Premature Ejaculation
Disease Details
Family Health Simplified
- Description
- Premature ejaculation is a condition where a man ejaculates sooner during sexual intercourse than he or his partner would like, often within one minute of penetration.
- Type
- Premature ejaculation is not typically classified as a genetically transmitted condition. It is generally considered to be a multifactorial condition with various psychological, neurological, and physiological factors potentially playing a role. While there may be some genetic components that contribute to susceptibility, it does not follow a clear pattern of genetic transmission.
- Signs And Symptoms
-
Premature ejaculation is a sexual disorder characterized by the following signs and symptoms:
1. Ejaculation that always or nearly always occurs within one minute of vaginal penetration.
2. Inability to delay ejaculation during all or nearly all vaginal penetrations.
3. Negative personal consequences, such as distress, frustration, and the avoidance of sexual intimacy.
The symptoms are typically persistent and occur in nearly all sexual encounters. - Prognosis
- The prognosis for premature ejaculation (PE) is generally positive with appropriate treatment. Many men can achieve significant improvement through behavioral techniques, counseling, and sometimes medication. It's important for individuals to seek professional help to determine the most suitable treatment plan and manage any underlying conditions or psychological factors.
- Onset
- For premature ejaculation, onset refers to the timing of ejaculation earlier than desired, either before or shortly after penetration. This can occur in both lifelong cases, where the condition has been present since the individual became sexually active, and acquired cases, where it develops after a period of normal sexual function. Premature ejaculation can result in distress and interpersonal difficulties, which makes recognizing its onset crucial for diagnosis and treatment.
- Prevalence
- Premature ejaculation (PE) is a common sexual dysfunction among men. The prevalence of PE can vary significantly based on different studies and definitions used. On average, it is estimated that approximately 20-30% of men experience PE at some point in their lives.
- Epidemiology
- Premature ejaculation is a prevalent sexual dysfunction in males; however, because of the variability in time required to ejaculate and in partners' desired duration of sex, exact prevalence rates of PE are difficult to determine. In the "Sex in America" surveys (1999 and 2008), University of Chicago researchers found that between adolescence and age 59, approximately 30% of men reported having experienced PE at least once during the previous 12 months, whereas about 10 percent reported erectile dysfunction (ED). In males, although ED is the most prevalent sex problem after age 60, and may be more prevalent than PE overall according to some estimates, premature ejaculation remains a significant issue that, according to the survey, affects 28 percent of men age 65–74, and 22 percent of men age 75–85. Other studies report PE prevalence ranging from 3 percent to 41 percent of men over 18, but the great majority estimate a prevalence of 20 to 30 percent—making PE a very common sex problem.There is a common misconception that younger men are more likely to develop premature ejaculation and that its frequency decreases with age. Prevalence studies have indicated, however, that rates of PE are relatively constant across age groups.
- Intractability
- Premature ejaculation (PE) is generally not considered an intractable condition. It can often be managed and treated effectively with a combination of behavioral techniques, psychological counseling, and medications such as selective serotonin reuptake inhibitors (SSRIs) or topical anesthetics. In some cases, a combination of treatments may be necessary for optimal results.
- Disease Severity
- Premature ejaculation (PE) is not typically classified by disease severity in the same way as other medical conditions. Instead, it is considered a sexual dysfunction characterized by the inability to control ejaculation sufficiently for both partners to enjoy sexual activity. It can lead to personal distress, interpersonal difficulties, and can significantly impact the quality of life. The severity can vary from occasional episodes to persistent issues in nearly all sexual encounters. Evaluating and managing PE often involves a combination of behavioral techniques, counseling, and sometimes pharmacological treatments.
- Healthcare Professionals
- Disease Ontology ID - DOID:13709
- Pathophysiology
-
Premature ejaculation (PE) is characterized by ejaculation that occurs sooner than desired, either before or shortly after penetration, causing distress or frustration. The exact pathophysiology of PE is complex and not fully understood, but it is believed to involve multiple factors:
1. **Neurobiological factors**:
- Abnormal serotonin levels: Serotonin is a neurotransmitter that plays a key role in ejaculation. Low levels of serotonin in certain brain regions may lead to reduced latency to ejaculation.
- Nervous system hypersensitivity: Increased sensitivity of penile nerve receptors may result in quicker ejaculation.
2. **Psychological factors**:
- Anxiety: Performance anxiety or other forms of psychological stress can play a significant role in PE.
- Behavioral patterns: Learned behaviors from adolescence or early sexual experiences can contribute to the condition.
