Premature ejaculation
Encyclopedia
Premature ejaculation is a condition in which a man ejaculates earlier than he or his partner would like him to. Premature ejaculation is also known as rapid ejaculation, rapid climax, premature climax, or early ejaculation.
Masters and Johnson
Masters and Johnson
The Masters and Johnson research team, composed of William H. Masters and Virginia E. Johnson, pioneered research into the nature of human sexual response and the diagnosis and treatment of sexual disorders and dysfunctions from 1957 until the 1990s....

 defines PE as the condition in which a man ejaculates before his sex partner achieves orgasm
Orgasm
Orgasm is the peak of the plateau phase of the sexual response cycle, characterized by an intense sensation of pleasure...

, in more than fifty percent of their sexual encounters. Other sex researchers have defined premature ejaculation as occurring if the man ejaculates within two minutes of penetration
Sexual penetration
Sexual penetration is a sexual activity that involves the entry into a bodily orifice, such as the vagina, anus or mouth, with a body part or an object....

; however, a survey by Alfred Kinsey
Alfred Kinsey
Alfred Charles Kinsey was an American biologist and professor of entomology and zoology, who in 1947 founded the Institute for Sex Research at Indiana University, now known as the Kinsey Institute for Research in Sex, Gender, and Reproduction, as well as producing the Kinsey Reports and the Kinsey...

 in the 1950s demonstrated that three quarters of men ejaculate within two minutes of penetration in over half of their sexual encounters.

Most men experience premature ejaculation at least once in their lives. Because there is great variability in both how long it takes men to ejaculate and how long both partners want sex to last, researchers have begun to form a quantitative definition of premature ejaculation. Current evidence supports an average intravaginal ejaculation latency time
Intravaginal ejaculation latency time
Intravaginal ejaculation latency time is defined as the time between the start of vaginal intromission and the start of intravaginal ejaculation. IELT can help evaluate sexual effects of medications such as selective serotonin reuptake inhibitors . IELT is one factor used to diagnose and treat...

 (IELT) of six and a half minutes in 18-30 year olds. If the disorder is defined as an IELT percentile below 2.5, then premature ejaculation could be suggested by an IELT of less than about 2 minutes. Nevertheless, it is well accepted that men with IELTs below 1.5 minutes could be "happy" with their performance and do not report a lack of control and therefore would not be defined as having PE. On the other hand, a man with 2 minutes IELT may have the perception of poor control over his ejaculation, distressed about his condition, has interpersonal difficulties and therefore be diagnosed with Premature Ejaculation. Over 72% of teenage males (in sexual relations) ejaculate prematurely.

Possible psychological and environmental factors

Psychological factors commonly contribute to premature ejaculation. While men sometimes underestimate the relationship between sexual performance and emotional well-being, premature ejaculation can be caused by temporary depression
Clinical depression
Major depressive disorder is a mental disorder characterized by an all-encompassing low mood accompanied by low self-esteem, and by loss of interest or pleasure in normally enjoyable activities...

, stress over financial matters, unrealistic expectations about performance, a history of sexual repression, or an overall lack of confidence. Interpersonal dynamics strongly contribute to sexual function, and premature ejaculation can be caused by a lack of communication between partners, hurt feelings, or unresolved conflicts that interfere with the ability to achieve emotion
Emotion
Emotion is a complex psychophysiological experience of an individual's state of mind as interacting with biochemical and environmental influences. In humans, emotion fundamentally involves "physiological arousal, expressive behaviors, and conscious experience." Emotion is associated with mood,...

al intimacy. Neurological premature ejaculation can also lead to other forms of sexual dysfunction
Sexual dysfunction
Sexual dysfunction or sexual malfunction refers to a difficulty experienced by an individual or a couple during any stage of a normal sexual activity, including desire, arousal or orgasm....

, or intensify the existing problem, by creating performance anxiety. In a less pathological context, premature ejaculation could also be caused simply by extreme arousal.

One study of young married couples (Tullberg, 1999) reported that the husband's IELT seems to be affected by the phases of the wife's menstrual cycle
Menstrual cycle
The menstrual cycle is the scientific term for the physiological changes that can occur in fertile women for the purpose of sexual reproduction. This article focuses on the human menstrual cycle....

, the IELT tending to be shortest during the fertile phase
Ovulation
Ovulation is the process in a female's menstrual cycle by which a mature ovarian follicle ruptures and discharges an ovum . Ovulation also occurs in the estrous cycle of other female mammals, which differs in many fundamental ways from the menstrual cycle...

. Other studies suggest that young men with older female partners reach the ejaculatory threshold sooner, on average, than those whose partners are their own age or younger .

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
Ampulla of ductus deferens
At the fundus of the bladder the ductus deferens of some mammalian species becomes enlarged and sometimes tortuous. This portion is termed the ampulla....

 vas deferens
Vas deferens
The vas deferens , also called ductus deferens, , is part of the male anatomy of many vertebrates; they transport sperm from the epididymis in anticipation of ejaculation....

