QUITE often, men boast about their sexual prowess and their ability to maintain erections for prolonged periods. However, premature ejaculation, which affects 20-30 per cent of men worldwide, is a real problem that affects even Jamaican men.
HOW DO EXPERTS DEFINE PREMATURE EJACULATION?
The International Society of Sexual Medicine defines premature ejaculation as a male sexual dysfunction that is typified by ejaculation that always or nearly always occurs prior to or within one minute of vaginal penetration. Additionally, many men are unable to delay ejaculations on all or nearly all vaginal penetrations.
The definition of this condition is debatable. Certainly many men are surprised by the inclusion of one minute in the diagnosis. Several men with premature ejaculation may not clearly meet the specific definition. However, it is agreed that this condition has emotional and social consequences.
ARE THERE DIFFERENT TYPES OF PREMATURE EJACULATION?
Yes. Premature ejaculation may be classified as lifelong or acquired. Lifelong premature ejaculation is that which has occurred since initiation of sexual activity. This is distinct from acquired premature ejaculation which occurs in a man who previously had normal ejaculatory control. Some acquired cases may be partner-specific, that is, seen with one partner and not another.
WHAT CAUSES PREMATURE EJACULATION?
A definite cause of premature ejaculation is unknown. There are many sexual experts who believe that premature ejaculation has a psychogenic basis. This may be due to anxiety or novelty of the other partner. However, others suggest a biogenic cause of the disorder. This may be supported by the finding of dysfunction at receptors for the chemical serotonin. Theories of causation include penile hypersensitivity and hyperarousability.
HOW IS PREMATURE EJACULATION DIAGNOSED?
Premature ejaculation is diagnosed by the report of the man who suffers with the condition. The physician must elicit details of the timing between penetration and ejaculation, the ability of the patient to control ejaculation and satisfaction of the patient and partner. Associated erectile dysfunction, depressive symptoms and quality of life must be determined.
HOW IS PREMATURE EJACULATION TREATED?
Treatment usually commences with non-pharmaceutical means. This may involve behaviour therapy and psychotherapy. The "stop and start" and "squeeze techniques" have been associated with premature ejaculation treatment for many years. The stop and start technique involves stopping coitus and restarting, to delay ejaculation. The squeeze technique involves using physical pressure on the penis to again delay ejaculation. Short-term benefit is seen in many men who use these techniques. Psychotherapy may involve counselling with both partners to determine a cause and solution to the problem.
Medication for treatment of premature ejaculation include anti-depressants and phosphodiesterase inhibitors like Viagra, Cialis and Levitra. These drugs may be used daily or on demand. The drugs are effective in most patients with minimal side effects. Desensitising creams and sprays with local anaesthetic agents have also been used. However, these topical agents may cause numbness to both the penis and vagina and results in unsatisfactory intercourse.
Dr Belinda F Morrison is a consultant urologist and lecturer at the University of the West Indies and Mona Institute of Medical Sciences, Mona, Kingston 6. Please send questions and comments to firstname.lastname@example.org.