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Paradigm Shift in Treatment for Men with Premature Ejaculation
Premature ejaculation is the most common sexual dysfunction in men. It is estimated that 20% to 30% of men suffer from this condition. USA News.com reported an interesting statistic which I found remarkable. US News stated in their commentary that the average length of a sex act is 7.3 minutes, but an astonishing 43% of men finish (or ejaculates) in under two minutes.
Premature ejaculation is when a man ejaculates during sexual intimacy sooner than he or his partner desires.
Premature ejaculation can be classified as either primary or secondary ejaculation. Primary Ejaculation is a lifelong condition and usually occurs starting with your first sexual encounter. Whereas Secondary Ejaculation is acquired, meaning that you’ve experienced sexual intimacy in the past without ejaculatory problems.
What causes premature ejaculation (PE) are poorly understood. Historically it was thought that PE was a psychological problem involving partner-related issues, anxiety, or early sexual experience which imprinted negative behavioral patterns. With advancements in medical research, we now know that PE has a complex interaction that includes both biological as well as psychological components.
Psychological Causes of Premature Ejaculation
- Anxiety (performance related)
- Relational Problems with partner
- Unresolved conflict
Biological Causes of Premature Ejaculation
- Hormone disorders
- Abnormal Neurotransmitters
- Nerve damage
- Diabetes Mellitus
- Cardiovascular disease
- Prostrate disease
- Illicit drug use
- Excessive alcohol consumption
- Abnormal reflex activity of the ejaculatory system
There are several treatment modalities for men suffering from premature ejaculation: 1) Psychological therapy 2) Behavioral therapy, 3) Medical therapy, and 4) Alternative therapy.
Psychological therapy focuses on helping a man identify and work through difficulties within relationships. Counseling can also address anxieties regarding sexual performance, expectations, and confidence. Psychotherapy by itself is limiting and is often used in conjunction with behavioral and medical modalities.
Behavioral therapy concentrates its focus on various exercises and behavior modifications. This form of therapy often includes the cooperation and participation of the other sex partner that in some cases may be problematic.
The squeeze method and start-and-stop method are both examples of behavioral therapies. Both work on the premise of stimulating the man’s penis close to the point of ejaculation, then either change or withdraw the stimulation until the man gains control. This process repeats several time until the man is allowed to ejaculate. Exercises like these and others continue until he is able to achieve prolonged erections and demonstrate good control over the ejaculatory reflex.
Medical Therapies are relatively new in the treatment of PE. While medications are approved by the FDA they are often used off-label, meaning the drugs were originally manufactured for treatment of a different disease or illness other than PE. Physicians have noticed that certain classes of medications such as antidepressants and topical anesthetics had delayed the onset of orgasms in people taking these medications.
Selective serotonin reuptake inhibitors (SSRIs) are the most common class of antidepressant used in the treatment of premature ejaculation. Low levels of Serotonin (a neurotransmitter) is thought to be partially responsible for PE in men. SSRI medications (Prozac, Zoloft, and Celexa) increase serotonin levels and are thought to increase the ejaculatory threshold and delay a man’s orgasm.
Topical Anesthetics are comprised of different formulations of creams or sprays that contain lidocaine or prilocaine. These products are applied to the head of the penis approximately 15 minutes to 20 minutes before intercourse. The topical application lessens the sensitivity of the penis and helps delay ejaculation. The downside is that if left on the penis too long it could cause a loss of the erection and in some instances cause vaginal numbness.
Alternative therapy is a paradigm shift away from the therapies outline above. It’s a solution that removes the anxieties and performance issues surrounding the act of sex and restores and deepens the sexual intimacy that may have been missing in the relationship.
With the standard treatments of PE we know that time is not a friend to the man with PE. Once he reaches an orgasm he loses his erection and there is a refractory period of time before there can be an continuation in sexual intimacy, reaching and fulfilling the sexual needs of his partner.
We have found that the use of Trimix, a medical therapy traditionally used for Erectile Dysfunction, along with desensitizing techniques, have dramatically improved sexual intimacy in the man that suffers from PE. Trimix is a compounded drug consisting of three vasodilators that will help a man achieve an erection within 8-10 minutes.
The dose is customized to a patient’s needs and desire – he can choose the duration of his erection, opting for anywhere from approximately a half hour up to two hours. This allows the man to have sex without losing his erection after he reaches an orgasm, so that he may continue with intercourse and satisfy the sexual needs of his partner. By continuing to have intercourse the patient is actually desensitizing the head of his penis, building confidence, while meeting the sexual needs of himself and his partner. This paradigm shift has dramatically improved the sexual performance of the man with PE, while shoring up the relationship with his partner.