Premature ejaculation Is Treatable

29Sep09

As with any condition it is important to identify specifically what one means when the use a specific named condition. Also just because a condition occurs does  not make it abnormal. It is possible for some conditions to be a normal variation with in the range of health.

Many men occasionally ejaculate sooner during sexual intercourse than they or their partner would like.  If you regularly ejaculate sooner than you and your partner wish then you may have a condition known as premature ejaculation.

Premature ejaculation is a common sexual complaint. Estimates vary, but as many as one out of three men may be affected by this problem at some time.

Both psychological and biological factors can play a role in premature ejaculation. In my experience  most men feel embarrassed to talk about it especial to their health care provider. Men you should know premature ejaculation is a common and treatable condition.

In order for any treatment to be effective the underlying cause needs to be determined. Medications, psychological counseling and sexual techniques that delay ejaculation can improve sex for you and your partner. For many men, a combination of treatments works best.

Symptoms

The main feature of this condition is that you ejaculate sooner than you would like AND it causes  concern or distress. If it does not cause you concern and distress it is not a problem.

Premature ejaculation can be  either lifelong (primary) or acquired (secondary).

According to the International Society for Sexual Medicine, lifelong premature ejaculation is characterized by:

  • Ejaculation that always or nearly always occurs within one minute or less of vaginal penetration (no real data exists on same sex partners, or other sexual activities.)
  • The inability to delay ejaculation on all or nearly all vaginal penetrations
  • Negative personal consequences, such as distress, frustration or the avoidance of sexual intimacy

According to the definition in the Diagnostic and Statistical Manual of Mental Disorders (DSM) secondary premature ejaculation:

  • Is marked by persistent or recurrent ejaculation with minimal stimulation before, on, or shortly after penetration, and before you wish it
  • Causes personal distress or relationship problems
  • Develops after you’ve had previous, satisfying sexual relationships without ejaculatory problems

When to see a Primary Care Provider

Talk with your Nurse Practitioner if you ejaculate sooner than you and your partner wish during most sexual encounters.  The range of normal from the beginning of intercourse to ejaculation is generally considered to be two to 10 minutes.

Causes

Premature ejaculation can be complicated and involves an interaction of both psychological and biological factors.

Psychological causes
Some  believe that early sexual experiences may establish a pattern that can be difficult to change later in life, such as:

  • Situations in which you may have hurried to reach climax in order to avoid being discovered
  • Guilty feelings that increase your tendency to rush through sexual encounters

Other factors that can play a role in causing premature ejaculation include:

  • Erectile dysfunction. Men who are anxious about  getting or maintaining an erection during sexual intercourse may form a pattern of rushing to ejaculate which can be difficult to change.
  • Anxiety. Many men with premature ejaculation also have problems with anxiety — either specifically about sexual performance, or caused by other issues.
  • Relationship problems. If you have previously had satisfying sexual relationships in which premature ejaculation happened infrequently or not at all, it’s likely that interpersonal issues between you and your current partner are contributing to the problem.

Biological causes
Several biological factors may contribute to premature ejaculation, and these should be explored before attempting a behavioral modification plan, because it may undermine your efforts. It would be important to physiologically optimize your body so that behavior changes can be implemented and maintained.

  • Abnormal hormone levels
  • Abnormal levels of brain chemicals called neurotransmitters
  • Certain thyroid problems
  • Inflammation and infection of the prostate or urethra
  • Inherited traits

Rarely, premature ejaculation is caused by:

  • Nervous system damage resulting from surgery or trauma
  • Withdrawal from narcotics or a drugs (the condition may resolve once you have been detoxed)

Although both biological and psychological factors likely play a role in most cases of premature ejaculation, experts think a primarily biological cause is more likely if it has been a lifelong problem (primary premature ejaculation).

