Premature Ejaculation: From Etiology to Diagnosis and Treatment


Many theories have been suggested, including that PE was the result of masturbating quickly during adolescence to avoid being caught, performance anxiety , passive-aggressiveness or having too little sex; but there is little evidence to support any of these theories.

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Premature ejaculation (PE) is a common male sexual complaint, with a self- reported prevalence of 20–30% in observational studies. Over the past 10–20 years. Request PDF on ResearchGate | On Jan 1, , Emmanuele A. Jannini and others published Premature ejaculation. From etiology to diagnosis and treatment.

Several physiological mechanisms have been hypothesized to contribute to causing premature ejaculation, including serotonin receptors, a genetic predisposition, elevated penile sensitivity and nerve conduction atypicalities. The nucleus paragigantocellularis of the brain has been identified as having involvement in ejaculatory control. However, studies have been inconclusive in isolating the gene responsible for lifelong PE.

Complementary, surgical, and experimental modalities for management of premature ejaculation

PE may be caused by prostatitis [12] or as a medication side effect. The physical process of ejaculation requires two actions: The emission is the first phase. It involves deposition of fluid from the ampullary vas deferens , seminal vesicles and prostate gland into the posterior urethra. It involves closure of bladder neck, followed by the rhythmic contractions of the urethra by pelvic-perineal and bulbospongiosus muscle and intermittent relaxation of external urethral sphincters.

Sympathetic motor neurons control the emission phase of ejaculation reflex, and expulsion phase is executed by somatic and autonomic motor neurons.

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Castiglione F, et al. Premature ejaculation as a medical problem under evidence-based criteria generated by the International Society for Sexual Medicine in as being not the result of a nonsexual mental illness , a problem in a given relationship, or caused by medication, by the person ejaculating around a minute after penetration and before the person wants to ejaculate, occurring for a duration longer than 6 months and happening almost every time, and causing significant distress for person. There is no uniform cut-off defining "premature", but a consensus of experts at the International Society for Sexual Medicine endorsed a definition of around one minute after penetration. By the 21st century, most men with premature ejaculation could cure themselves, either on their own or with a partner, using self-help resources, and only those with unusually severe problems had to consult sex therapists, who cured 75 to 80 percent. Retrieved from " https: Sensing it, they were to signal their partner, who squeezed the head of the penis between thumb and index finger, suppressing the ejaculatory reflex and allowing the man to last longer. Men with PE often report emotional and relationship distress, and some avoid pursuing sexual relationships because of PE-related embarrassment.

These motor neurons are located in the thoracolumbar and lumbosacral spinal cord and are activated in a coordinated manner when sufficient sensory input to reach the ejaculatory threshold has entered the central nervous system. The Kinsey Report suggested that three-quarters of men ejaculate within two minutes of penetration in over half of their sexual encounters.

Current evidence supports an average intravaginal ejaculation latency time IELT of six and a half minutes in to year-olds. Likewise, those with higher IELTs may consider themselves premature ejaculators, suffer from detrimental side effects normally associated with premature ejaculation, and even benefit from treatment.

Premature ejaculation as a medical problem under evidence-based criteria generated by the International Society for Sexual Medicine in as being not the result of a nonsexual mental illness , a problem in a given relationship, or caused by medication, by the person ejaculating around a minute after penetration and before the person wants to ejaculate, occurring for a duration longer than 6 months and happening almost every time, and causing significant distress for person.

Several treatments have been tested for treating premature ejaculation. A combination of medication and non-medication treatments is often the most effective method. Many men attempt to treat themselves for premature ejaculation by trying to distract themselves, such as by trying to focus their attention away from the sexual stimulation. There is little evidence to indicate that it is effective and it tends to detract from the sexual fulfilment of both partners. Other self-treatments include thrusting more slowly, withdrawing the penis altogether, purposefully ejaculating before sexual intercourse, and using more than one condom.

Using more than one condom is not recommended as the friction will often lead to breakage. Some men report these to have been helpful. By the 21st century, most men with premature ejaculation could cure themselves, either on their own or with a partner, using self-help resources, and only those with unusually severe problems had to consult sex therapists, who cured 75 to 80 percent. Freudian theory postulated that rapid ejaculation was a symptom of underlying neurosis. It stated that the man suffers unconscious hostility toward women, so he ejaculates rapidly, which satisfies him but frustrates his lover, who is unlikely to experience orgasm that quickly.

