General description:


Premature ejaculation (PE) means ‘coming too quickly’ is also known as early discharge or quick discharge, early fall, rapid ejaculation, rapid climax, premature climax, or early ejaculation) affects 25%-40% of the men.

Premature ejaculation occurs when a man ejaculates sooner during sexual intercourse than he or his partner would like. Premature ejaculation is a common sexual complaint. Estimates vary, but as many as 1 out of 3 men say they experience this problem at some time.

As long as it happens infrequently, it's not cause for concern. However, you might be diagnosed with premature ejaculation if you:
  • Always or nearly always ejaculate within one minute of penetration
  • Are unable to delay ejaculation during intercourse all or nearly all of the time
  • Feel distressed and frustrated, and tend to avoid sexual intimacy as a result

Both psychological and biological factors can play a role in premature ejaculation. Although many men feel embarrassed talking about it, premature ejaculation is a common and treatable condition. Medications, counselling and sexual techniques that delay ejaculation — or a combination of these — can help improve sex for you and your partner

Recently, a survey done of several thousand males, shows that 50 per cent of them ‘often’ or ‘sometimes’ had this worry. It’s common in younger men.

However, various surveys showed that many middle-aged men still have this problem.

This problem makes people unhappy and frustrated and in severe cases PE can threaten or even ruin a marriage – simply because it spoils the sex lives of both partners. Sometimes, the condition is so bad that the man cannot even manage to have intercourse because he invariably ejaculates before he can get into the vagina. This can be devastating for a man’s self-confidence. And it can be hugely frustrating and annoying for his partner, too especially if she wants to get pregnant. One of the majorcontributorstowards this problem is wrong or misuse of sex practices during early days. Anxiety too plays a part in many cases of PE.

However, various surveys have shown that many men do not report premature ejaculation to their physician, possibly because of embarrassment or a feeling that no treatment is available for the problem.

Premature ejaculation may alter self-esteem, may cause marital dysfunction/divorce, and may be a factor in depression, with its obvious consequences. This is a very frustrating disorders of male sexual function in which man feels totally helpless. This leads to bitterness in husbands & wife relationships. His pleasure is often decreased by the abrupt early discharge.

When a man is, ejaculating fast, the woman will probably be left unsatisfied. Her frustration will only increase the negative pattern. As he concentrates on controlling his ejaculation, this concentration may begin to get in the way of maintaining the erection. This then can bring about the loss of erection. After some time this may even completely inhibit the erection from occurring. Often a problem that might begin with premature ejaculation gets joined to a problem of impotence, and then both issue have to be dealt with.

After a time the couple will begin to withdraw from each other, not wanting to enter an experience that is going to end up frustrating them. The man doubts his masculinity, and the wife later experiences a lessening of confidence in her, along with anger toward her partner. To clarify, a male may reach climax after 8 / 10 minutes of sexual intercourse, but this is not premature ejaculation if his partner regularly climaxes in 5 minutes and both are satisfied with the timing.

Another male might delay his ejaculation for a maximum of 15 minutes, yet he may consider this premature if his partner, even with foreplay, requires 20 minutes of stimulation before reaching climax.

The organ systems directly affected by premature ejaculation include the male reproductive tract (i.e., penis, prostate, seminal vesicles, testicles, and their appendages), the portions of the central and peripheral nervous system controlling the male reproductive tract.

If the premature ejaculation occurs so early that it happens before commencement of sexual intercourse and the couple is attempting pregnancy, then pregnancy is impossible to achieve unless artificial insemination is used.

The genes of a male who ejaculates rapidly (but not so rapidly that ejaculation occurs before intromission) would be more likely to be passed on to succeeding generations.

Premature ejaculation is of two types:

Primary premature ejaculation: -

Primary premature ejaculation applies to individuals who have had the condition since they became capable of functioning sexually.

Secondary premature ejaculation

means that the condition began in an individual who previously experienced an acceptable level of ejaculatory control and for unknown reasons; he began experiencing premature ejaculation later in life.