3. **Genetic factors**:
- Family history: There may be a hereditary component, with some individuals genetically predisposed to PE.
4. **Hormonal factors**:
- Hormonal imbalances: Abnormal levels of hormones like testosterone could potentially influence ejaculatory control.
5. **Penile hypersensitivity**:
- Some cases of PE may be due to heightened sensitivity of the penile skin, leading to quicker triggering of the ejaculatory reflex.
Research is ongoing to better understand the interplay of these factors in the pathophysiology of PE. - Carrier Status
- Premature ejaculation is a condition related to the timing of ejaculation during sexual activity and is not considered to be a genetic disorder or one that would have a "carrier status." Therefore, the concept of carrier status does not apply to this condition. It is typically influenced by psychological, biological, or relational factors and can be managed with various therapeutic approaches.
- Mechanism
- The physical process of ejaculation requires two actions: emission and expulsion. The emission is the first phase. It involves deposition of fluid from the ampullary vas deferens, seminal vesicles and prostate gland into the posterior urethra. The second phase is the expulsion phase. It involves closure of bladder neck, followed by the rhythmic contractions of the urethra by pelvic-perineal and bulbospongiosus muscle and intermittent relaxation of the external male urethral sphincter.Sympathetic motor neurons control the emission phase of ejaculation reflex, and expulsion phase is executed by somatic and autonomic motor neurons. These motor neurons are located in the thoracolumbar and lumbosacral spinal cord and are activated in a coordinated manner when sufficient sensory input to reach the ejaculatory threshold has entered the central nervous system.
- Treatment
-
Premature ejaculation (PE) treatment options include behavioral techniques, medications, and therapy:
1. **Behavioral Techniques**: These include the "stop-start" method and the "squeeze" technique to help delay ejaculation.
2. **Medications**:
- **Selective Serotonin Reuptake Inhibitors (SSRIs)**: Drugs such as sertraline, paroxetine, and fluoxetine, which can delay ejaculation.
- **Topical Anesthetics**: Lidocaine or prilocaine creams or sprays applied to the penis to reduce sensitivity.
- **Phosphodiesterase-5 Inhibitors**: Medications like sildenafil (Viagra) may be used in conjunction with SSRIs.
3. **Therapy**: Counseling or sex therapy to address any psychological contributing factors such as anxiety, stress, or relationship issues.
Consultation with a healthcare provider is recommended for appropriate diagnosis and treatment selection. - Compassionate Use Treatment
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For premature ejaculation, off-label and experimental treatments may include:
1. **Dapoxetine:** Originally an antidepressant, it's used for its ability to delay ejaculation.
2. **Selective Serotonin Reuptake Inhibitors (SSRIs):** Medications like sertraline, fluoxetine, and paroxetine can be used off-label to delay ejaculation.
3. **Topical Agents:** Lidocaine-prilocaine creams or sprays can be applied to reduce penile sensitivity.
4. **Phosphodiesterase Type 5 Inhibitors:** Medications like sildenafil (Viagra) and tadalafil (Cialis) have been explored for their potential benefits in delaying ejaculation.
5. **Tramadol:** Originally used for pain relief, it has shown some efficacy in delaying ejaculation when taken off-label.
6. **Behavioral Techniques and Psychotherapy:** Counseling and techniques like the start-stop method or squeeze technique can be effective.
It’s important to consult a healthcare provider for personalized advice and to discuss potential risks and benefits of these treatments. - Lifestyle Recommendations
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### Lifestyle Recommendations for Premature Ejaculation:
1. **Exercise Regularly**: Engage in regular physical activity to improve overall health and reduce stress.
2. **Healthy Diet**: Maintain a balanced diet rich in fruits, vegetables, lean proteins, and whole grains.
3. **Stress Management**: Practice stress-reducing techniques such as meditation, yoga, or deep-breathing exercises.
4. **Limit Alcohol and Avoid Drugs**: Reduce alcohol consumption and avoid recreational drugs as they can affect sexual performance.
5. **Quit Smoking**: Smoking can impair circulation and contribute to sexual dysfunction.
6. **Open Communication**: Discuss openly with your partner to reduce anxiety and build intimacy.
7. **Consistent Sleep Schedule**: Ensure adequate and quality sleep to improve overall health and reduce stress.
8. **Pelvic Floor Exercises**: Strengthen pelvic floor muscles through exercises like Kegels to improve control.
9. **Scheduled Intimacy**: Engage in regular, scheduled sexual activity to reduce performance pressure.
