A Closer Look at Premature Ejaculation

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While male relationship dysfunctions number in the thousands, only two major male sexual dysfunctions are recognized - premature ejaculation (PE) and erectile dysfunction (ED).

No valid estimate currently exists for how common Premature Ejaculation (PE) is among all MSM (Men who have Sex with Men).  The studies that do exist, however, show some interesting patterns.  In one study, lower urinary tract symptoms, HIV positive status, having fewer than six lifetime sexual partners, and dissatisfaction with sexual life were associated with greater risk for PE.  In another study, condom usage was found to decrease the risk for PE.  Several studies found that Erectile Dysfunction was more common between MSM than the exclusively heterosexual, but PE was less common among MSM than the exclusively heterosexual.  People in these studies reported two unusual sexual dysfunctions:  delayed ejaculation and painful receptive anal sex.   The U.S. Government Healthy People 2020 Initiative has identified health disparities between MSM and the exclusively heterosexual an obstacle to the national health.  As a result we should be seeing more and better research on this topic.

The Mirror recently conducted an email interview about PE with Dr. Dr. Mohit Khera, an Assistant Professor of Urology at Baylor College of Medicine.

Can you define “premature ejaculation”? 

Three common themes occur in patients with premature ejaculations (PE):

1) A rapid ejaculation usually less than one minute.

2) Feelings that they lack control of their ejaculation timing.

3) Experiences of distress and interpersonal difficulty, possibly leading to frustration and avoidance of sexual intimacy.

The studies on premature ejaculation are very interesting.  We give the couple a stop watch and ask them to time their sexual intercourse.  Before we used the stop watch technique, we found that many men with PE tended to underestimate their time to orgasm and men without PE tended to overestimate their time to orgasm.

How common is PE among men in general? 

A:  Roughly 30 percent of men suffer from premature ejaculation, yet very few men seek treatment.  The percent of men with PE varies among countries and different ethnic groups.  For example, it tends to be higher in Asian countries but lower in European countries.  This may be due to cultural differences, different attitudes, and beliefs towards sex.

What factors are thought to influence PE?

Biological factors include an increased sensitivity of the head of the penis, an inflamed prostate, chronic pelvic pain, thyroid problems, and certain drugs.  Neurobiological factors include problems with neurotransmitters in the brain, such as serotonin.  Finally psychological factors play a large role in the development of PE. These factors include history of sexual abuse, impaired self-body image, depression, performance anxiety, and problems with intimacy.

What types of treatments are available for PE?

While several treatment options exist for men with PE, the use of local anesthetics to diminish the sensitivity of the penis is one of the oldest and well-proven treatments for PE.

Another commonly used therapy is anti-depressants.   SSRIs can treat PE because they increase serotonin, which is known to delay orgasm.  Many men with PE also suffer from depression.  While antidepressants effectively treat PE, they need to be taken daily or at least 4-6 hours prior to intercourse.   Antidepressants can also have systemic side effects such as, nausea, headache, dry mouth, weight gain, and reduced sexual desire.

Finally, psychological counseling, or sex therapy, is very effective in treating PE.  This therapy focuses on teaching techniques, such as the squeeze technique or the start-stop technique, to delay ejaculation.  The goal of psychological counseling is increased confidence, lowered performance anxiety, increased partner communication, and reduced interpersonal problems that may have caused the PE.

What would be the best way to approach your doctor about a problem like PE/RE?

Only 9 percent of men with PE actually seek medical attention for their condition.  Most men do not seek treatment because they are embarrassed or do not believe treatment will help.  A recent study found that 91.5 percent of patients who did seek treatment for PE felt that the treatment was not effective.  Furthermore, many physicians are also uncomfortable discussing PE with their patients.   Let your physician know that you suffer from PE and you are interested in discussing treatment options.Sean McShee

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