Ejaculation - issues and Solutions

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Of the two major commonly reported cases of male sexual dysfunction, erectile dysfunction accounts for about 10% while premature ejaculation is reported to account for some 80 percent. Some statistics indicate that one in three men suffer from premature ejaculation indicating a prevalence rate of between 27 percent and 34 percent in men of all ages.

According to The American Psychiatric Association, premature ejaculation is defined as the "persistent or recurrent ejaculation with minimum sexual stimulation before, on or shortly after penetration and before the person wishes it..." Simply stated, PE is a condition where a man frequently ejaculates earlier than he or his partner wishes to either before, on or shortly after copulating with his partner. Premature ejaculation is also known as rapid ejaculation.

Premature ejaculation causes marked distress or interpersonal difficulty for a man and his partner as it allows neither partner to enjoy the sexual act in a proper manner. The man feels dissatisfaction because of the inability to hold out the pleasurable sensations of sexual contact for a longer period of time while his partner is equally dissatisfied for not being able to reach her sexual peak.

It is also common for men that are experiencing PE to question their masculinity and lose confidence in their sexual performance. They may feel misunderstood as to the extent of frustration and humiliation they regularly experience while a partner may suffer in silence for fear of upsetting their man further or become frustrated at their partner's seeming unwillingness to fix the problem.

However, many men occasionally experience premature ejaculation during sexual intercourse, but as long as it does not happen frequently, there is no cause for the man to worry. The time period that qualifies for PE has however become a highly debatable topic owing to the fact that men ejaculate at different times during different sexual encounters. Scientists and researchers now define premature ejaculation as a condition in which the man achieves orgasm in about 120 seconds or 2 minutes after vaginal penetration. Others specify the number of penile thrusts, considering less than 8 to 15 thrusts prior to ejaculation to be premature. With that said, if this should occur on a more regular basis, then he may be suffering from PE.

Causes of Premature Ejaculation (PE)

The causes of premature ejaculation are still unknown. There were earlier beliefs that PE was as a result of psychological issues rather than biological causes. However there are new indications that the causes of PE are more complicated, and involve a complex interaction of both psychological and biological factors.

There are basically two types of PE which are the primary and secondary types. Primary premature ejaculation is a condition where the man has been suffering from premature ejaculation throughout his entire sexual life. On the other hand, secondary premature ejaculation is where the man develops premature ejaculation later in life due to one or several possible causes. The majority of men suffering from premature ejaculation fall into the secondary category.

Ejaculation is a reflex action that is triggered when a certain level of stimulation is attained. Therefore the ability to control this reflex action depends mostly on the capability of the man to recognise and regulate the amount of stimulation he is receiving so that he does not reach the point of triggering off his ejaculatory reflexes before he wants to.

Premature ejaculation can have both psychological and biological causes as hereunder listed.

Psychological Causes

Some of the psychological causes of premature ejaculation include the following:

Early Sexual Experiences

Though PE is a problem that occurs in men of all ages, younger men are more prone to suffering from this disorder. A reason for this might be as a result of established patterns of events that occurred in their earlier sexual experiences. A lot of first experiences of sexual intercourse often involve excitement mixed anxiety and a demand to perform quickly to avoid being caught.

In such first experiences, performance - the desire to "get it right", is often the focus rather than the pleasurable and erotic aspect of the experience. As a result, a good percentage of young men reach orgasm too quickly. This might be considered a problem by such young men, and next time there might be fear of a repeat which increases the chances of a premature ejaculation happening and thus a pattern is formed. This might continue well into adulthood if not treatment is undertaken.

Anxiety and Stress

Anxiety related to a man's sexual performance or caused by other issues can also be a cause for premature ejaculation. When sex is linked with performance rather than with pleasure, developing ejaculatory control might become a difficult proposition. It is therefore better for a man to focus on what will bring pleasure to him and his partner.



Erectile Dysfunction Fears

Men suffering from erectile dysfunction could also develop premature ejaculation as they may be anxious of obtaining and maintaining an erection during sexual intercourse and thus rushing to ejaculate quickly. Once a pattern of rushing to ejaculate is formed, it may become difficult changing it.

Biological causes

The biological factors that may contribute to premature ejaculation include the following: -

1. Abnormal hormone levels

2. Insufficient concentration of the neurotransmitter serotonin

3. Abnormal reflex activity of the ejaculatory system

4. Certain thyroid problems

5. Inflammation and infection of the prostate or urethra

6. Inherited traits

Treatment of premature ejaculation

Despite the fact that premature ejaculation exists as a clinical diagnosis, it cannot be classified as a disease or an illness.

