PREMATURE EJACULATION

During sex, the flow of events is pretty much straight forward because you’ll struggle to describe the act of one body thrusting into another in any sense of organized logic, one would say it’s not an enigma and it doesn’t call for use of euphemisms when describing sex. It would take great pains and too much deliberation to find a secret that’s more public than sex in all its forms.

But surprisingly, even after centuries of research, literature and technological advancements, the world can’t seem to rid itself of the subjectivity surrounding sex. Sex has very many aspects that come with describing it and one of the most discussed topics we will deliberate on with as much objectivity for human males is premature ejaculation.

Premature ejaculation occurs when a male experiences orgasm and expels semen within a few moments of beginning sexual activity and with minimal penile stimulation. There have been many names that have been given to the condition but they all describe the same condition, it has also been called premature climax. There isn’t a consensus that defines time frame that falls in the premise of being described as premature but the International Classification of Diseases (ICD-10) applies a cut-off of 15 seconds from the beginning of sexual intercourse. However, some research reports have used a cut off of 1 minute to describe the condition. The typical ejaculatory period is 4-8 minutes and anything longer than that is termed as delayed ejaculation.

Causes:

The exact cause for premature ejaculation isn’t certain but research and sound theory has a few plausible propositions to describe the causes of the condition, some of which include:

  1. Performance anxiety: This may be defined as a persistent phobia that exists in one who is to perform infront of an audience. Performance in this instance is anxiety to anticipated sexual performance which may lead to increased sensitivity and hence faster ejaculation.
  2. Passive aggressiveness: Too little sex has been proposed as one of the causes of premature ejaculation. However, the evidence to support this narrative is insufficient.
  • Drugs: Some medications have been known to cause premature ejaculation. Alcohol and recreational drugs such as amphetamines that cause erectile dysfunction are also known to cause premature ejaculation.
  1. Organic disease such as Prostatitis: Although the underlying mechanism isn’t entirely clear. Premature ejaculation is one of the signs of prostatitis that manifests years before the actual symptoms of prostatitis.

Diagnosis: The factors that determine or suggest the presence of the condition are not identifiable through any diagnostic tests but through talking to the affected person when they present with situations such as ejaculating around a minute after penetration and before the person wants to ejaculate, occurring almost every month for a period longer than six months.

Management: There are medical and non-medical ways of managing premature ejaculation. And sometimes it’s a combination of both.

  1. Sex therapy: Sex therapists have proposed techniques to help with premature ejaculation; these include strengthening of the pelvic floor, desensitizing responses, or mechanisms to reduce excessive arousal.
  2. Medications: Medications that increase serotonin signaling in the brain slow ejaculation. These can however cause many other undesirable effects such as loss of libido and erectile dysfunction and these should only be initiated by qualified medical personnel after proper assessment. These medications include SSRIs such as paroxetine and dapoxetine.
  • Self-treatment: By focusing attention elsewhere other than the sexual stimulation. It helps delay ejaculation. There is little evidence to support this although some reports suggest success in self-treatment which may include slower thrusts, ejaculating before intercourse or withdrawal altogether.
  1. Psychotherapy: There is little evidence to support this but Freudian theory suggests premature ejaculation to be due to underlying neurosis.

References

  1. 1.“An evidence-based unified definition of lifelong and acquired premature ejaculation: report of the second international society for sexual medicine ad hoc committee for the definition of premature ejaculation”. Sexual Medicine. 2(2): 41–59. doi:1002/sm2.27PMC 4184676PMID 25356301.


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