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Premature Ejaculation

Updated: Oct 19

Premature Ejaculation (PE) is a medical problem affecting men across all ages and background. It happens when a man ejaculates his semen sooner than wanted or as expected during intercourse. Usually this happens within 1 to 3 minutes of penetration (the average time for ejaculation is about 5+ minutes upon starting sex) but the more severe cases may not even last a minute before climaxing.

PE therefore is also known as rapid ejaculation, premature climax or early ejaculation. While not many men will want to talk about it to their doctors or seek active help, but it is gaining traction nowadays and more men are experiencing it. It is a misconception that only older males suffer from this sexual complaint as a sign of an aging prostate but on the contrary younger males suffer from it too.

As common as 1 in every 3 men from 18 to 59 years old have experienced PE during their lifetime. The increase in quality of life and the advent of modernization has probably played a role in causing this condition on the male body aggravated by a sedentary lifestyle. More often than not PE is a problem for men who have erection problems (erectile dysfunction or ED) and both conditions usually co-exist to a certain level. This is when men are not able to get hard or keep an erection that's firm enough for penetrative sex. Since an erection goes away after ejaculation, it can be tough to know if the problem is PE or ED in the first place. It is interesting to note that premature ejaculation may not even be a problem once the ED is treated. Therefore, ED should be treated first.


The main causes of PE are:

1. metabolic disorders and lifestyle factors

2. psychological factors or trauma

3. weakening of the pelvic floor muscles


The key though is to differentiate whether a PE is a physiologic or temporary PE as opposed to a pathologic or long-term PE. Most PEs are caused by many stressors in life from lifestyle factors such as overexertion, lack of sleep, dehydration, alcoholism, drugs and obesity to anxiety, depression, trauma and injury.

Whereas some may also be caused by psychological factors like traumatic early sexual experience and/or weakening of the male pelvic floor muscles in the course of our normal natural aging process. Inflammation of the surrounding organs in the male genitalia may also cause PE to a certain extent which may or may not be exacerbated by metabolic disorders.


Treatment:


1. Selective serotonin reuptake inhibitors (SSRIs)

Priligy is a treatment for premature ejaculation (PE) in men 18 to 64 years old. It contains the active ingredient dapoxetine and it is also known as a urological medicine. Priligy increases your time to ejaculation and can improve your control over ejaculation and reduce your distress over how fast you ejaculate. This may improve your satisfaction with sexual intercourse. However, it is not reccomended to take more than one tablet once every 24 hours due to the increased risk of fainting.


2. Phosphodiesterase-5 inhibitors.

Some medications used to treat erectile dysfunction also might help premature ejaculation.

They work by dilating the blood vesseles in the penile tissues hence improving erection. With an increased blood flow to the penile shaft, sensitivity reduces hence the orgasm threshold reduces too causing a delay in ejaculation. Although these drugs do not cure PE per say but they help by giving a good erection and when a good erection is attained, the chances of ejaculating earlier is reduced. These drugs include sildenafil (Viagra), tadalafil (Cialis, Adcirca), avanafil (Stendra) and vardenafil. Side effects might include headache, facial flushing and indigestion. These medications might be more effective when used in combination with an SSRI.

Drugs for PE can be taken each day or only before sex. Your health care provider will suggest when you should take a drug based on your activity level. The best time to take the drug is not clear. Most doctors suggest from 2 to 6 hours before sex. PE can return if you stop taking these drugs therefore most men with PE need to take these drugs on an ongoing or as required basis.


3. Numbing Creams or Sprays

Numbing creams and sprays may be put on the head of the penis about 20 to 30 minutes before sex. If you leave the numbing cream/spray on your penis for longer than suggested, your erection may go away. Also, the numbing cream/spray should not be left on the exposed penis during vaginal intercourse because it may cause vaginal numbness. Do remember to wash the cream off your penis 5 to 10 minutes before sex. Wearing a condom can also help dull the sensation especially around the penile head.


4. Pelvic floor exercises

The male perineal muscles are targeted during Kegel exercise. Weak pelvic floor muscles might make it harder to delay or hold ejaculation. Pelvic floor exercises (Kegel exercises) can help strengthen these muscles. These effects are further amplified with the use of the Emsella Chair.

To perform these exercises, one should find the right muscles. To find your pelvic floor muscles, stop urinating in midstream or tighten the muscles that keep you from passing gas. Both actions use your pelvic floor muscles. Once you've identified your pelvic floor muscles, you can exercise them in any position. However, you might find it easier to do them lying down at first.

Perfect your technique. Tighten your pelvic floor muscles, hold for three seconds and then relax for three seconds. Try it a few times in a row. When your muscles get stronger, try doing Kegel exercises while sitting, standing or walking.

Stay focused. For best results, focus on tightening only your pelvic floor muscles. Be careful not to flex the muscles in your abdomen, thighs or buttocks. Avoid holding your breath. Instead, breathe freely during the exercises.

Repeat three times a day. Aim to do at least three sets of 10 repetitions a day. For an easier treatment option, the Emsella kegel chair is a faster way of doing this by achieving up to 12000 kegels per session.