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3 Most Practical Steps to Correct Premature Ejaculation

Three Most Practical Steps to Correct Premature Ejaculation

– How to Handle Premature Ejaculation (or PE)?

 

Problems

A. Background

In men, the sequential process of sexual acts comprises the following steps:

  1. Sexual arousal through mental or/and physical stimulation;
  2. Erection – Penis gets hard and ready for vaginal penetrations.
  3. Sexual intercourse – It is the process of vaginal penetration with various frequency and depth, which play an important role
    in the pace of progress of sexual excitement toward orgasm and eventual ejaculation.
  4. Orgasm & ejaculation – As intercourse progresses, sexual excitement reaches its peak, called climax to experience orgasm
    with ejaculation to shoot semen into the vagina for insemination.
  5. De-tumescence – Within seconds or minutes after ejaculation, the penis becomes flaccid for a resting period, i. e., refractory
    period, which may widely vary and last few minutes to hours or days depending on age and general health.

That is the normal sequence. But some men may ejaculate sooner than they and their partners want and expect. If so, these men have premature ejaculation.

B. What is the definition of premature ejaculation and how have we define it?

Its definition has changed and evolved over time through more understanding of male sexuality. For example, it was defined as: less than 1-minute penetration in 1976; <15 thrusts in 1986; <50% of coital satisfaction in sexual partner in 1970; still variable but three (3) sure components in an agreement are a short ejaculatory latency, a lack of control over ejaculation, and a lack of sexual satisfaction.

Even to date, PE is still not well defined. Therefore, different definitions have been given by various organizations over time as follows:

  • In 2009, ISSM (International Society of Sexual Medicine) defined PE as:
    1. Ejaculation which always or nearly always occurs prior to or within about 1 minute of vaginal penetration;
    2. Inability to delay ejaculation on all or nearly all vaginal penetrations;
    3. Negative personal consequences, such as distress, bother, frustration and/or the avoidance of sexual encounters.
  • In 2004, WHO defined PE as the inability to delay ejaculation with ejaculation before / soon after starting intercourse (15 seconds).
  • In 2004, AUA (American Urological Association) defined it as ejaculation sooner than desired, before or shortly after penetration that causes distress one/both partners.
  • In 2001, EAU (European Association of Urology) defined it as the inability to control ejaculation for sufficient time before vaginal penetration.
  • In 2001, APA (American Psychologic Association) defined it as persistent or recurrent ejaculation with minimal sexual ejaculation.

C. How often does premature ejaculation occur?

It has been reported:

  • in around 4-40% of men, one time or the other in their lifetime.
  • the most common sexual dysfunction in men less than 40, among them, 20-30% may have it.
  • considered to be under-reported owing to personal embarrassment. In fact, it is, and…

So, you are not alone. Clinically, premature ejaculation has indeed bothered many men. Though not curable, it is manageable.

D. What may cause premature ejaculation (PE)?

By the timing of its occurrence, PE may be divided into two (2) types: Primary (lifelong) and secondary or acquired (maybe suddenly or gradually).

Hereditary or genetic factor may play an important role in PE although personal psychological factors may also contribute to its
happening.

But for practical management, we should focus on what we can do and ignore whatever its hereditary or genetic factors may be
because we can not do anything about it but concentrate on what we can do within our reach and knowledge understanding now:

  • Psychogenic PE – anxiety, novelty of partner or situation, low frequency of sexual activity;
  • Biogenic PE – substance abuse (e.g. alcohol), endocrinopathy (e.g. hyperthyroidism), chronic prostatitis, opiate withdrawal.

Such classification is for the convenience of study. In reality, both aspects in causing PE are always interacting at their various degree
and proportion among individuals.

In short, some commonly mentioned associated conditions are:

  • Erectile dysfunction
  • General anxiety
  • Situational anxiety
  • Depression
  • Substance abuse
  • Relationship distress
  • Prostatitis

E. How do we diagnose premature ejaculation (PE)?

Usually, detailed history stressing sexual history, lifestyle, history of drug overuse or misuse or abuse, and physical examination
are sufficient to reach a diagnosis. Laboratory and other physiological tests are rarely indicated.

 

Solution – 

Happiness, Positive, Emotions, BallRear Mirror, Solution, Problem, Analysis

How do the doctors treat premature ejaculation (PE)?

A. Behavioral treatment

Curtain, Theater, Action, Think, ProceedButterflies, Lifestyle, Butterfly, Occur

  1. Traditional approaches:
    • Stop-squeeze method (Masters and Johnson) – involve removal or withdrawal of penis at a point of ejaculation with squeezing glans penis or frenulum to subside the urge to ejaculate.
    • Start-stop method (Semen) – involve a pause of vaginal penetration at the point of ejaculation.
  2. Psychotherapy may be beneficial.
  3. Combination of pharmacotherapy and psychotherapy is considered as the current way of care for premature ejaculation.

B. Medication

Health, Care, Medicine, Healthy, DoctorMedical, Appointment, Doctor, Healthcare

First line – SSRI or topical anesthetic agent.

  1. unlicensed SSRI (Escitalopram, Fluoxetine, Fluvoxamine, Paroxetine, Sertraline)
    • dapoxetine on demand by mouth 3-5 hours before intercourse, an SSRI (selective serotonin reuptake inhibitor), increases IELT (intravaginal ejaculation latency time) by a
      factor of 2.5-3 with limited and tolerable side effects.
    • Daily use of an SSRIs by mouth like paroxetine 20-40 mg, or sertraline 25-200 mg, or fluoxetine 5-20 mg
  2. topical desensitizing creams, PSD502-a topical aerosol, increases an IELT by a factor of 6 with minimal local and
    negligible systemic side effects. Others – SS cream, Benzocaine, Prilocaine, Lidocaine, EMLA cream (prilocaine-
    lidocaine cream); the timing of its use – 20 minutes.

Second line – antidepressants

  1. Centrally acting opioid analgesic (Tramadol)
  2. tricyclic antidepressants on daily use or on demand, like Clomipramine, daily use with 25-50 mg or on demand with 50 mg, 5 hours before intercourse.
  3. PDE-5I, like Viagra.

 

Outcome

Chart, Percentage, Diagram, Target, Goal

  • Maybe successful up to 75-80% success rate with medication and/or behavioral modification.

 

Conclusion

  • PE has affected some 5-40% of men one time or the other over the lifetime. Despite no definite means to rid it permanently, the
    following may help to slow it down to meet reasonable satisfaction as follows: Do sex under less stressful environs and with
    ample foreplay to bring, move, & match with your partner’s pace of sex arousal; slow down the pace & decrease the depth of
    penetration; and others…
  • The care for ED attests: Doctors have never cured anything for anyone, but help patients understand and modify something to some degree with/without medication and or surgery at a reasonable time in a reasonable way. This is life reality.

Let’s Hear From You

After reading this article, please leave a positive comment if you feel the content could help you excel and succeed in life. As well, please share the information on social media profiles with family and friends you care about.

Also do not forget to sign up for the FREE monthly NewsLetter authored by Dr. Lin, aiming to help you maintain a good health and to live a long active life ahead of you.

Of course, if you have further questions, please do not hesitate to reach me at 734-846-2699 or by email to realinct2002@yahoo.com. If you need more help/support,  set up a private counseling with me to decide what would be most reasonable care for you. Doing so, you can eliminate unnecessary anxiety and fear. Don’t you like that? I am ready to help you in need.

And I wish you the very best to fulfill a long, active, vibrant life.

 

James Chin-Ti Lin, M.D.       Certified urologist, award-winning author, and founder of www.ForMeFirst.com and www.sick-ask.com

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