Premature ejaculation is the most common of ejaculatory disorders; approximately 20% to 30% of men have premature ejaculation.
Ejaculation problems involve the improper discharge of sperm, prostatic, and seminal vesicle fluid through the urethra.
There are three different types of premature ejaculation:
- Premature ejaculation is ejaculation after minimal or no physical stimulation.
- Retarded ejaculation is ejaculation after a long delay of physical stimulation.
- Retrograde ejaculation is orgasm without ejaculation, also called “dry” ejaculation.
What are the symptoms of premature ejaculation?
Classically, premature ejaculation includes:
- brief ejaculatory latency;
- loss of control;
- psychological distress in the patient and/or partner.
Generally, premature ejaculators will only have about a minute or less of intravaginal time before they ejaculate.
Retarded ejaculation will present as a long delay of intravaginal time to the point where the patient will not be satisfied with the sexual relation.
Anejaculation or retrograde ejaculation is the experience of a dry orgasm. The semen doesn’t go out of the urethra. It can either flow to the bladder instead or not be produced at all. Following the sexual act in the latter case, patients will notice the presence of semen in their first urine.
What causes premature ejaculation?
There are many potential causes of premature ejaculation. These include neurological causes that affect the following areas:
- central control of ejaculation;
- innervations to the seminal tract;
- sensory innervation to the genitalia/prostate.
Premature ejaculation may be caused by negative conditioning and penile hypersensitivity. Retarded ejaculation may be an early sign of diabetes or may develop following surgery for benign prostatic hyperplasia (BPH).
Anejaculation (retrograde ejaculation) may be caused by radical prostatectomy, cystoprostatectomy (removal of the bladder and the rectum), or the use of certain medications such as alpha-blockers (tamsulosin) and antidepressants (SSRIs).
What is the treatment for premature ejaculation?
The treatment will vary according to the cause of premature ejaculation. Couples’ sexual therapy or psychological therapy can be useful when psychological causes are involved. Other nonpharmacological therapies include actively trying to “hold it in.”
Drug therapy has also proven to be successful. The medications used to treat premature ejaculation are selective serotonin reuptake inhibitors (SSRIs) and tricyclic antidepressants (TCAs).
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