Risk factors

Various factors can increase your risk of premature ejaculation, including:

  • Erectile dysfunction. You may be at increased risk of premature ejaculation if you occasionally or consistently have trouble getting or maintaining an erection. Fear of losing your erection may cause you to unconsciously hurry through sexual encounters.
  • Health problems. A medical concern that causes you to feel anxious during sex, such as a heart problem, may cause you to unknowingly rush to ejaculate.
  • Stress. Emotional or mental strain in any area of your life can play a role in premature ejaculation, often limiting your ability to relax and focus during sexual encounters.
  • Certain medications. Rarely, drugs that influence the action of chemical messengers in the brain (psychotropics) may cause premature ejaculation.

Complications

Premature ejaculation doesn’t increase your risk of serious health problems, it can cause problems in your personal life, including:

  • Relationship strains. The most common complication of premature ejaculation is relationship stress. Premature ejaculation is more common with new partners.
  • Fertility problems. Premature ejaculation can occasionally make fertilization difficult or impossible for couples who are trying to become pregnant. If premature ejaculation isn’t effectively treated, you and your partner may need to consider artificial insemination.

What would a typical visit look like to your PCP for PE?

Make an appointment with your Nurse Practitioner to discuss sexual health or urological health concerns.  Your PCP knows that a healthy sex life is very important to your well-being. A good primary care provider will ask you about your satisfaction with your sex life before you even have a chance to bring it up.

It’s normal to feel embarrassed when talking about sexual problems, but you can trust that your NP has had similar conversations with many of his patients. Premature ejaculation is a very common — and treatable — condition.

Talking about premature ejaculation will allow you get the treatment you need to get your sex life back on track. The following suggestions will help you get the most out of your appointment:

  • Symptoms. How often do you ejaculate before you or your partner would wish? How long after you begin having intercourse do you typically ejaculate?
  • Sexual history. Think back on your relationships and sexual encounters since you first became sexually active. Have you had problems with premature ejaculation before? With whom, and under what circumstances?
  • Medical history. Write down any other medical conditions with which you’ve been diagnosed, included mental health conditions. Also note the names and strengths of all medications you’re currently taking or have recently taken, including prescription and over-the-counter drugs.
  • Questions to the Nurse Practitioner. Creating your list of questions in advance can help you make the most of your time.

What should you be asking?

  • What may be causing my premature ejaculation?
  • What tests do you recommend?
  • What treatment approach do you recommend?
  • How soon after I begin treatment can I expect improvement?
  • How much improvement can I reasonably expect?
  • Am I at risk of this problem recurring?
  • Is there a generic alternative to the medicine you’re prescribing?
  • Are there any brochures or other printed material that I can take home with me?

During your visit:
You will be asked a number of very personal questions. Be ready to answer questions such as:

  • How often do you have premature ejaculation?
  • Has this problem developed gradually or suddenly?
  • Do you have premature ejaculation only with a specific partner or partners?
  • Do you experience premature ejaculation when you masturbate?
  • Do you have premature ejaculation every time you have sex?
  • How often do you have sex?
  • How much are you bothered by premature ejaculation?
  • How much is your partner bothered by premature ejaculation?
  • How satisfied are you with your current relationship?
  • What were your first sexual experiences?
  • Are you also having trouble getting and maintaining an erection (erectile dysfunction)?
  • What medications have you recently started or stopped taking?
  • Do you use recreational drugs?

In the meantime
While you wait for your appointment, consider taking a break from sexual intercourse and instead focusing on other ways of enjoying and connecting with your partner. Premature ejaculation can cause considerable strain and anxiety in a relationship, but it is a treatable condition. Deciding to talk with your doctor is the most important step you can take. In the meantime, enjoy the many other ways in which you and your partner bring each other pleasure.

Tests and diagnosis

In addition to a detailed interview about your sex life, your NP will want to know about your health history and may perform a general physical exam. He or she may refer you to a urologist who specializes in sexual dysfunction or to a mental health professional to help make the diagnosis.

The PCP will order blood tests to check your male hormone (testosterone) levels and other tests. If you have had any tests done in the previous 6 months you should bring or forward a copy of the results.

Treatments and drugs

Treatment options for premature ejaculation include sex therapy, health behavior counseling, and medications. For many men, a combination of these treatments works best.

Sexual therapy
In some cases, sexual therapy may involve simple steps, such as masturbating an hour or two before intercourse so that you’re able to delay ejaculation during sex. Your doctor may also recommend avoiding intercourse for a period of time and focusing on other types of sexual play so that pressure is removed from your sexual encounters.