Irrespectively of whether the cause is psychological or biological, treatments for premature ejaculation include behavioural therapy, psychological counselling, and medications. There could also be a combination of any of these methods of treatment.



Behavioural Therapy

Behavioural therapy helps about 60% to 90% of men with premature ejaculation. In general, practice and relaxation will help in dealing with the problem. However it should be noted that premature ejaculation often returns and additional behavioural therapy may be needed.

Below are some examples of behavioural therapy methods that can be used for the treatment of premature ejaculation.

The "Squeeze" Technique

This method was developed by Masters and Johnson some decades ago. If a man senses that he is about to ejaculate, he simply withdraws from his partner, then him or his partner squeezes the shaft of his penis between a thumb and two fingers. The squeeze should be light and for about 20 seconds, then let go and resume sexual activity. The technique is repeated as often as necessary during intercourse. With practice, a man can gain good control over ejaculation without the squeeze.

The "Stop and Start" Method

This second method which was developed by Dr. Helen Kaplan helps men with premature ejaculation to recognize when they are about to climax and then to slow down or reduce stimulation in order to extend the time until ejaculation. By starting and stopping sexual stimulation you can learn to prolong the sex act.

Abstaining from Intercourse

Couples may be instructed to avoid sexual relations for a period of time to help reduce anxiety. This is beneficial as while avoiding intercourse they can spend time to focus on other types of sexual plays that eliminate pressure from the sexual encounters. This can help the man to connect and re-establish a satisfying physical bond with his partner.

More Foreplay

By engaging in more foreplay, couples can help each other achieve a state of high arousal by stimulating each other through kissing, cuddling, hugging, petting, stimulating the breasts, genitals, and other erogenous zones before copulating. This way, ejaculation and orgasm can be achieved almost at the same time by the couples.

Masturbation

In some cases, behavioural therapy may involve simple steps such as masturbating an hour or two before intercourse to help in the delay of ejaculation or stimulation of the partner to a state of arousal before copulating. Also since an ejaculation has already occurred, the man will now take a longer time to ejaculate when having sex with his partner.

Routine Kegel Exercises

Researchers have noted that some men who suffer from premature ejaculation have a faster neurological response in the pelvic muscles. Men with premature ejaculation caused by neurological factors can undertake certain exercises like Kegel to help them gain voluntary control over the PC muscle and thus give them more control over ejaculation. The added benefit of this is that it can also give men stronger erections and can therefore help to alleviate erectile dysfunction.

Counselling or Psychotherapy

This can help patients and their partners resolve conflicts and personal issues that might include anxiety, stress and resentment that can be contributing to premature ejaculation. In most cases this is more effective when couples attend sessions together.

Current approaches to psychotherapy enables men amongst other things to learn techniques to control and/or delay ejaculation, increase confidence in sexual performance, reduce performance anxiety, modify rigid sexual patterns, overcome intimacy issues, resolve feelings and thoughts that interfere with sexual functions and to increase communication between him and his partner.

Medications

There are two classes of medications that can be used in the treatment of premature ejaculation and these include the use of (a) certain antidepressants and (b) topical anaesthetic creams.

Antidepressant Drugs

The 1990s ushered in a new era in the treatment of premature ejaculation when physicians discovered certain antidepressant drugs that had a side effect of delaying ejaculation. This type of medication can be helpful as they have a common side effect of prolonging the time it takes to achieve orgasm.

However, antidepressants are not approved by the Food and Drug Administration (FDA) to treat premature ejaculation. Nonetheless, studies have shown that they are safe and effective. These medications include selective serotonin reuptake inhibitors (SSRIs) such as fluoxetine (Prozac), paroxetine (Paxil) or sertraline (Zoloft); and tricyclic antidepressants, such as clomipramine (Anafranil).

Topical Anaesthetics/Desensitizing Creams

Local anaesthetic creams may be applied to the penis to decrease stimulation. The decreased feeling in the penis may help in prolonging the time before ejaculation.

Topical creams are applied to the glans penis 10-30 minutes before intercourse and a condom is often used to enhance absorption. The condom can either be removed before intercourse or used during intercourse. Either method prevents possible genital numbness in the partner. Topical anaesthetics include the combination product lidocaine-prilocaine (EMLA) and an herbal Korean product (SS Cream).

To determine whether one is suffering from premature ejaculation, it is important to ask whether you or your partner's expectations about stamina are realistic considering the fact that the average time from insertion to ejaculation is less than three minutes. Also it would be helpful to note that female orgasm doesn't occur automatically as a result of prolonged intercourse. Equally of note is the fact that majority of women find it easier achieving orgasm through manual or oral stimulation than through intercourse.

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