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Premature Ejaculation

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The only article you will ever need to read on premature ejaculation. We'll tell you everything you need to know. How we define premature ejaculation, what are the causes, and what are the treatments.

We’ll divide this article into 4 basic sections:

  1. Mechanism of Ejaculation

  2. Definition

  3. Causes

  4. Treatments

Mechanism of Ejaculation

A lot of people worry about having developed premature ejaculation, and many of them don’t really have it at all. So let me clear this misconception once and for all. Porn isn’t bad at all, except when you start using it as a sex education class! Pornography is a source of entertainment, and just like any film, it is also a work of fiction. No normal, healthy male can last the 30-40 mins. you see in porn without ejaculating at least once. In fact, the average length of a sex act is 7.3 minutes, but 43 percent of men finish in under two minutes. So let’s go behind the scenes of the male climax:

Ejaculation is controlled by the central nervous system. When men are sexually stimulated, signals are sent to your spinal cord and brain from all your senses. Now when men reach a certain level of sexual excitement, signals are then sent from your brain to your penis. This transfer of information through nerves is what us doctors call the reflex arc. This reflex arc causes semen to be released through the penis, which is called ejaculation.

Ejaculation has 2 phases: Emission and Expulsion

Phase 1: Emission

Emission is when sperm moves from the testicles to the prostate, and this is the semen factory where sperm is mixed with a bunch of other stuff to make semen. The semen then moves from the prostate to the base of the penis. This is through tubes that are called vas deferentia.

Phase 2: Expulsion or Discharge

Expulsion is when the muscles at the base of the penis contract; pelvic floor muscles. This forces semen out of the penis. Usually, ejaculation and orgasm (climax) happen at the same time. In most cases, erections go away after this step. Yes, remember this point. If anyone’s telling you they can go on after orgasming, they’re lying. It’s not biologically possible.

Definition of Premature Ejaculation Let’s now define premature ejaculation, and see what the medical books say. Premature ejaculation effects up to 30% of the male population, and is the most common sexual disorder in men.

The International Society of Sexual Medicine defines premature ejaculation under 3 headings:

  1. Ejaculation that always or nearly always occurs prior to or within about 1 minute of vaginal penetration from the first sexual experience (lifelong PE) or a clinically significant and bothersome reduction in latency time, often to about 3 minutes or less (acquired PE; caused by medical, psychological reasons)

  2. The 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 intimacy

Causes of Premature Ejaculation

Psychological factors play a massive role in premature ejaculation. Let me explain some of them:

  • The reflex arc that controls ejaculation is essentially a learned reflex, and so faulty learning causes psychological premature ejaculation. Most commonly, a history of sexual repression, with strict sexual teaching and upbringing due to which wrong conditioning with masturbation happens, for example, when learning to ejaculate quickly to avoid being found masturbating; the brain ejaculation reflex becomes faulty

  • Negative sexual experiences in childhood; Sexual abuse or rape leading to poor body image

  • Religious beliefs; Guilty feelings that increase your tendency to rush through sexual encounters

  • Sexual inexperience

  • Novelty of a relationship; overexcitement or too much stimulation

  • Unrealistic expectations about sexual performance

  • Overall lack of confidence

  • Depressed or anxious, particularly about sexual performance

  • Anxious about rejection by your partner

  • Stress in other areas of life

  • Relationship problems

  • Some men develop premature ejaculation because they have Erectile Dysfunction. Men who are anxious about obtaining or maintaining an erection during sexual intercourse might form a pattern of rushing to ejaculate

On a biological level, we know that certain neurochemicals trigger, and certain neurochemicals prolong ejaculation time. For eg. Testosterone, Thyroid and Dopamine are known to trigger, while Serotonin (5HT), Nitric Oxide, Oxytocin (the love hormone), Prolactin and Estrogen inhibit ejaculation. This is importance to know because investigations are to be done before starting treatment. Out of all the neurochemicals, serotonin is the most widely researched in premature ejaculation. Serotonin is a natural substance made by nerves. High amounts of serotonin in the brain increase the time to ejaculation. Low amounts can shorten the time to ejaculation, and lead to PE.

Other than that, some of the other causes of premature ejaculation can be:

  • Phimosis; super sensitivity leading to super fast signal to the brain

  • Inflammation and infection of the prostate or urethra

  • Diabetes

  • Multiple Sclerosis

  • Excessive drug and alcohol use

  • Nerve damage from surgery or trauma (rare)

  • Weak pelvic floor muscles; impairing the discharge mechanism of the ejaculation reflex

  • Inherited traits

Treatment With The Doctor

There are many nutraceuticals as well as medications for prolonging ejaculation time. These medicines essentially work on slowing down the processing of sensations from the penis, and thus, the brain’s signal to release semen is transmitted late. If one drug doesn't work, your doctor may have you try a different drug. If the second drug doesn't work, others will not likely help. Drugs for PE can be taken every day or only before sex. Your health care provider will decide when you should take a drug based on your activity level. Most doctors suggest from 2 to 6 hours before sex. PE can return if you stop taking these drugs. Most men with PE need to take these drugs on an ongoing basis.

If medicines don’t work, the next step is surgical intervention. Surgery works on the penis sensitivity; and so if the sensitivity of the penis is less, the signals to the brain from the penis are fewer and reach later. Bear in mind that Psychiatrists do not perform these procedures, and you are best advised to consult a urologist for these options. The 5 main procedures used are these:

  1. Frenuloplasty/Frenectomy: The frenulum is the most sensitive part of the penis, and a tight frenulum results in friction and quick discharge. Frenuloplasty is essentially done to loosen the frenulum. If that doesn’t work, the frenulum may be removed completely by a procedure called frenectomy.

  2. Glans Enhancement: Here an injection of hyaluronic acid is given on the glans of the penis to make it bigger. The chemical creates a barrier to the sensations and so reduces their intensity. This is a temporary procedure and needs to be repeated periodically, usually once in 1-2 years.

  3. Dorsal Neurectomy: Here the nerves of penis are crossed, so the signal to the brain is reduced

  4. Botox; used in discharge mechanism; effectively stops muscles from working/significantly reduces their functioning; lasts for 2-3 months; given at pelvic floor muscles

  5. Circumcision; arguably the most effective procedure, but controversial due to religious and ethical reasons

Let's start meaningful discussions at the world's best mental health, sexual health and addiction forum:

Stay tuned for the next segment on how to last longer without consulting a doctor. Here is a YouTube video on today's topic!

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