, seminal vesicle
Seminal vesicle
The seminal vesicles or vesicular glands are a pair of simple tubular glands posteroinferior to the urinary bladder of male mammals...

s, and prostate gland into the posterior urethra
Urethra
In anatomy, the urethra is a tube that connects the urinary bladder to the genitals for the removal of fluids out of the body. In males, the urethra travels through the penis, and carries semen as well as urine...

. The second phase is the expulsion phase. It involves closure of bladder neck, followed by the rhythmic contractions of the urethra
Urethra
In anatomy, the urethra is a tube that connects the urinary bladder to the genitals for the removal of fluids out of the body. In males, the urethra travels through the penis, and carries semen as well as urine...

 by pelvic-perineal and bulbospongiosus muscle
Bulbospongiosus muscle
Bulbospongiosus is one of the superficial muscles of the perineum. It has a slightly different origin, insertion and function in males and females. In males, it covers the bulb of the penis...

, and intermittent relaxation of external urethral sphincter
Urethral sphincter
The term urethral sphincter refers to one of two muscles used to control the exit of urine in the urinary bladder through the urethra. The two muscles are the external urethral sphincter and the internal urethral sphincter...

s.

It is believed that the neurotransmitter
Neurotransmitter
Neurotransmitters are endogenous chemicals that transmit signals from a neuron to a target cell across a synapse. Neurotransmitters are packaged into synaptic vesicles clustered beneath the membrane on the presynaptic side of a synapse, and are released into the synaptic cleft, where they bind to...

 serotonin
Serotonin
Serotonin or 5-hydroxytryptamine is a monoamine neurotransmitter. Biochemically derived from tryptophan, serotonin is primarily found in the gastrointestinal tract, platelets, and in the central nervous system of animals including humans...

 (5HT) plays a central role in modulating ejaculation. Several animal studies have demonstrated its inhibitory effect on ejaculation. Therefore, it is perceived that low level of serotonin in the synaptic cleft in these specific areas in the brain could cause premature ejaculation. This theory is further supported by the proven effectiveness of selective serotonin reuptake inhibitors (SSRIs), which increase serotonin level in the synapse, in treating Premature Ejaculation.

Sympathetic motor neurons control the emission phase of ejaculation
Ejaculation
Ejaculation is the ejecting of semen from the male reproductory tract, and is usually accompanied by orgasm. It is usually the final stage and natural objective of male sexual stimulation, and an essential component of natural conception. In rare cases ejaculation occurs because of prostatic disease...

 reflex, and expulsion phase is executed by somatic and autonomic motor neurons. These motor neurons are located in the thoracolumbar and lumbosacral spinal cord
Spinal cord
The spinal cord is a long, thin, tubular bundle of nervous tissue and support cells that extends from the brain . The brain and spinal cord together make up the central nervous system...

 and are activated in a coordinated manner when sufficient sensory input to reach the ejaculatory threshold has entered the central nervous system
Central nervous system
The central nervous system is the part of the nervous system that integrates the information that it receives from, and coordinates the activity of, all parts of the bodies of bilaterian animals—that is, all multicellular animals except sponges and radially symmetric animals such as jellyfish...

.

Several areas in the brain, and especially the nucleus paragigantocellularis, have been identified to be involved in ejaculatory control. Scientists have long suspected a genetic
Genetics
Genetics , a discipline of biology, is the science of genes, heredity, and variation in living organisms....

 link to certain forms of premature ejaculation. In one study, ninety-one percent of men who have had premature ejaculation for their entire lives also had a first-relative with lifelong premature ejaculation. Other researchers have noted that men who have premature ejaculation have a faster neurological response in the pelvic muscles. Simple exercises commonly suggested by sex therapists can significantly improve ejaculatory control for men with premature ejaculation caused by neurological factors. Often, these men may benefit from anti-anxiety
Anxiety
Anxiety is a psychological and physiological state characterized by somatic, emotional, cognitive, and behavioral components. The root meaning of the word anxiety is 'to vex or trouble'; in either presence or absence of psychological stress, anxiety can create feelings of fear, worry, uneasiness,...

 medication or SSRIs, such as sertraline
Sertraline
Sertraline hydrochloride is an antidepressant of the selective serotonin reuptake inhibitor class. It was introduced to the market by Pfizer in 1991. Sertraline is primarily used to treat major depression in adult outpatients as well as obsessive–compulsive, panic, and social anxiety disorders in...

 or paroxetine
Paroxetine
Paroxetine is an SSRI antidepressant. Marketing of the drug began in 1992 by the pharmaceutical company SmithKline Beecham, now GlaxoSmithKline...

, as these slow down ejaculation times http://www.healthfinder.gov/newsletters/relation092506.asp. Some men prefer using anaesthetic creams; however, these creams may also deaden sensations in the man's partner, and are not generally recommended by sex therapists.

