A Physician’s point of view
In the January 2005 issue of Patient Care, George P. N. Samraj, Louis Kuritzky, and Allen D. Seftel discuss the definition, diagnosis and treatment of premature ejaculation ( PE ) and how research information translates into practical usefulness in the clinician’s office. According to the authors, premature ejaculation ( PE ) exists in almost 39% of the population. Since men are reluctant to seek treatment, clinicians need to be self-motivated in identifying and treating the dysfunction to assist their patients.
Since there is not one consistent definition for premature ejaculation ( PE ), clinicians may need to rely on a synopsis of definitions in order to best identify someone with the condition. The main characteristics tend to be:
1.
Short ejaculation latency time after vaginal entry.
2.
Consistently having short ejaculation latency over a period of time.
3.
Distress in the male or female partner or both.
Despite the obvious distress that premature ejaculation ( PE ) causes in men, there is still a great deal of reluctance in discussing it with physicians. The popularity of
phosphodiesterase-5 ( PDE-5 ) inhibitors in treating Erectile Dysfunction does give some men hope that sexual dysfunctions such as premature ejaculation ( PE )
can be treated with a pharmacological agent. Unfortunately, there is no single drug specifically approved for the treatment of premature ejaculation ( PE )
.
Diagnosis is best made through a complete sexual history. Physicians may need to be creative when asking questions about sexual dysfunctions, especially if the patient did not first present with the issue. Once men are comfortable discussing sexual issues with their doctor, it is important to include questions about distress levels of one or both partners in order to gauge whether or not a short ejaculatory latency time is indeed a serious level of concern for him. If the patient and the partner are not distressed, then making a diagnosis of premature ejaculation ( PE )
solely based on length of ejaculatory latency is not valid.
While no one study pinpoints exact causes for premature ejaculation ( PE )
, some studies point to physiological factors such as prostatitis, while others consider previous sexual or psychological trauma. Since some medications that work on serotonin reuptake inhibitors are effective in providing relief for premature ejaculation ( PE )
, it is probable that a connection between serotonin levels play a role in the condition.
Treatment can take many forms such as sexual counseling. One or both partners can participate in counseling sessions to learn triggers for short ejaculatory responses, coping mechanisms, and non-pharmacological interventions for treating premature ejaculation ( PE )
. Some of these interventions include wearing more than one condom to reduce penile sensitivity and use of the squeeze technique. The squeeze technique requires the partner to apply firm squeezing pressure to the base of the glans penis, thereby interrupting intercourse and teaching the male to time his orgasm until a later moment. Counseling can be an intensive process, as well as expensive.
The most popular drug therapies include using selective serotonin reuptake inhibitors ( SSRIs ) commonly used to treat depression. Since SSRIs have delayed ejaculation as a side effect, many physicians are using medications like paroxetine on a regular dosing schedule to provide relief for men who do not notice improvement with other techniques. On-demand dosing of SSRIs has proved less successful than daily dosing, although some men may benefit from on-demand treatment. With new studies pointing to the connection between SSRIs and suicidal tendencies, it is critical to provide medication counseling as part of the treatment process. Topical ointments are also available and can provide benefits for men who are not willing to take long-term medications, yet want on-demand treatment for the condition.
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