All Willing Souls Can Do It
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Dr. Lin's Quest beyond Medication and Surgery
It has been reported in around 4-40% of men one time or the other in their life time, but is considered to be under-reported owing
to personal embarrassment. So, you're not alone. It's indeed bothersome; although not curable, it is manageable.
What is the definition of premature ejaculation and how have we define it?
Its definition has changed and evolved over time through more understanding of male sexuality.
For example, it was defined as: less than 1-minute penetration in 1976; <15 thrusts in 1986; <50% of coital satisfaction in sexual
partner in 1970; still variable but three (3) sure components in agreement are a short ejaculatory latency, a lack of control over
ejaculation, and a lack of sexual satisfaction.
In 2009, ISSM (International Society of Sexual Medicine) defined PE as: 1. Ejaculation which always or nearly always occurs prior to
or within about 1 minute of vaginal penetration; 2. Inability to delay ejaculation on all or nearly all vaginal penetrations; 3. Negative
personal consequences, such as distress, bother, frustration and/or the avoidance of sexual encounters.
What may cause premature ejaculation (PE)?
By the timing of its occurrence, PE may be divided into two (2) types: lifelong and acquired (maybe suddenly or gradually).
Hereditary or genetic factor may play an important role in PE although personal psychological factors may also contribute to its
But for practical management, we should focus on what we can do and ignore whatever its hereditary or genetic factors may be
because we can not do anything about it, but concentrate on what we can do within our reach and knowledge understanding now:
and proportion among individuals.
How do we diagnose premature ejaculation (PE)?
Usually, detailed history stressing sexual history, lifestyle, history of drug overuse or misuse or abuse, and physical examination
are sufficient to reach a diagnosis. Laboratory and other physiological tests are rarely indicated.
How can we treat premature ejaculation (PE)?
# unlicensed SSRI (Escitalopram, Fluoxetine, Fluvoxamine, Paroxetine, Sertraline)
# dapoxetine, a SSRI (selective serotonin reuptake inhibitor), increases IELT (intravaginal ejaculation latency time) by a
factor of 2.5-3 with limited and tolerable side effects.
# topical desensitizing creams, PSD502-a topical aerosol, increases a IRLT by a factor of 6 with minimal local and
negligible systemic side effects. Others - SS cream, Benzocaine, Prilocaine, Lidocaine, EMLA cream (prilocaine-
lidocaine cream); timing of its use – 20 minutes.
# Centrally acting opioid analgesic (Tramadol)
# Others: not FDA-approved, paroxetine, with a substantial and prolonged side effect profile.
- tricyclic antidepresssants, centrally acting opiates, PDE-5I.
PE has affected some 5-40% of men one time or the other over lifetime. Despite no definite means to rid it permanently, the
following may help slowing it down to meet reasonable satisfaction as follows: Do sex under less stressful environs and with
ample foreplay to bring, move, & match with your partner's pace of sex arousal; slow down the pace & decrease the depth of
penetration; and others...
|Prostate - BPH / LUTS,
|Sex Life, ED (Erectile
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