“Communication is to relationships what breath is to life” – Virginia Satir

Premature Ejaculation

The definition for premature ejaculation has been debated over the years but many experts in the field currently rely on the International Society of Sexual Medicine (ISSM) definition which identifies the following criteria:

• Ejaculation which occurs always or nearly always before or within one minute of vaginal penetration.
• Failure to delay ejaculation during nearly all episodes of vaginal penetration.
• Personal distress, bother, frustration and/or the avoidance of sexual encounters.

Premature ejaculation may be classified as ‘lifelong’ (primary) or ‘acquired’ (secondary):

• Lifelong premature ejaculation is characterised by onset from the first sexual experience and remains a problem during life.
• Acquired premature ejaculation is characterised by a gradual or sudden onset with ejaculation being normal before onset of the problem. Time to ejaculation is short but not usually as fast as in lifelong premature ejaculation.

The ISSM definition only applies to men with lifelong premature ejaculation who have vaginal intercourse. The prevalence of premature ejaculation varies according to definition and is difficult to assess in view of many men not wanting to seek help or even discuss the problem. The EAU reports a prevalence of 20-30%.

Risk factors:
• Premature ejaculation may be anxiety-related. It is therefore more common in young men and early in a relationship.
• Amphetamines, cocaine and dopaminergic drugs may cause PE. Although effective for the treatment of premature ejaculation in some men, sildenafil may also be a cause of premature ejaculation in others.
• Some men affected by PE reported a short frenulum. A frenulectomy can be effective in relieving the problem and a short frenulum should be excluded as a cause of PE.
• Urological causes – e.g., prostatitis.
• Neurological causes – e.g., multiple sclerosis

Treatment:

Treatment should be tailored to the needs of the individual. The condition may be more of an issue in some relationships than others. Psychosexual, psychotherapeutic and relationship therapy may be sufficient.

Medication for PE:

• Selective serotonin reuptake inhibitor (SSRI) antidepressants are the most commonly used (off-label use) but need to be taken daily for 12 weeks before the maximum effect is achieved. Paroxetine, Clomipramine, Sertraline and Fluoxetine have all been shown to be effective.
• Sildenafil (Viagra) is an effective alternative, especially in older men and when associated with erectile dysfunction. Studies suggest that it improves intravaginal latency times, reduces performance anxiety and improves sexual satisfaction.

How to manage Premature Ejaculation:

• More frequent sex (or masturbation): premature ejaculation is more likely if there is a longer gap between sexual intercourse.
• Using a condom to decrease sensation.
• Using a cream with a numbing (anaesthetic) effect might help. It usually does not affect the sensation of the partner and does not decrease the intensity of the man’s orgasm.
• Sex with the woman on top reduces the likelihood of premature ejaculation.
• Squeeze and stop-start techniques: stimulating the penis almost to the point of ejaculation and then stopping. These techniques are often effective but may take a few months to produce any benefit and relapse is common.
• Behavioural treatments are useful for secondary premature ejaculation but are not recommended first-line for lifelong premature ejaculation. They are time-intensive and require commitment from the partner.

Premature ejaculation may have a significant adverse effect on both self-confidence and the relationship. It can lead to sexual dissatisfaction, a feeling that something is missing from the relationship and an impaired sense of intimacy. If the condition remains untreated it can lead to increased irritability, relationship difficulties and to a lack of sexual and emotional intimacy.

Elmari specialises in the following:
  • Sexology
  • Individual Psychotherapy
  • Clinical Hypnotherapy
  • Sex therapy
  • Couples Therapy
  • Relationship/Marital Enrichment
  • Pre-marital Counselling
  • Conflict Resolution and Effective Communication Skills
  • Divorce Counselling
  • Trauma Counselling

 
The diagnoses and treatment of male and female sexual dysfunction, eg
  • Loss of sexual desire
  • Libido differences
  • Sexual Pain Disorders:
    Vaginismus,
    Dyspareunia,
    Vulvadinia ext
  • Inability to reach orgasm
  • Erectile dysfunction
  • Ejaculation control and timing
  • Sexual behaviour disorders
  • General Sexual Problems
  • Sexual Enrichment
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