Premature Ejaculation

Premature ejaculation is another orgasmic dysfunction. It is also known as rapid ejaculation, fast ejaculation, early ejaculation, early orgasm, premature climax, rapid climax etc.

Definition: Premature ejaculation is a condition in which the male partner ejaculates before he or his partner wishes. WHO defines premature ejaculation as the inability to control ejaculation sufficiently for both partners to enjoy sexual interaction. In severe cases, ejaculation may occur before vaginal entry or in the absence of erection. In short premature ejaculation is the inability of a man to control the ejaculation till the completion of sexual intercourse in such a way that both partners achieve full sexual satisfaction. Premature ejaculation may be classified as lifelong or acquired. Life long PE may begin during teenage. Acquired PE is secondary to other conditions.

Epidemiology: It is one of the most common sexual problems of men, affecting 25%-40%. Every one engaged in sexual intercourse might have experienced it at least once. The second largest group of men seeking the treatment of a sexologist is for premature ejaculation. The famous study conducted by Alfred Kinsey in 1950s found that about 75% of men ejaculate within two minutes of penetration in more than half of their sexual intercourse. Population based studies conducted in United States and United Kingdom showed a prevalence estimate of 5% and 30%.

Our study: Premature ejaculation is the second largest sexual problem for which men seek treatment in South India especially in Kerala. Our patients are mostly from Kerala, a few from other parts of India. Out of the 5831 patients consulted for sexual problems at Dr Promodus Institute from February 01, 2006 to January 31, 2011 premature ejaculation accounts for about 22 percent.

Causes: There are multiple causes for premature ejaculation. Any infection or disease of the genito urinary system can sometimes cause premature ejaculation. Infection in urinary bladder, prostate gland, seminal vesicles and inflammation of prostate gland are found to be some of the common causes of PE. Some of the other diseases such as hyperthyroidism, diabetes mellitus also can cause PE. Major psychogenic factors responsible for PE are conflict between the partners, mental conflicts, mood state, performance anxiety, habituation and hypersensitivity of the penis.

Treatment: Clinical evaluation and investigations play major role in identifying the cause of PE. Treatment is guided by the findings of the assessment. In acquired PE Primary cause should be treated first followed by medicines to increase the ejaculatory latency if there is no improvement after treating the primary condition.

The most common treatment methods available are behavioral therapies, selective serotonin reuptake inhibitors and local anesthetics. Treatment may vary depend upon the causes.  There are different techniques in behavioural therapy. These techniques by itself alone may not be effective. It gives the desired result only when done in a scientific and very systematic manner. Otherwise it is likely to fail and this is one of the reasons for criticism against the behavioral methods. Sex therapy based on the behavioural frame work is most effective treatment among the psychological methods provided if done very systematically under the guidance of an expert therapist.

Medical treatment includes different SSRIs and anaesthetic agents. Often its effect is temporary and limited to the period of treatment. On demand short acting drugs are also available. For certain patients these medicines are found to be very effective. Choice of drugs depends on the type of illness, its symptoms and needs of the patient. Long term systematic treatment with medicines gives better results. In certain cases a combination of medicines and sex therapy give the best results with long term or permanent cure.

Treatment of PE is done by a team of doctors including Sexologist, Andrologist, General Physician as per the need.

 Conclusion: Premature ejaculation has been recognized as a disorder with both psychogenic and organic etiologies. The cause of PE is often multi factorial in which any particular mode of treatment alone may not be effective and what is required is a combination of medication and sex therapy. Dr Promodus Institute of sexual & marital health offers effective treatment for premature ejaculation based on multidisciplinary perspective.