Premature Ejaculation (PE)

The last twenty years have seen an advance in evidence-based medical knowledge regarding Premature Ejaculation (PE). Let's see what is happening with this problem and its treatment.

Why do we need to treat PE?

Premature ejaculation is the most common male sexual dysfunction. It affects about a third of men at various times in their lives, with little variation depending on age and continent. Many studies have shown that it causes very significant suffering in men of course, but also in the partner and the couple. PE has a very strong impact on the quality of life of men in general, in particular on sexual satisfaction which is greatly reduced. Premature ejaculation also has a strong impact on self-confidence and self-esteem.

This problem also impacts on female sexuality. Moreover, men with premature ejaculation often feel immense guilt vis-à-vis their partner. Communication difficulties can appear in the couple as the two partners find it difficult to approach the problem: the woman because she is afraid of plunging her man into an anxiety of failure, of hurting and upset him and man because he chooses instead denial and avoidance. Intercourse becomes less frequent (“you're still going to ejaculate too fast, what's the point of trying?”), which further increases the speed of ejaculation and can lead the couple into a seizure, explains sex specialist in Delhi.

 

How to define PE?

It is defined as follows by the best sexologist in Delhi: PE is a male sexual dysfunction characterized by ejaculation which always or almost always occurs before or at most about one minute after vaginal penetration, by an inability to delay ejaculation during all or almost all vaginal penetrations and through negative personal consequences, such as pain, hassle, frustration and / or avoidance of sexual intimacy. There are two main clinical forms: primary PE where ejaculation is very rapid, following shortly or sometimes preceding penetration, almost systematic for all sexual relations, with all partners, since the start of sexual activity. Concretely, most frequently, they are men, mainly young and inexperienced, experiencing strong performance anxiety. They are under 30, and they have an obvious lack of learning. These young men often have a guilty masturbation, and they are used to quickly release their tensions by masturbation.

Secondary PE occurring after a period of sexual life when ejaculation was not a problem. This change can be due to life events affecting private life (for example the arrival of a child), to psychological, relational or medical problems. In this case, it is often linked to an erectile dysfunction. (The man then seeks maximum excitement to obtain and maintain an erection that he is afraid of losing and, therefore, he precipitates the onset of his ejaculation).

Besides these two main clinical forms, there are also men who complain that everything is normal in terms of their ejaculation delay. These are men who have in mind performances disconnected from sexual reality. Perhaps it is necessary to look on the side of pornography with its actors "delayed ejaculators or ejaculators". In this sense, porn movies would lead to pressure to conform to an imaginary standard.

What are the causes of PE?

All the research carried out highlights two dimensions that can explain this pathology. The first is sexological and the other neurochemical.

• The sexological dimension is based on a lack of sexual skills to manage sexual arousal. Concretely, the patient cannot keep his excitement at levels lower than that which triggers the ejaculatory reflex and he is then unable to prolong the duration of the penetration.
• The neurochemical dimension is based on work concerning the key role of a cerebral neurotransmitter: Serotonin. PE is linked to the fact that we do not find enough active serotonin in the intersynaptic spaces.

How to treat PE?

The therapeutic management of PE derives from these two dimensions. Of course, its modalities vary depending on the individual and the situation, but most often, PE will respond to a combined treatment, combining sexological therapy with pharmacological treatment.

Several behavioral sex therapies exist aimed at making the patient acquire skills in his sexual choreography allowing him to modulate his arousal. The most classic protocols are “Stop and go” or “stop-start” (The principle is to break down the excitation into stages and stop at these stages), compressions or “Squeeze” (The principle is to '' teach the man, through various compressions, to reduce his arousal when he is about to ejaculate) and sex-functional therapy (The principle is to manage the intensity of the stimulation that the man receives and changes caused by excitement, especially breathing and muscle tension).

Pharmacological premature ejaculation treatment in Delhi is based on the use of a Serotonin reuptake inhibitor which allows rapid efficacy on the symptom useful to motivate the patient, essential in the event of severe PE (less than a minute) for set up a possibility of skills acquisition or when the couple is in crisis and the demand for a quick result.

Conclusion

Every patient with PE has the opportunity to treat it. For this, he must overcome the embarrassment and shame to consult with a sexologist in Delhi. PE is most often a pathology that concerns the couple and the inclusion of the partner in the care process is most often useful. Each patient should be able to benefit from basic psychosexual education. The sexologist doctor in Delhi now has different treatments and can offer each patient and each couple an appropriate psychosexological intervention, alone or in addition to pharmacotherapy.