation. But given its high prevalance, it is not surprising that there are many possible causes of PE:
- Emotion, such as stress, anxiety, depression, guilt, lack of self-confidence, concerns about performance, and problems in the relationship.
- Physical, such as abnormal hormones levels, abnormal neurotransmitter levels in your brain, inflamation or infection of the prostate or urethra, or genetic issues.
Evaluation of PE
The history and exam will include:
- A Family History
- A Social History of recreational drugs
- A Medical history of any metabolic conditions, and a review of present prescriptions.
- Laboratory evaluation of hormones
- Neuropsych screening
Treatment of PE
Treatment is directed at possible underlying causes. Fortunately, there are multiple medication options, as well as hygienic measures. Medications prescribed include:
- Dapoxetine, brand name Priligy
- Escitalopram, brand name Lexapro
- Sertraline, brand name Zoloft
- Tramadol, brand name Ultram
- PE-5 Inhibitors such as Sildenafil (brand name Viagra), Tadalafil (brand name Cialis), and Vardenafil (brand name Levitra)
Delayed Ejaculation
Delayed or Impaired Ejaculation
Delayed Ejaculation (DE) - also called Impaired Ejaculation, Retarded Ejaculation, or Inhibited Ejaculation, is when an extended period of sexual stimulation is required to reach ejaculation and release semen.
- It may be a temporary or acquired versus a lifelong problem
- It may be Generalized or Situational, and may be less of a problem with masturbation
- It may result in other problems such as retrograde ejaculation or inability to ejaculate at all, called anejaculation.
- Short ejaculatory latency that causes personal distress and is beyond the ability to control.
Delayed Ejaculation
How slow is too long?
The median intravaginal ejaculatory latency time (IELT) was 7.3 minutes from penetration to ejaculation. For men with Premature Ejaculation, median time was reduced to 1.8 minutes. For Delayed Ejaculation time was delayed for 30 minutes or more.
Prevalance of DE
Unlike Premature Ejaculation, Delayed Ejaculation is an uncommon and a challenging disorder to treat. Its lower frequency may be attributed to the fact that it is only a problem if it is ongoing or causes stress to your partner.
Causes of DE
No one has clearly defined the cause of Premature Ejaculation. But given its high prevalance, it is not surprising that there are many possible causes of PE:
- Emotion, such as stress, anxiety, depression, guilt, lack of self-confidence, concerns about performance, and problems in the relationship.
- Physical, such as abnormal hormones levels, abnormal neurotransmitter levels in your brain, inflamation or infection of the prostate or urethra, or genetic issues.
Evaluation of DE
The history and exam will include:
- A Family History
- A Social History of recreational drugs
- A Medical history of any metabolic conditions, and a review of present prescriptions.
- Laboratory evaluation of hormones
- Neuropsych screening
Treatment of DE
Treatment is directed at possible underlying causes. Fortunately, there are multiple medication options, as well as hygienic measures. Medications prescribed include:
- Testosterone
- Cabergoline, brand name Dostinex
- Bupropion, brand name Welbutrin
- Amantadine, brand name Symmetrel
- Cyproheptadine, brand name Periactin
- Midodrine
- Imipramine
- Ephedrine
- Pseudoephedrine
- Yohimbine
- Buspirone, brand name Buspar
- Oxytocin
- Bethanechol