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Erectile Dysfunction (ED)

Premature Ejaculation

Premature ejaculation is a common sexual problem that may affect as many as 75% of men.

It is described as an inability to delay ejaculation to a point that is mutually desirable for both partners. To understand premature ejaculation, one should first understand the process of erection. An erection develops when blood flows into the erectile chambers of the penis. These chambers, known as the corpora cavernosa, are elastic sleeves filled with blood vessels within the penis and are adjacent to the urethra, which is the urinary channel. Erection develops when a chemical message is sent that causes a marked increase of blood flow which expands and stretches these elastic sleeves. Once blood flows into these sleeves, it has to be trapped there so that it does not leak back out.

Once an erection develops, a process called emission takes place. Fluid from the seminal vesicles and the prostate, along with sperm which is delivered from the testicles by the vas deferens (the tubes that connect the testicles to the prostate) is deposited into the urethra, the channel which runs through the penis. This fluid, the semen, is stored in the urethra until ejaculation occurs.

Ejaculation takes place when a signal is sent from a control center in the brain which leads to contraction of muscles adjacent to the urethra which cause the semen to be ejaculated from the tip of the penis. After ejaculation, the erection subsides. The blood which had been trapped in the elastic sleeves is now released and the penis gradually returns to its non-erect state.

The trigger for ejaculation is sent from a control center in the brain.

A variety of causes have been suggested for premature ejaculation. Some suggest it may be caused by stress or anxiety. Others suggest it is a learned response. An easy way to picture the process is to think of the control center in the brain as a thermostat. In some men, this thermostat is set too low. The signal to ejaculate is sent too quickly which leads to premature ejaculation. With that in mind, the different treatments are designed to lengthen the time to ejaculation by resetting the thermostat. There are a variety of treatment options available for premature ejaculation, which are listed below.

Masters and Johnson Technique

Masters and Johnson first described a method to prolong the time to ejaculation which relies on behavior modification. A man approaches the point close to climax and then stops and relaxes before starting again. Each time, he brings himself closer to orgasm until he learns the point where it can no longer be controlled. By repeating this procedure a number of times on different occasions, a man can learn the “point of no return”. A man can practice this with his partner by engaging in sexual stimulation until he reaches the point just before ejaculation. At that point, he stops and allows himself to partially lose his erection. This step is repeated several times until a man feels comfortable postponing his ejaculation. Although this method is effective, it can take weeks or months to cause a change in the threshold for ejaculation. Although this works for some men, it can be difficult for others to achieve favorable improvement with this technique.

Squeeze Technique

The squeeze technique is a variation of the Masters and Johnson method. As a man approaches climax, either he or his partner squeezes the tip of the penis just below the head of the penis as he approaches the point of climax. Pressure is held there until the sensation of impending orgasm diminishes. This

pressure can even be held until there is some reduction in erection. The process can then be started over again so that over time a man prolongs the time period until he reaches ejaculation.

Reduced Sensation

Oversensitivity can be a cause for premature ejaculation. Some men find that the sensation of sex with a condom is less intense. By wearing a condom, they may reduce the amount of sensory input so that it takes a longer period of stimulation to reach climax.

Another approach to decrease sensitivity requires the use of a topical anesthetic cream to desensitize the penis. However, some men notice that with topical anesthetic cream, intercourse is less pleasurable because of the reduced sensitivity. In addition, there can be times when the topical aesthetic cream is transmitted to the female partner which can cause her to have decreased sensitivity as well.

Drug Therapy

There are several different medications which can delay ejaculation. They belong to a class of medications known as selective serotonin reuptake inhibitors (SSRIs) which are types of antidepressants. These medications include sertraline (Zoloft), paroxetine (Paxil), and fluoxetine (Prozac). When these drugs are used to treat depression, men notice the side effect that it may cause them to take a longer period of time to reach ejaculation. The medications likely affect the “thermostat” in the brain which controls the signal for ejaculation. Although these drugs are not indicated for the treatment of premature ejaculation, they are frequently used with benefit in men who have premature ejaculation. The “side effect” of delayed ejaculation is used to help the man who reaches climax too quickly. These medications can “reset the thermostat” so that a man can last longer before reaching ejaculation. These drugs may need to be taken anywhere from 1-12 hours before sexual activity. For a subset of men, one of these pills may need to be taken on a daily basis to provide benefit.

Second Erection Technique

Another approach to premature ejaculation is called the second erection technique. Men often note that if they climax quickly with their first erection they can last a longer time if they are able to get a second erection. With the second erection, it may take a longer period of time until they ejaculate. However, for many men, it may be difficult to obtain the second erection. In that circumstance, Viagra may be used which helps promote the ability of a man to get an erection. Viagra is taken one hour before sexual activity. Once a man has his first erection and ejaculation, he may find Viagra makes it easier to obtain the second erection.

In summary, premature ejaculation is a common problem for which a variety of treatments are available.

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