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Premature Ejaculation

Ejaculation is a male reflex consisting of several steps. The process begins with erotic or sexual stimulation and a limited amount of penile friction. A message then travels from the penis to the spinal cord and then to the brain. The brain, in turn, signals part of the body's nervous system, causing a contraction of the male sexual organs. These include the prostate, seminal vesicles and bladder neck. This results in semen being released and deposited into the back of the urine passage (urethra).

Ejaculation, as we know it, then occurs when this fluid is propelled out of the penis due to the contraction of deep pelvic muscles. An accompanying pleasurable sensation referred to as orgasm normally occurs with ejaculation. Ejaculate volume is usually between one half and one teaspoon and the interval between initial vaginal penetration and ejaculation is normally between two and ten minutes.

The most common ejaculatory disorder is known as premature or rapid ejaculation. While the definition varies, it is usually thought of as an interval of less than two minutes. In extreme cases, ejaculation can occur even before penetration. Unfortunately, many men (and women too) have learned about ejaculatory "standards" from pornographic movies in which there appear to be extraordinarily sustained erections and ejaculations that appear to constitute "quarts" of fluid. This can result in expectations which are unrealistic.

A typical case might be a young male who comes in for evaluation at the suggestion of his wife or sexual partner. He describes rapid ejaculation and states that his partner is reluctant to have intercourse with him because of this problem. History reveals that he ejaculates shortly after or even before penetration, leaving his partner sexually unsatisfied and later reluctant to have intercourse. This can create an atmosphere of hostility, which then exacerbates the problem.

In addition to listening carefully to this history, it is important to examine the individual's genital organs and prostate gland to exclude an infectious or other local cause for this problem. A screening for testosterone level should also be obtained to assure that there is no deficiency.

Various methods have been used to address premature ejaculation. These have included using thick condoms, topical anesthetic creams, penile injections to prolong erection, and sex-therapist recommended behavioral modification techniques. While each of these methods can be effective, couples often find them frustrating and abandon them.

The popularity of the selective serotonin reuptake inhibitors (SSRI's) Paroxetine and Sertraline for the treatment of depression has created a simpler way of dealing with the problem. Many men taking these drugs for depression have noted delay before ejaculating. By taking these drugs and certain others in daily small doses the time between vaginal penetration and ejaculation can be delayed without other side effects. These medications are not as effective when just taken prior to intercourse. Efforts are in progress to develop therapy which could be used only prior to sexual relations or "on demand".

Currently the SSRI's and other related drugs are not approved for this indication and their usage for this purpose should be carefully explained before prescribing them. Often after a period of time, the problem lessens whereupon the medication can be reduced or even discontinued.

Treating Premature Ejaculation
Male Care Center - (303) 571-1355
David Sobel, MD.
David Sobel, MD.
David Sobel, MD.
Erectile Dysfunction
Erectile Dysfunction
Low Testosterone
Low Testosterone
Penile Curvature/Peyronie’s Disease
Penile Curvature/Peyronie’s Disease
Premature Ejaculation
Premature Ejaculation
Benign Prostatic Hypertrophy (BPH)
Benign Prostatic Hyperplasia (BPH)
 

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