Premature ejaculation

Medically Reviewed by Dr Sravya, MBBS, MS

Introduction

Male sexual dysfunction that is quite common is premature ejaculation (PE). Although the exact incidence of the disorder is unidentified independent of age or race, it may affect as many as 20–30% of males.

Early ejaculation may affect a patient’s mental and emotional well-being as well as their interpersonal connections with spouses and/or partners. Despite this, there remains a therapeutic need unfulfilled since this aspect of male sexual wellness is typically disregarded.

As a result, physicians must first inquire about the patient’s sexual history. However, a thorough medical history, psychiatric history, and physical exam are frequently required to provide context for the PE and to examine possible causes of obtained PE.

Accurately managing the beginning of suitable therapy or altering ongoing treatment depends on having a clear knowledge of the patient’s expectations for therapeutic results. Establishing genuine therapy goals with the patient is the most effective way to do this.

Table of Contents

Solutions for Patient Management and Increase ejaculation time

1) Control of ejaculatory function by serotonin (5-HT)

2) Cognitive behavioural therapy

Increasing serotonin levels in synapses is the goal of pharmacological therapy.
SSRIs achieve this by raising serotonin levels at synapses, which increases postsynaptic neuronal transmission which causes increased ejaculatory time.
The first drug created especially for the prevention and treatment of premature ejaculation is dapoxetine. It is a short-acting, fast-acting SSRI that is legal in a large number of nations, including Australia, New Zealand, and several European Union nations.

3) Additional Proposed Pharmacological Management Solutions

There is evidence that tricyclic antidepressants (TCAs) can effectively cure Premature ejaculation.
The main medication used to treat Premature ejaculation in patients without a prescription is clomipramine.
To increase the patient's awareness of control over ejaculation, phosphodiesterase-5 inhibitors were also studied and used for the treatment of decreased ejaculatory time, however, their use as a pharmacological method.
The use of lidocaine-prilocaine ointment in 11 well-being-married males having decreased ejaculation but no erectile issues was the subject of an open-ended test, unblinded trial. The patients were told to use 2.5 g of the ointment and cover their penis using a condom 30 minutes earlier engaging in sexual activity. After every application, patients were allowed to provide feedback on the ointment effect on their ejaculation.
In people who have premature ejaculation, fluoxetine in combination with sildenafil appears to significantly increase ejaculatory time and intercourse pleasure compared to fluoxetine alone.

4) Psychological and Psychosexual Therapy

Another type of therapy that may help a patient with PE is psychological counseling.
Additional psychological and social reasons for decreased ejaculation can be identified and examined with the help of the doctor in this type of care.
The stress produced by PE may be significantly reduced with psychological therapy. The information, still, is varied and short on long-term monitoring for psychological methods of early ejaculation therapy.
As additional PE treatments, psychosexual behavioral techniques have also been applied. Patients who select this course of treatment will learn how to increase ejaculation.
In this method, which is also referred to as "edging," sexual activity starts and develops to a stage that is close to peak or ejaculation. All sexual stimulation needs to stop at this moment until the emotion fades so that sexual activity may continue.
The 'squeeze' approach is another method that has been reported. This method advances sexual activity to the point of almost euphoric ejaculation. The penis is now taken out of the vagina, and the glans of the penis are pinched.
Masturbating before expected intercourse is another typical technique employed by younger boys to postpone ejaculation.

5) Counseling for premature ejaculation

To determine the outcomes of applying counseling for early ejaculation with a coaching mobile app that provides therapeutic activities on the patient's smartphone.
The mobile coaching programme helps users complete two physical exercises and two mental distance activities during 10-minute training sessions.
Users must perform the four exercises alternately throughout every training session: the physical task comes first, followed by a mental-distancing activity, a second physical exercise, as well as a third mental-distancing exercise
The first physical activity in a training session has the user contract and release his abdominal muscles 10 times in around two minutes. The programme directs the user in performing the exercise correctly by providing vocal directions through a voice-over and using an animated, three-dimensional "avatar" to show the user what to do.
To complete the second exercise in the session, the user must continually slide their fingertip over the smartphone touch screen and delete seven different sex-related self-esteem statements for seven days.
The third exercise within the set demands the user to ten times in around three minutes, contract and release his gluteus muscles.
The preceding mental-distancing exercise is repeated in the fourth and last exercise of the session.
The user is advised after this exercise how many sessions he still has to do to attain 3 sessions each day.
The programme records private use information and transfers it to a safe remote server where it is stored and will later be analyzed.
The programme records the beginning and ending times of each exercise as well as the beginning and ending times of any subsequent pausing, restarting, and halting actions taken by users.

Causes of premature ejaculation

Several sexual dysfunction conditions have been linked to hormonal imbalances. For this reason, although it has not yet been fully explained, it has been found that hyperthyroidism correlates with premature ejaculation. To determine the best course of therapy for people with PE, healthcare providers must consider any potential underlying disorders as PE is one of the most often self-reported sexual dysfunctions.
Sex steroid hormones, pituitary hormones, and thyroid hormones have all been suggested as possible possibilities in the control of the ejaculatory process, but the specific mechanisms are still unclear, requiring more research to find viable therapy targets.

Conclusion

In conclusion, early ejaculation is a frequent sexual disorder that can have a considerably negative effect on a person’s quality of life and personal relationships. It is characterized by an inability to regulate ejaculation, which causes it to occur during sexual activity earlier than planned. There are a variety of psychological and physical causes for this illness.

While early ejaculation can be unpleasant and frustrating, it’s vital to remember that there are effective management and coping mechanisms for this problem. In addition to counseling and therapy, behavioral strategies like the squeeze technique can assist people improve their ejaculatory control and handle any underlying psychological issues like performance anxiety.

Medical therapies, such as topical anesthetics, oral drugs, and even off-label usage of some antidepressants, can be administered by healthcare practitioners to postpone ejaculation and enhance sexual pleasure in situations where psychological measures are insufficient.