Sunday September 16, 2012
Faster than a speeding bullet
By Dr CHRISTOPHER HO CHEE KONG
Premature ejaculation is defined as ejaculating within one minute of vaginal penetration.
A COMMONLY misunderstood condition which frustrates men is premature ejaculation (PE).
What is PE? It is the act of ejaculating before a man or his partner would like to.
Epidemiological studies have shown that this disease afflicts men of all nations equally. It is also a disease that affects men across all ages.
About a third of men often complain of this problem, but the actual figure is about 1-3%. PE has long been a condition that has been under-reported and under-diagnosed, mainly because of the embarrassment faced by sufferers, who have to put up with the social stigma related to the condition.
The Asia-Pacific Premature Ejaculation Prevalence and Attitude Study carried out among more than 5,000 heterosexual men found that most men are reluctant to talk about it, while the majority of couples do not completely understand the condition.
The International Society of Sexual Medicine defines PE as ejaculating within one minute of vaginal penetration, associated with the inability to delay ejaculation, and causing a negative impact on the man.
Why one minute? Studies have shown that the average time to achieve ejaculation in a man is about five minutes. Among men who complained of premature ejaculation, 90% stated it was less than a minute.
So how do doctors diagnose this problem? By getting a good history. If a man is distressed because he ejaculates early (about a minute) and he has no control over it, he would probably need treatment.
There is a questionnaire called the Premature Ejaculation Diagnostic Tool (PEDT) that may aid in the diagnosis. Other than that, there is no special equipment or test that can be used to diagnose this problem.
Previously, PE was thought to be a psychological disorder. We now know this is not entirely true. It has been shown to have a neuro-biological cause as well (organic).
Certain neuro-transmitters (biochemical substances that transmit impulses across nerves) like serotonin are involved in the process of ejaculation. Ejaculation is a complex process involving the interplay of many factors that are not completely understood.
PE may occur in a man who has had normal ejaculation before. This is known as acquired PE. In this situation, it may be due to a psychological problem rather than an organic cause.
On the other hand, if a man has never had normal ejaculation before, he probably has a neuro-biological cause for it. This is also known as lifelong PE.
Hyperthyroidism (a disease where the thyroid hormones are elevated) and prostatitis (inflammation of the prostate gland) may also cause premature ejaculation.
Treating PE should not focus solely on prolonging the ejaculation time. It is important that proper attention is given to the emotional and relationship factors as well. PE may be treated by sex therapy, medication, or a combination of both.
This involves education about ejaculation, an exploration of how the affected man’s PE experience compares with that of most other men, and a programme of exercises (this includes the “stop-start” and “sensate focus” technique) designed to help him increase his ejaculatory control and enjoyment of sexual intimacy.
It is usually carried out by a trained psychologist or psychiatrist.
Selective Serotonin Reuptake Inhibitors (SSRI) – These drugs manipulate the serotonin pathway, and in a way, increase the threshold of sexual climax and ejaculation.
The conventional SSRIs like paroxetine and sertraline are traditionally used to treat depression, but have been found to be effective for PE. The only problem is the associated side effects like drowsiness, constipation and nausea.
Moreover, conventional SSRIs need to be taken for at least two weeks before the beneficial effects could be seen. Stopping the conventional SSRIs also need to be done gradually over a few days.
To overcome all these problems, a new SSRI drug is currently available in the market. It is known as dapoxetine. It is a short-acting drug that can be taken on-demand.
In other words, dapoxetine can be taken only when it is needed (ie one to two hours before sex). Side effects of dapoxetine are also uncommon. It has been proven in studies to be effective in increasing ejaculatory time as well as satisfaction of the couple involved.
Topical anaesthetics – Lidocaine and prilocaine cream can be used to reduce the sensitivity and sensation of the penis. It has been proven to be effective, but the problem is it may cause total numbness of the penis. This will diminish the pleasure derived from sex.
In addition to that, the cream may be transferred to the partner and cause numbness to the partner as well.
Tramadol – Studies have also proven the effectiveness of tramadol to delay ejaculation.
Tramadol is a drug that is usually used to reduce pain. How it works in delaying ejaculation is not completely understood.
However, the drawbacks are side effects like nausea, vomiting and drowsiness.
It is also important to look out for concommitant erectile dysfunction (inability to maintain satisfactory erection of the penis for penetration) as treatment of erectile dysfunction with phosphodiesterase-5 inhibitors (like sildenafil, vardenafil and tadalafil) may overcome the problem of premature ejaculation as well.
PE is a man’s disease, but it affects both the man and his partner. Treatment is available and the combination of both medication as well as psychological sexual therapy may help.
Consultation with a urologist or psychiatrist would be needed.
1. International Society for Sexual Medicine’s Guidelines for the Diagnosis and Treatment of Premature Ejaculation. http://www.issm.info/images/uploads/PE_Guidelines.pdf.
■ This article is contributed by The Star Health & Ageing Panel, which comprises a group of panellists who are not just opinion leaders in their respective fields of medical expertise, but have wide experience in medical health education for the public. The members of the panel include: Datuk Prof Dr Tan Hui Meng, consultant urologist; Dr Yap Piang Kian, consultant endocrinologist; Datuk Dr Azhari Rosman, consultant cardiologist; A/Prof Dr Philip Poi, consultant geriatrician; Dr Hew Fen Lee, consultant endocrinologist; Prof Dr Low Wah Yun, psychologist; Datuk Dr Nor Ashikin Mokhtar, consultant obstetrician and gynaecologist; Dr Lee Moon Keen, consultant neurologist; Dr Ting Hoon Chin, consultant dermatologist; Prof Khoo Ee Ming, primary care physician; Dr Ng Soo Chin, consultant haematologist. For more information, e-mail email@example.com. The Star Health & Ageing Advisory Panel provides this information for educational and communication purposes only and it should not be construed as personal medical advice.