The squeeze technique
Your doctor may instruct you and your partner in the use of a method called the squeeze technique. This method works as follows:

  • Step 1. Begin sexual activity as usual, including stimulation of the penis, until you feel almost ready to ejaculate.
  • Step 2. Have your partner squeeze the end of your penis, at the point where the head (glans) joins the shaft, and maintain the squeeze for several seconds, until the urge to ejaculate passes.
  • Step 3. After the squeeze is released, wait for about 30 seconds, then go back to foreplay. You may notice that squeezing the penis causes it to become less erect, but when sexual stimulation is resumed, it soon regains full erection.
  • Step 4. If you again feel you’re about to ejaculate, have your partner repeat the squeeze process.

By repeating this as many times as necessary, you can reach the point of entering your partner without ejaculating. After a few practice sessions, the feeling of knowing how to delay ejaculation may become a habit that no longer requires the squeeze technique.

Medications
Certain antidepressants and topical anesthetic creams are used to treat premature ejaculation. Although none of these drugs is specifically approved by the Food and Drug Administration to treat premature ejaculation, some are used for this purpose. You may need to try different medications or doses before you and your doctor find a treatment that works for you.

Antidepressants
A side effect of certain antidepressants is delayed orgasm. Doctors suggest that men who have premature ejaculation can take antidepressants to benefit from this specific side effect.

  • Your doctor may prescribe one of several selective serotonin reuptake inhibitors (SSRIs), such as sertraline (Zoloft), paroxetine (Paxil) or fluoxetine (Prozac), to help delay ejaculation.
  • If the timing of your ejaculation doesn’t improve, your doctor may prescribe the tricyclic antidepressant clomipramine (Anafranil), which also has been shown to benefit men with this disorder.
  • You may not need to take these medications every day to prevent premature ejaculation. Taking a low dose several hours before you plan to have sexual intercourse may be enough to improve your symptoms.

Other side effects of these antidepressants can include nausea, dry mouth, drowsiness and decreased libido.

Topical anesthetic creams
Topical anesthetic creams containing lidocaine dull the sensation on the penis to help delay ejaculation. Applied a short time before intercourse, these creams are wiped off when your penis has lost enough sensation to help you delay ejaculation.

Some men using topical anesthetic creams report reduced sexual pleasure because of lessened sensitivity. Although the cream is wiped off before intercourse, in some studies female partners reported that it also reduced their genital sensitivity and sexual pleasure. In rare cases lidocaine or can cause an allergic reaction.

Health Behavior Counseling
This approach, also known as counseling or talk therapy, involves talking with health care provider about your relationships, experiences, and specific actions that you can do or have done to help with this problem. These talk sessions can help you reduce performance anxiety or find effective ways of coping with stress and solving problems. For many couples affected by premature ejaculation, talking with a health care provider  together may produce the best results.

Complimentary and Alternative Interventions

A recent study compared the effectiveness of yoga to fluoxetine (Prozac) in the treatment of premature ejaculation. Study results showed that yoga and fluoxetine produced similar improvements in the length of time for which study participants were able to have intercourse before ejaculating. More research in this area is needed.  In some cases, premature ejaculation may be caused by poor communication between partners or a lack of understanding of the differences between male and female sexual functioning. Women typically require more-prolonged stimulation than men do to reach orgasm, and this difference can cause sexual resentment between partners and add pressure to sexual encounters. For many men, feeling pressure during sexual intercourse increases the risk of premature ejaculation.  Open communication between sexual partners, as well as a willingness to try a variety of approaches to help both partners achieve satisfaction, can help reduce conflict and performance anxiety. If you’re not satisfied with your sexual relationship, talk with your partner about your concerns. Try to approach the topic in a loving way and to avoid blaming your partner for your dissatisfaction.

If you do not have a primary care provider or would like to make an appointment with a Nurse Practitioner and are going to be in the New York City area click here.

MetroMedicalDirect.com — Raymond Zakhari The Adult Health Nurse Practitioner of New York, LLC



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