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    Premature Ejaculation (or PE)

    In men, the sequential process of sexual acts comprises the following steps:
  1. Sexual arousal through mental or / and physical stimulation;
  2. Erection - Penis gets hard and ready for vaginal penetrations.
  3. Sexual intercourse - It is the process of vaginal penetration with various frequency and depth, which play an important role
    in the pace of progress of sexual excitement toward orgasm and eventual ejaculation.
  4. Orgasm & ejaculation - As intercourse progresses, sexual excitement reaches its peak, called climax to experience orgasm
    with ejaculation to shoot semen into the vagina for insemination.
  5. De-tumescence - Within second s or minutes after ejaculation, penis become flaccid for a resting period, i. e., refractory
    period, which may widely vary and last few minutes to hours or days depending on age and general health.

    How often does premature ejaculation occur?
    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
    happening.

    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:

  1. Psychogenic PE – anxiety, novelty of partner or situation, low frequency of sexual activity;
  2. Biogenic PE – substance abuse (e.g. alcohol), endocrinopathy (e.g. hyperthyroidism), chronic prostatitis, opiate withdrawal.

    Such classification is for convenience of study. In reality, both aspects in causing PE are always interacting at their various degree
    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)?
    RX:
            # 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.

    Resource: http://www.medscape.com/viewarticle/755461_7.

    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...
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