QUITE often we hear men boasting about their sexual prowess and their ability to maintain erections for long periods. However, premature ejaculation is a real problem that affects even Jamaican men. The condition affects 20-30 per cent of men worldwide.
How do the experts define premature ejaculation?
The International Society of Sexual Medicine defines premature ejaculation as a male sexual dysfunction that is typified by ejaculation that always or nearly always occurs prior to or within one minute of vaginal penetration. Additionally, many persons are unable to delay ejaculation on all or nearly all vaginal penetrations.
The definition of this condition is debatable. Certainly many men are surprised by the inclusion of one minute in the diagnosis of this condition. Several men with premature ejaculation may not clearly meet the specific definition. However, it is agreed that this condition has emotional and social consequences.
Are there different types of premature ejaculation?
Yes. Premature ejaculation may be classified as lifelong or acquired. Lifelong premature ejaculation is that which has occurred since initiation of sexual activity. This is distinct from acquired premature ejaculation which occurs in a man who previously had normal ejaculatory control. Some acquired cases may be partner-specific, ie, seen with one partner and not another.
Is there a cause of premature ejaculation?
A definite cause of premature ejaculation is not known. There are many sexual experts who believe that premature ejaculation has a psychogenic basis. This may be due to anxiety or novelty of the other partner. However, others suggest a biogenic cause of the disorder. This may be supported by the findings of dysfunction at receptors for the chemical serotonin. Theories of causation include penile hypersensitivity and hyperarousability.
How is premature ejaculation diagnosed?
Premature ejaculation is diagnosed by the report of the man who suffers with the condition. The physician must elicit details of the timing between penetration and ejaculation, the ability of the patient to control ejaculation, and satisfaction of the patient and partner. Associated erectile dysfunction, depressive symptoms and quality of life must be determined.
How is premature ejaculation treated?
Treatment usually commences with non-pharmaceutical means. This may involve behaviour therapy and psychotherapy.
The 'stop and start' and 'squeeze' techniques have been associated with premature ejaculation treatment for many years. The stop and start technique involves stopping coitus and restarting to delay ejaculation. The squeeze technique involves using physical pressure at the penis to again delay ejaculation. Short term benefit is seen in many men who use these techniques. Psychotherapy may involve counselling with both partners to determine a cause and solution to the problem.
Medications for treatment of premature ejaculation include the anti-depressants and phosphodiesterase inhibitors (eg Viagra, Cialis and Levitra). These drugs may be used daily or on-demand. The drugs are effective in most patients with minimal side-effects. Desensitizing creams and sprays with local anaesthetic agents have also been used. However, these topical agents may cause numbness to both the penis and vagina and results in unsatisfactory intercourse.
Premature ejaculation is a common problem. A definite cause is unknown.
Treatment should involve a combination of behaviour therapy and medications.
Dr Belinda F Morrison is a urologist and lecturer at the University of the West Indies. Contact firstname.lastname@example.org.