If the patient has ED (erectile dysfunction) that began after the premature ejaculation, then treatment of both conditions may be required.

With regard to premature ejaculation, some type of performance anxiety is often a major factor. Performance pressure (ie, fear of failure to satisfy the partner) can arise from various events. ED (erectile dysfunction) is a common precipitating event. If the male is afraid his erection will not last, because of either actual occurrences of previous ED or made-up failure of his erection, this may precipitate premature ejaculation

Science of mechanism of ejaculation:


The physical process of ejaculation requires two sequential actions: emission and expulsion. The emission phase is the first phase. It involves deposition of seminal fluid from the ampullary vas deferens, seminal vesicles, and prostate gland into the posterior urethra. The second phase is the expulsion phase. It involves closure of bladder neck, followed by the rhythmic contractions of theurethra by pelvic-perineal and bulbospongiosus muscle, and intermittent relaxation of external urethral sphincters. Sympathetic motor neurons control the emission phase of ejaculation reflex, and expulsion phase is executed by somatic and autonomic motor neurons. These motor neurons are located in the thoracolumbar and lumbosacral spinal cord.

Causes of Premature Ejaculation:

The exact cause of premature ejaculation isn't known. While it was once thought to be only psychological, doctors now know premature ejaculation involves a complex interaction of psychological and biological factors.

Psychological causes

Psychological factors that might play a role include:

  • Early sexual experiences
  • Sexual abuse
  • Poor body image
  • Depression
  • Worrying about premature ejaculation
  • Guilty feelings that increase your tendency to rush through sexual encounters

Other factors that can play a role include:

  • Erectile dysfunction. Men who are anxious about obtaining or maintaining an erection during sexual intercourse might form a pattern of rushing to ejaculate, which can be difficult to change.
  • Anxiety. Many men with premature ejaculation also have problems with anxiety — either specifically about sexual performance or related to other issues.
  • Relationship problems. If you have had satisfying sexual relationships with other partners in which premature ejaculation happened infrequently or not at all, it's possible that interpersonal issues between you and your current partner are contributing to the problem.

Biological causes

A number of biological factors might contribute to premature ejaculation, including:
  • Abnormal hormone levels
  • Abnormal levels of brain chemicals called neurotransmitters
  • Inflammation and infection of the prostate or urethra
  • Inherited traits
  • Hormone disorder.
  • Urogenital Infections.
  • Neurogenic causes.
  • Increased penile sensitivity to touch.
  • Sex Centre disorder i.e. hyper excitability of sex centre.
  • Psychogenic i.e. psychiatric illness

Risk factors

Various factors can increase your risk of premature ejaculation, including:
  • Erectile dysfunction. You might be at increased risk of premature ejaculation if you occasionally or consistently have trouble getting or maintaining an erection. Fear of losing your erection might cause you to consciously or unconsciously hurry through sexual encounters.
  • Stress. Emotional or mental strain in any area of your life can play a role in premature ejaculation, limiting your ability to relax and focus during sexual encounters.

Complications

Premature ejaculation can cause problems in your personal life, including:
  • Stress and relationship problems. A common complication of premature ejaculation is relationship stress.
  • Fertility problems. Premature ejaculation can occasionally make fertilization difficult for couples who are trying to have a baby if ejaculation doesn't occur intravaginally.

We take detail history:

Detailed general & systemic examination.
Investigation & Diagnostic tests.
Complete Male Hormone Profile tests.
Biochemistry tests.
Urine is tested for pus cells.
Scrotum, epididydmus, prostate is examined for infection.
Semen is examined for pus & semen culture sensitivity.
Ultrasonography of scrotum & prostate may be required.

Treatment


Common treatment options for premature ejaculation include behavioural techniques, topical anaesthetics, medications and counselling. Keep in mind that it might take time to find the treatment or combination of treatments that will work for you. Behavioural treatment plus drug therapy might be the most effective course.