Premature ejaculation is a very common sexual dysfunction.
Incidence is as high as 31 %.
It is characterized by ejaculation occurring prior to, or immediately after intromission, sooner than the man wishes, causing distress to the man and/or his partner.
Causes of PE
Pathophysiology is not fully understood
Organic factors:
Psychogenic Factors:
Relationship/partner issues
Evaluation:
PE remain undiagnosed in many men, secondary to the man’s reluctance to discuss it with his clinician and lack of universal, validated criteria for screening men with PE.
Sexual history (what do you mean by PE? How long do you last from penetration to ejaculation? )
Sex status exam approach – immediate cause, history of disorder
Determine whether patient is able to identify his premonitory sensations (PS)
Ejaculatory tipping point
Treatment:
Conscious delaying of ejaculatory process- identification of PS and behavioral response to them
Men with PE must learn to “dial down” their mental and/or physical arousal in response to premonitory sensation.
Pharmacological therapy:
Topical anesthetics-
lidocaine/prilocaine cream
SS-cream
Problem with creams are they are messy and can lead to burning sensation and numbing.
Drugs-
SSRIs
PDE5 inhibitors
Generally speaking a combination of psychosexual education plus the use of low dose SSRIs will provide the most effective treatment.Although you may feel you can fix the problem yourself, you may need treatment to help you have a satisfying sex life. Talk with your doctor if you ejaculate sooner than you and your partner wish during most sexual encounters.
Retrograde ejaculation
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