Premature ejaculation (PE) is one of the most common types of ejaculatory dysfunctions (EjD) and importantly, more common than erectile dysfunction (ED) with a prevalence of 31% in men between 18-59 years old. It is a highly distressing and demoralising condition that a young man could suffer from in the early days of his sexual life. It has many a times led to break down in relationships compounding sexual dysfunction with additional psychogenic erectile dysfunction. PE could either be primary / lifelong or indeed secondary/acquired at a later stage in life. The definition of PE is vague and as such many patients remain undiagnosed or misdiagnosed. One definition of lifelong PE is ejaculation before or within one minute of vaginal penetration.
The mechanism or causative factors responsible for EjD have so far not been clearly understood. This is reflected in the fact that the treatment options offered to address this problem were centred on mechanical / physical means of delaying ejaculation such as pinching of the head of the penis (glans)/squeeze technique, intermittent withdrawal of penis during sexual intercourse to reduce stimulatory effect of intromission thereby delaying ejaculation or stop/start technique, using local numbing agents to postpone ejaculation at the cost of loss of sexual pleasure for the man and so on. Many young men adapt the policy of masturbation to ejaculate ahead of planned sexual intercourse as the penis is desensitized immediately after ejaculation and allows them to delay ejaculation when it matters most.
These measures were not always associated with success in delaying ejaculation and as such, the problem persisted. It is important to note that most men have erroneous concepts / ideas regarding time taken to ejaculate during penetrative sexual intercourse as a consequence of watching pornography and discussing sexual experiences with friends / colleagues who more often than not tend to boast about their lasting abilities and as such serve to undermine the confidence in ones own abilities. It is truth albeit bitter truth, that the average intra-vaginal ejaculatory latency time (IELT) is no more than 5 - 7 minutes! If only men could appreciate this, it would put a lot of things in perspective and avoid unnecessary distress / frustration.
Behavioural and psychosexual therapies have been the main stay of treatment options for PE. Off licence use of antidepressants has also been in practice for a long time until the most recent development of a short acting SSRI called Dapoxetine, which has proven to be efficacious in managing PE and increasing the IELT many folds. Reports of success with use of Tramadol and Viagra in addressing have been noted in the literature.
In selected cases, thyroid disorders have been associated with EjD, namely PE with hyper thyroid function and delayed ejaculatory dysfunction with under active thyroid. Other risk factors include prostatitis, emotional trauma and genetic predisposition.
PE may be associated with secondary ED or independent of ED but has significant impact on quality of life of men who suffer from it and these men need assurance, psychotherapy, sexological therapy, drug therapy in combination such as Viagra with an off license antidepressant or tramadol and one of the local technique. Such a multi modal approach may help in alleviating this distressing condition.
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by Sudhanshu Chitale