Differential diagnosis

Premature ejaculation should be distinguished from erectile dysfunction related to the development of a general medical condition. Some individuals with erectile dysfunction may omit their usual strategies for delaying orgasm. Others require prolonged noncoital stimulation to develop a degree of erection sufficient for intromission. In such individuals, sexual arousal
Sexual arousal
Sexual arousal, or sexual excitement, is the arousal of sexual desire, during or in anticipation of sexual activity. Things that precipitate human sexual arousal are called erotic stimuli, or colloquially known as turn-ons. There are many potential stimuli, both physical or mental, which can cause...

 may be so high that ejaculation occurs immediately. Occasional problems with premature ejaculation that are not persistent or recurrent or are not accompanied by marked distress or interpersonal difficulty do not qualify for the diagnosis of premature ejaculation. The clinician should also take into account the individual's age, overall sexual experience, recent sexual activity, and the novelty of the partner. When problems with premature ejaculation are due exclusively to substance use (e.g., opioid withdrawal), a substance-induced sexual dysfunction can be diagnosed.

Other ejaculation disorder types

  • Delayed ejaculation
    Delayed ejaculation
    Delayed ejaculation is the inability to ejaculate or persistent difficulty in achieving orgasm despite the presence of normal sexual desire and sexual stimulation...

     - Ejaculation takes a long time
  • Retrograde ejaculation
    Retrograde ejaculation
    In the human male reproductive system, retrograde ejaculation occurs when semen, which would normally be ejaculated via the urethra, is redirected to the urinary bladder. Normally, the sphincter of the bladder contracts before ejaculation forcing the semen to exit via the urethra, the path of least...

     - Semen flows from the prostate gland into the bladder rather than exiting out of the penis.
  • Inhibited orgasm in males

Treatment

When deciding the appropriate treatment, it is important for physician to distinguish PE as a "complaint" versus PE as a "syndrome". About 20 years ago, PE was classified into "lifelong PE" and "acquired PE". Recently, a new classification of PE was proposed based on controlled clinical and epidemiological stopwatch studies, and it included 2 other PE syndromes: "natural variable PE" and "premature-like ejaculatory dysfunction". Only men with lifelong PE with Intravaginal ejaculation latency time
Intravaginal ejaculation latency time
Intravaginal ejaculation latency time is defined as the time between the start of vaginal intromission and the start of intravaginal ejaculation. IELT can help evaluate sexual effects of medications such as selective serotonin reuptake inhibitors . IELT is one factor used to diagnose and treat...

(IELT) <1 to 1.5 minutes should require medication as a first option, along with or without therapy. For men who fall into one of the other categories, treatment should consist of patient reassurance, behavior therapy, and/or psychoeducation to explain irregular early ejaculation is a normal variation.

Dapoxetine
Dapoxetine
Dapoxetine is a short-acting selective serotonin reuptake inhibitor marketed for the treatment of premature ejaculation in men. Dapoxetine is the only drug with regulatory approval for such an indication. Currently, it is approved in several European countries, including Finland, Sweden,...

 (Priligy) is a short-acting selective serotonin reuptake inhibitor
Selective serotonin reuptake inhibitor
Selective serotonin re-uptake inhibitors or serotonin-specific reuptake inhibitor are a class of compounds typically used as antidepressants in the treatment of depression, anxiety disorders, and some personality disorders. The efficacy of SSRIs is disputed...

 (SSRI) marketed for the treatment of premature ejaculation. Dapoxetine is the only drug with regulatory approval for such an indication. Currently, it is approved in several European countries, including Finland, Sweden, Portugal, Austria and Germany. Dapoxetine is currently waiting for U.S. Food and Drug Administration (FDA) approval after concluding the Phase III study, which included participants from 25 other countries, including the United States. In this diverse population, dapoxetine significantly improved all aspects of PE and was generally well tolerated.

Tramadol
Tramadol
Tramadol hydrochloride is a centrally acting synthetic opioid analgesic used in treating moderate pain. The drug has a wide range of applications, including treatment for restless legs syndrome and fibromyalgia...

 (Ultram or Tramal) is an FDA approved atypical oral analgesic for mild pain. It is atypical because it is similar to an opioid, is an agonist at the mu receptor, but also is similar to an anti-depressant in that it increases levels of serotonin and norepinephrine. Tramadol also has few side effects, low abuse potential, and increases (IELT) 4-20 fold in >90% men.

Clomipramine
Clomipramine
Clomipramine is a tricyclic antidepressant . It was developed in the 1960s by the Swiss drug manufacturer Geigy and has been in clinical use worldwide ever since.- Indications :...

 (Anafranil) is sometimes prescribed to treat PE. One side effect of the drug can help delay ejaculatory response. The side effect is described by the Mayo Clinic as "Increased [SIC] sexual ability, desire, drive, or performance."
Another method is control instead of prevention.

One more method is entitled intracavernous pharmacotherapy. This is a method of injecting a drug known as a vasodilator directly into the penis to help men control premature ejaculation and maintain their erection. It has been proven to be effective in over seventy percent of test patients. This method is used by companies such as Florida Men’s Medical Clinic, Boston Medical Group
Boston Medical Group
The Boston Medical Group is, a network of medical offices sharing research information and treatment methods for erectile dysfunction and premature ejaculation....

and others.
The source of this article is wikipedia, the free encyclopedia.  The text of this article is licensed under the GFDL.
 
x
OK