PREMATURE EJACULATION (P.E.)
At one time, it was believed that premature ejaculation (P.E.) had completely psychological causes. We now know that there are significant, if not primary, physical problems that contribute to premature ejaculation. It is a legitimately-recognized medical problem that needs a thorough medical evaluation.
In many cases, sex therapy can also help in solving this particular problem and it is sometimes recommended that patients be treated by both a physician and a sex therapist concurrently.
A first appointment will typically be between 45 and 60 minutes. It will include both a verbal history and a physical exam.
Your physician will take a thorough medical history because he will need to place your premature ejaculation in the context of your history. This may include questions such as how long you last prior to ejaculation.
Some men ejaculate during foreplay. Some even ejaculate while in the process of getting undressed and before significant contact has occurred. Others penetrate, but ejaculate much earlier than they would like and spend most of the time inside attempting not to ejaculate.
Some other questions include:
- What is the quality of your erections?
- What happens when you try to have intercourse?
- Do you have decreased rigidity?
- Do you have difficulty maintaining your erection?
- If so, at what point do you lose it?
- Do you wake up at any point in the morning or while sleeping with an erection?
- How rigid is it then?
- What is your sexual interest level (libido) like?
- Does your penis have a curve, a bend, or a twist in it when it is rigid?
- What is the status of the relationship you are in? Are you married, divorced, single, gay, etc.?
- How is the relationship going?
- How is the premature ejaculation affecting your relationship?
If premature ejaculation exists with erectile dysfunction, it is very important to determine which came first. Many men with erectile dysfunction have difficulty maintaining their erections even prior to ejaculation. Since they feel consciously or subconsciously pressured during intercourse to ejaculate prior to losing their erections, they can sometimes get into the habit of having premature ejaculation.
In general, when the erectile dysfunction preceded the premature ejaculation, the erectile dysfunction should be dealt with as the primary issue. Often, when these men can achieve successful and long-lasting erections, they will not ejaculate as quickly. If after treatment for erectile dysfunction the premature ejaculation remains a problem, it should be addressed separately.
The doctor may discuss some other subjects with you depending on his thoughts on diagnosis. These include:
- After ejaculation, how long does it take you to have a second erection and reach an orgasm? Some men have long-standing premature ejaculation, but their habit has been to ejaculate quickly (either through masturbation or with their partner) for the first ejaculation and then to have more leisurely intercourse because they last longer the second time. Many of these men come to the physician when they get older or have other medical problems and lose the ability to get a rigid second erection in the same lovemaking session. At this point, the premature ejaculation interferes significantly with their lovemaking. It is also important to know how long it takes you to get a second erection. Such information will be useful in determining treatment options.
- How often do you ejaculate? This can be either through masturbation or with a partner. Many men who develop premature ejaculation do not have satisfying sexual experiences. Because of this, they become somewhat avoidant of sexual situations even in the context of a relationship or marriage and have decreased frequency of intercourse and ejaculation. With decreased frequency and longer time periods between ejaculations, many men will ejaculate more quickly. Premature ejaculation can then become a vicious cycle. One of the ways of breaking the cycle is to encourage the man to ejaculate at some point prior to intercourse so that he will then last longer during intercourse.
- How has the premature ejaculation affected your relationship? Often, premature ejaculation is a chronic problem. For many couples, this has caused significant disturbance in their sexual relationship. Many women harbor significant resentment, especially if this is a problem that the man has refused to address for a number of years. Usually, a partner is very grateful that the man has sought treatment because it shows that he understands there is a problem and would like to satisfy his partner more completely.
- Have you had prior treatments? If you have been placed on medication, it is important to know which medication and the dosage. If you have done any behavior modification, it is important to let the physician know this as well.
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Your physician will do biothesiometry to check the threshold for sensation of vibrations. Recent studies have shown that men with premature ejaculation tend to have a decreased threshold for sensation. In other words, their penises are more sensitive. Since ejaculation is a reflex (one that is modified to some degree by conscious thought) these men will ejaculate more quickly. It just takes much less stimulation to trigger their reflex.
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P.E. treatment options often include a variety of different modalities. Premature ejaculation is best treated through a combination of interventions. These treatment options include:
- Behavior Modification – Learning behaviors and techniques that can make the patient last longer. There are several good books and exercise videotapes available.
- Medical Treatment – There are a number of medical options available. There are medications that may significantly delay ejaculation. There are also medications and treatments that allow a patient to maintain an erection even after ejaculation to more completely satisfy a partner. Some men may ejaculate again prior to losing their erection.
A specialist will offer a variety of options based on what is appropriate for each particular situation. Patients should participate fully in developing a treatment plan.
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