PREMATURE EJACULATION (PME)

• There can be four types of disturbances in semen ejaculation (i.e. orgasmic discharge)
  1. Premature ejaculation i.e. early discharge or early orgasm.
  2. Absent ejaculation, Delayed ejaculation, Retrograde ejaculation & others
  
  

   

  What is Premature Ejaculation?

  Premature ejaculation (also known as early discharge or quick orgasm, early fall, Shigra-patan) is one of the most frequent, of sexual disorders in the male and is characterized by sudden ejaculation of the semen, just prior to or immediately after vaginal penetration during intercourse (before one wishes or before he could satisfy the female partner). Approximately 10% to 30% people of all age group suffer with quick semen discharge. Premature or 'before time' in other words, is a condition where the man has no voluntary control over his ejaculation. He is quick on the trigger once he starts the coitus. This is a very frustrating disorders of male sexual function in which man feels totally helpless. This leads to bitterness in husbands & wife relationships. For the man, lack of control of his body functioning leaves him feeling unsure of himself. His pleasure is often decreased by the abrupt early discharge. Eventually his preoccupation with trying to postpone ejaculation will hinder his ability enjoy himself to sexual pleasure. When a man is, feeling inadequate, and ejaculating fast, the woman will probably be left unsatisfied. Her frustration will only increase the negative pattern. This is an easily treatable condition.
  
  What is normal time of discharge: In one scientific study European males took approximately ten minutes in discharge whereas Americans took fourteen minutes in getting orgasm.
  
  How common is pre mature ejaculation due to some well-defined internal causes?
  Many of recent studies have proved that, most cases of quick ejaculation are Psychogenic is not correct (which was old belief). In one study by Schwartz & Pirke & colleague found that in many patient of pme male hormones were deranged. Similarly Colpi et all found that evoked sacral potentials & Bulbocavernosal reflex were hyper-excitable in many patients.
  Thus psychogenic cause should never be labeled unless Hormonal & other causes have been excluded, by thorough examination, hormones & other tests as mentioned below.

  Causes of Premature Ejaculation:

  Diagnosis of Cause

  1) We take detail history
  2) Detailed general & systemic examination
  3) Investigation & Diagnostic tests
  For accurate diagnosis of the cause patient's blood is tested following tests:
  Complete Male Hormone Profile tests
  Biochemistry tests
  Urine is tested for pus cells
  Penile Nerve conduction tests & central nervous system is if required.
  Scrotum, epididydmus, prostate is examined for infection.
  Semen is examined for pus & semen culture sensitivity.
  Ultrasonography of scrotum & prostate may be required.
  Various antibodies are tested against relevant microbial agent
  Detail sex counseling is done for knowing the cause of PME. 

  Treatment:

  (1) Oral Medicines: After the finding out the cause of premature ejaculation. Various drugs to treat sex centre & other causes are prescribed along with sex therapy. These medicines are not costly & have no side effects & patient has to purchase from market. Response comes with in two week & patients are cured in two-month time. Medicines can be
  a) Hormone pills when hormone disorder found
  b) Medicines to cure the urogenital infections when infection as the cause confirmed
  c) Neurotransmitter serotonin level increasing drugs as Anafranil, Paxil, prozac, & Zoloft, Luvox, Celexa, & others are used in those patients having low serotonin is very effective
  d) Specific treatment of central nervous disorder need to be done when that is the cause.
  e) Other medicines which h may be effective in selective patients are Propranolol & Alpha adrenergic blockers as phenoybenzamine, Alphuzosin, Terazosin, Tamsulosin
  
  (2) INJECTION THEREPY: Rarely injection therapy is advised which is very effective in treating premature ejaculation. It is used only when oral drug therapy has failed. Sometime we also use it as temporary method to build confidence of those patients who are highly demoralized due to their previous failures. Patient is advised various Vasoactive injections by which penis becomes hard in three minutes & remains hard at least for 30 minutes thus almost all patient do the satisfactory sex with injection therapy without any fear. After few weeks of injection therapy & concurrent sex therapy patient develops capacity to control his ejaculation & he may stop injection after sometime.
  
  3) TOPICAL THERAPY is effective but it is only a temporary treatment. By these creams sensitivity of penis to sexual excitation & time of discharge increases. It has no side effects.
  
  4) Phytoterapy: extract of saliva haeamatodes & some other natural products are effective in pre mature ejaculation.
  
  (2) Sex Therapy: 
  In sex therapy two exercises are taught to patient along with medicines. These are:
  Stop-start technique
  Kegel exercises
  Squeeze Therapy
  & certain behavioral therapy exercises
  
  These sex therapy exercises when practiced by patient for four weeks then patient is able to sustain erection without ejaculation for at least 8 to 10 minutes. After the full course of treatment once you have reached the point where you can chose when you will ejaculate, you may find it helpful to continue using the sex therapy exercises on various occasions to help lengthen the lovemaking period. This would be particularly true if it has been some time since the last ejaculation, because then you are more likely to ejaculate more quickly. The use of this should be incorporated into love making and used at any point along the way for the rest of your life.
  
  If premature ejaculation has evolved into impotence, then that should be given attention first. Then impotence must be treated before the premature ejaculation.