10. **Seek Professional Help**: Consider consulting a healthcare professional for personalized advice and potential therapy if needed. - Medication
- Dapoxetine, a selective serotonin reuptake inhibitor (SSRI), has been approved for the treatment of premature ejaculation in several countries. Other SSRIs are used off-label to treat PE, including fluoxetine, paroxetine, citalopram, escitalopram and clomipramine. The opioid tramadol, an atypical oral analgesic is also used. Results have found PDE5 inhibitors to be effective in combination treatment with SSRIs. The full effects of these medications typically emerge after 2-3 weeks, with results indicating about ejaculatory delay varying between 6–20 times greater than before medication. Premature ejaculation can return upon discontinuation, and the side effects of these SSRIs can also include anorgasmia, erectile dysfunction, and diminished libido.Topical anesthetics such as lidocaine and benzocaine that are applied to the tip and shaft of the penis have also been used. They are applied 10–15 minutes before sexual activity and have fewer potential side effects as compared to SSRIs. However, this is sometimes disliked due to the reduction of sensation in the penis as well as for the partner (due to the medication rubbing onto the partner). Another research was conducted in 21 men who were randomized (15 treatment, 6 placebo) and had complete follow-up data. Baseline mean ± standard deviation IELT was 74.3 ± 31.8 vs 84.9 ± 29.8 seconds among the treatment and placebo groups, respectively (p=0.39). After 2 months, men in the treatment group had significant improvement in IELT with a mean increase of 231.5 ± 166.9 seconds (95% confidence interval of 139-323 seconds) which was significantly greater than men on placebo (94.2 ± 67.1 seconds, p= 0.043).
- Repurposable Drugs
-
Repurposable drugs for premature ejaculation include:
1. **Selective Serotonin Reuptake Inhibitors (SSRIs):**
- **Sertraline**
- **Paroxetine**
- **Fluoxetine**
These drugs are primarily used for depression and anxiety but have been shown to delay ejaculation.
2. **Tramadol:**
An opioid analgesic that can also help delay ejaculation.
3. **Clomipramine:**
A tricyclic antidepressant sometimes used off-label for its ejaculation-delaying effects.
4. **Dapoxetine:**
Specifically designed for premature ejaculation but being explored for repurposing in various contexts.
These drugs should always be used under medical supervision due to potential side effects and drug interactions. - Metabolites
- Premature ejaculation (PE) primarily involves neurobiological and psychological factors rather than specific metabolic pathways or metabolites. Therefore, no distinct metabolites are exclusively associated with premature ejaculation. Treatment and management typically focus on behavioral therapy, pharmaceutical interventions, and addressing psychological factors.
- Nutraceuticals
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Nutraceuticals, which are products derived from food sources with extra health benefits in addition to the basic nutritional value, have been explored for managing premature ejaculation. However, the evidence supporting their effectiveness is generally limited and not robustly established. Some common nutraceuticals that are speculated to help include certain amino acids, vitamins, and herbal extracts such as:
1. **L-arginine**: An amino acid that may improve blood flow and erectile function, possibly impacting ejaculation control.
2. **Zinc**: A mineral that plays a role in testosterone production and sexual health.
3. **Ginkgo biloba**: An herbal supplement that might improve blood flow and has been suggested to address sexual dysfunctions.
4. **Maca root**: A Peruvian herb that is often marketed for improving sexual desire and performance.
It is essential to consult with a healthcare provider before using any nutraceuticals for the treatment of premature ejaculation to ensure safety and efficacy tailored to individual health needs. - Peptides
-
Premature ejaculation (PE) is a common sexual dysfunction in men. Here are details regarding peptides and nanotechnologies in relation to PE:
1. **Peptides:**
- Some research is exploring the role of peptides in treating PE. Oxytocin antagonists, a type of peptide, have been investigated for their potential to delay ejaculation.
- Another peptide, melanocortin, has been studied for its effects on sexual function and arousal, which might indirectly impact PE.
2. **Nanotechnologies:**
- Nanotechnology applications in PE treatment are still in the early stages. However, advancements could lead to new delivery systems for medications that enhance absorption and efficacy.
- Potential future research might involve nanocarriers to deliver drugs precisely to target areas, minimizing side effects and maximizing therapeutic benefits for PE.
Current mainstay treatments for PE include behavioral techniques, pharmacotherapy (like SSRIs), and topical anesthetics. Always consult a healthcare provider for personalized advice and treatment options.