Definition - PE has been defined as persistent ejaculation with minimal stimulation, which is not a result of withdrawal of opiates, and that results in marked distress. This definition assumes regular sexual activity with the same person for around six months. Some definitions - inability to delay ejaculation (no self
controle) on all or most vaginal penetrations; and negative consequences (
eg distress, bother, guilt / depression, avoidance of intimacy).
The prevalence of PE:- Based on epidemiological data,
PEis estimated to be 22.7 per cent, which is higher than the estimated prevalence of erectile
cialis.
The causes of PE are not precisely known. This is due partly to the different types of PE and partly to a lack of consensus on definition. There are four proposed types of PE. Lifelong PE is thought to be caused by
neurobiological or genetic factors, whereas acquired PE might be caused by hormonal or vitamin deficiency, poor neurological co-ordination, infection, withdrawal of opiates, performance anxiety or other
psychosexual or relationship concerns. The remaining categories are not thought to have any biological causation.
Type of premature ejaculation: 1- Lifelong. 2- Acquired. 3- Natural variable. 4- Situational.
The nature of the problem needs to be established, as PE may be caused by
prostatitis (more commonly
subclinical prostatitis), necessitating an examination of the prostate on
USG. It is also essential to know what the patient wants out of the consultation, as some men expect sexual activity to be mutually orgasmic and have unrealistic expectations of normal ejaculatory latency. If the prostate is tender on examination, treatment with 500mg
ciprofloxacin twice daily for four weeks may resolve the problem. It is also important to determine whether the man has erectile dysfunction rather than PE.
No further examinations are needed, although the opportunity can be taken to look at testosterone, lipid and glucose levels.
Treatment of premature ejaculation
The most common treatment options for PE are treatment of basic cause that is leading to PE. Behavioural therapies; local anaesthetics, and selective serotonin
reuptake inhibitors (
SSRIs) or equivalent medication.
Phospho-
diesterase type 5 inhibitors (
PDE5Is) have been used, but their precise mechanism of action is unclear.
A man who fears that he will lose an erection before ejaculating may well increase the speed of intercourse, thus giving himself PE. The underlying problem in these circumstances is loss of tumescence related to the narrowing of the
pudendal artery, in which case a
PDE5I may be a more appropriate prescription.
While
SSRIs have not been found to maintain ejaculatory delay in all men after cessation of treatment, some with acquired PE have been able to sustain ejaculatory delay. Where possible, appointments should involve both partners, as the solution involves a couple rather than a solitary approach.
Sensate focus
Each couple will have their own ‘rules’ for sexual activity and intimacy, and negative feelings,
eg pressure to perform, tiredness, pain, upset, guilt or worry, can affect both partners' desire for sexual activity. These feelings need to be articulated and discussed for PE to resolve. If the relationship has deteriorated to the point where no intimacy is present, or where no sexual activity is attempted, relationship counselling rather than sex therapy is needed. Behavioural therapy, Squeeze technique, Stop/start technique have their limitations.
Kegal exercise helps.
New treatments
Recently, two further treatments have been investigated, with promising results:
topical eutectic mixture for PE (TEMPE)27 – an aerosol delivery of
lidocaine-
prilocaine;
dapoxetine – a serotonin transport inhibitor and the first
SSRI licensed for treatment of PE.The potential advantages of
dapoxetine are that it is a short-acting
SSRI with few side-effects. It has been found to be effective on first dose, rather than after seven to ten days, as with other
SSRIs.
The choice of whether to start medication or refer to a sex therapist can be difficult. A two-month course may be sufficient to help alleviate the pressure on men to perform in their sexual relationships. At the end of two months, a re-assessment of whether the man has been able to delay and control ejaculation can be undertaken. If there is no improvement, alternative pharmacological therapies and sex therapy may help.
PREMATURE EJACULATION TIPS 
