Friday, March 27, 2009

Premature ejaculation (PE)

  • the inability to control ejaculation sufficiently for both partners to enjoy sex
  • primary premature ejaculation is always present
  • secondary premature ejaculation develops after a period of satisfactory sexual functioning

Biology

  • if semen is released from the urethra without force, it is termed emission
  • ejaculation and emission are mediated by the alpha-adrenergic sympathetic nervous system
  • androgens have a role

Epidemiology

  • prevalence = 36-38%
  • 13% of attendees and sexual disorders clinic have premature ejaculation

Aetiology

1. Psychological

  • anxiety promotes emission but inhibits orgasm
  • those with primary PE are more impaired in sexual functioning and are more anxious
  • those with secondary PE are more likely to have coexisting erectile dysfunction, and reduction in sex drive, and a reduction in arousal
2. Learning

  • many factors may interfere with the learning of the ability to identify the point of impending ejaculation
3. Physical

  • drugs do not cause PE
  • those with PE do not have penile hypersensitivity

Management

  • education in ejaculatory control using the ‘pause’ technique
  • sensate focus therapy
  • if difficulty is experienced with these methods, the ‘squeeze technique’ can be used
  • some antidepressants (e.g. FLUOXETINE) have a beneficial effect on PE

1 comment:

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