Dr. M.J. Bazos, MD
Patient Handout
EJACULATION,
PREMATURE
About Your
DiagnosisPremature ejaculation (PE) is
a relatively common disorder seen primarily in heterosexuals. It occurs in about
25% to 40% of men at different points in their sexual life. It is characterized
by an inability to maintain an erection during sexual intercourse for a long
enough time to satisfy the individual. Because the problem does involve such an
intimate part of a relationship, premature ejaculation can lead to social
isolation and psychological distress. If, however, the man’s partner does
not complain about the premature ejaculation, it is unlikely that the man will
seek professional help about this
problem.Living With Your
DiagnosisIn most instances, the
ejaculation comes less than a minute after entering the vagina. Rarely,
ejaculation can occur either immediately before or immediately after vaginal
entry. However, in either case, the ejaculation occurs before the individual or
his partner would desire it. One should not, however, be preoccupied with the
length of time. The real deciding factor in diagnosing premature ejaculation is
that both the patient and his partner are dissatisfied with this aspect of their
sexual functioning. It is also important to keep in mind that most men ejaculate
prematurely, but generally not all the time as do individuals with this
disorder. In assessing the individual with premature ejaculation, the following
questions should be asked:• Why is
the patient seeking therapy now?•
What is the couple’s length of sexual
experience?• Are there any other
emotional aspects that might be affecting their sexual
behavior?• Are their expectations
for sexual intercourse reasonable?•
Is the man desperate about losing his partner because of rapid
ejaculation?• Does sexual activity
occur under secretive conditions where the couple might be
interrupted?• Does the sexual
partner have some form of sexual disorder, such as an unusual amount of pain
during sexual activity or a decreased interest in sex? The answers to these
questions will allow the individual evaluating the man with premature
ejaculation to determine whether this condition is acquired or lifelong, and
also to determine what other psychosocial factors need to be addressed to help
treat the condition. Usually, men who have premature ejaculation are able to
delay an orgasm during masturbation but not during sexual intercourse. To be
considered abnormal, premature ejaculation must cause distress for the patient
or difficulties with a relationship, and must not be related to any drugs the
patient may be taking. In particular, withdrawal from some narcotics causes
premature ejaculation. There are different types of premature ejaculation. PE is
classified according to the onset, whether it is lifelong or acquired later, and
by context, whether it is generalized or just situational. PE can be caused by a
psychological condition or by a combination of factors. As young males become
more sexually experienced with age, the majority learn how to delay orgasm.
However, some men continue to have premature ejaculation, and they are the ones
who may seek help for this disorder. In lifelong premature ejaculation, the
problem begins with the first sexual intercourse and continues throughout all
the patient’s relationships until treatment is sought. When premature
ejaculation occurs after there has been a period of normal sexual functioning,
it is usually because of a decreased frequency of sexual activity or intense
performance anxiety with a new partner. Some men who have stopped regular use of
alcohol may have premature ejaculation because they relied on their drinking to
delay organism, instead of learning from experience how to do
so.TreatmentThe
treatment of premature ejaculation can involve a range of therapy, from simply
reassuring the patient and providing him with realistic expectations about
sexual activity, to the use of medications. In particular, the use of
clomipramine in a dose of 25–50 mg has been shown, in some cases, to
increase the time before ejaculation by an average of 250%. In addition, other
serotonin drugs, such as Zoloft, Paxil, and Prozac, may also be of some benefit.
In general, those individuals who respond to clomipramine or other medications
will have a reoccurrence of the disorder if the medication
isstopped. Much attention has been focused
on the so-called squeeze technique for the treatment of premature ejaculation.
In this technique, the male will focus his attention on the sensations he is
obtaining through his penis during intercourse, and then he will signal his
partner to stop moving or to apply a
firm squeeze to the penis in an attempt to
interrupt ejaculation. This obviously requires excellent communication between
an individual and his partner, which probably improves functioning as well. It
is important to remember that in premature ejaculation, as with any sexual
dysfunction, the primary concern is not what is “normal sexual
behavior” but what sexual difficulties are adversely affecting the
pleasure and enjoyment of both partners involved. It is those conditions that
merit treatment.The
DOsIf you have premature ejaculation,
it is important to create an appropriate atmosphere for sexual activity. Fear of
interruption and clandestine (secret) sexual activity increase chances of
premature ejaculation. You should also communicate with your partner to allow
for both of you to express your feelings and expectations regarding sex.
Together you might develop techniques (e.g., squeeze technique) that may prolong
an erection. Most important, try to relax. Anxiety (especially performance
anxiety) only makes this condition worse.
The
DON’TsBecause your ejaculation
may be rapid and unpredictable, avoid such risky “birth control”
methods as withdrawal before ejaculation. Do not feel embarrassed to discuss
this condition with your
physician.When to Call Your
DoctorYou should call your physician
if you are unable to achieve an erection, if you have a bloody or foulsmelling
discharge, pain on intercourse, or significant depression secondary to premature
ejaculation.Websites:http://www.doctors-10tv.com/alt/men/men.htmhttp://www.catalog.com/ie/hr.htmhttp://www.cei.net/~impotenc