But even years of psychoanalysis accomplished little, if anything, in curing premature ejaculation. There is no evidence that men with premature ejaculation harbor unusual hostility toward women. Several techniques have been developed and applied by sex therapists, including Kegel exercises to strengthen the muscles of the pelvic floor and Masters and Johnson's "stop-start technique" to desensitize the man's responses and "squeeze technique" to reduce excessive arousal.

To treat premature ejaculation, Masters and Johnson developed the "squeeze technique", based on the Semans technique developed by Dr. James Semans in Sensing it, they were to signal their partner, who squeezed the head of the penis between thumb and index finger, suppressing the ejaculatory reflex and allowing the man to last longer. The squeeze technique worked, but many couples found it cumbersome. From the s to the s, sex therapists refined the Masters and Johnson approach, largely abandoning the squeeze technique and focused on a simpler and more effective technique called the "stop-start" technique.

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During intercourse, as the man senses he is approaching climax, both partners stop moving and remain still until the man's feelings of ejaculatory inevitability subside, at which point, they are free to resume active intercourse. These techniques appear to work for around half of people, in the short term studies that had been done as of Drugs that increase serotonin signalling in the brain slow ejaculation and have been used successfully to treat PE.

These include selective serotonin reuptake inhibitors SSRIs , such as paroxetine or dapoxetine , as well as clomipramine. Ejaculatory delay typically begins within a week of beginning medication. The treatments increase the ejaculatory delay to 6—20 times greater than before medication. Men often report satisfaction with treatment by medication, and many discontinue it within a year.

Desensitizing topical medications like lidocaine that are applied to the tip and shaft of the penis can also be used.

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These are applied "as needed", 10—15 minutes before sexual activity and have fewer potential systemic side effects as compared to pills. Two different surgeries are available to permanently treat premature ejaculation: Premature ejaculation is a prevalent sexual dysfunction in men; [47] however, because of the variability in time required to ejaculate and in partners' desired duration of sex, exact prevalence rates of PE are difficult to determine.

There is a common misconception that younger men are more likely to suffer premature ejaculation and that its frequency decreases with age. Prevalence studies have indicated, however, that rates of PE are constant across age groups. Male mammals ejaculate quickly during intercourse, prompting some biologists to speculate that rapid ejaculation had evolved into men's genetic makeup to increase their chances of passing their genes.

Ejaculatory control issues have been documented for more than 1, years. Sex researcher Alfred Kinsey did not consider rapid ejaculation a problem, but viewed it as a sign of "masculine vigor" that could not always be cured. From Wikipedia, the free encyclopedia. This article is about the medical condition. For the music group, see Premature Ejaculation band. The Journal of Sexual Medicine. Explicit use of et al. The Scope of the Problem". Journal of Sex and Marital Therapy.

Archives of Sexual Behavior. Journal of Sexual Medicine. Overview Premature ejaculation occurs when a man ejaculates sooner during sexual intercourse than he or his partner would like. However, you might be diagnosed with premature ejaculation if you: Request an Appointment at Mayo Clinic. Ejaculation and orgasm disorders. Ferri's Clinical Advisor Saitz TR, et al. Advances in understanding and treating premature ejaculation.

Gur S, et al. Current therapies for premature ejaculation. Wein AJ, et al.

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Disorders of male orgasm and ejaculation. Althof SE, et al. An update of the International Society of Sexual Medicine's guidelines for the diagnosis and treatment of premature ejaculation PE. The Journal of Sexual Medicine.

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Cooper K, et al. Behavioral therapies for management of premature ejaculation: Serefpglu EC, et al. Do we have effective therapy? Translational Andrology and Urology. Pelvic floor muscle training in males: Hill BJ, et al. The effect of condoms on penile vibrotactile sensitivity thresholds in young, heterosexual men. Contemporary management of disorders of male orgasm and ejaculation.

Castiglione F, et al. Current pharmacological management of premature ejaculation:

Premature Ejaculation Treatment by Dr. P.S. Tiwari