Premature Ejaculation: You're Not Alone

Rapid Ejaculation ??????

You're Not Alone

Ejaculation involves a buildup of seminal fluid within the urethra and the subsequent expulsion of fluid during intercourse. This process is controlled by the sympathetic nervous system and requires coordination of the prostate, seminal vesicles, bladder neck, urethra and pelvic floor muscles. Orgasm is a distinctly separate purely emotional event which manifests itself a good, or some would say 'high' sexual feeling. Although ejaculation can occur without orgasm and orgasm can occur without ejaculation, these events typically occur together in men. However, for purposes of this discussion concerning rapid ejaculation (RE) the term 'ejaculation' will be considered to include orgasm.

The American Urological Association defines rapid ejaculation (RE) as "Ejaculation that occurs sooner than desired, either before or shortly after penetration, causing distress to one or both partners." Rapid ejaculation, perhaps more frequently called 'premature' ejaculation, is the most common male sexual problem occurring in about 25-30 percent of men. Hundreds of millions of men worldwide likely have this RE. Unlike erectile dysfunction (ED) which becomes more prevalent with advancing age, RE is equally as prevalent at any age. Practically speaking, just as many men in their sixties have RE as do men in their twenties. With some exception, RE tends to be a life long problem.

... no man desires to stay longer than he who cannot.

Obviously RE is very common, but is it truly a medical problem? It is not physically harmful, but can it have other ill effects? Psychological studies do suggest that RE really is a problem which may interfere with a man's self esteem. Female partners of men with RE may not understand this condition to be a real medical problem. This may cause dissatisfaction on the part of both partners and lead to conflicts in relationships. Men who experience RE are often reluctant to start new relationships and many are too embarrassed to discuss the problem with a partner, or even with a doctor. Despite this, affected individuals are typically very concerned about their partners sexual satisfaction, and their own inability to "perform." That is, no man desires to stay longer than he who cannot.

The distinction between RE and ED is an important one. The National Institutes of Health (NIH) defines erectile dysfunction / impotence as, "The inability to achieve or maintain an erection sufficient for satisfactory sexual performance." Obviously, ED refers to hardness or rigidity of the penis, whereas RE refers to ejaculation (with or without orgasm). While RE and ED sometimes occur together, the cause and hence the treatments for each of these problems is often different. It is important that patients understand the difference between RE and ED so that they may be better able to discuss the symptoms to their doctors.

... there are very real physical causes.

As was the case with ED, researchers and doctors traditionally believed that RE was the result of a purely behavioral problem. Older literature suggested that RE was a behavior somehow related to early sexual experiences. Again as with ED, there indeed may be an emotional component with RE, but newer research suggests that there are very real physical causes. As with many medical discoveries, advancements in the understanding of RE seems to have occurred much by chance. In clinical studies performed using medications for depression, it came to light that sexual side effects were common with certain antidepressant medications. This led to the off-label (not FDA approved for the treatment of RE) use of medications such as clomipramine (Anafranil), paroxetine (Paxil), fluoxetine (Prozac) and sertraline (Zoloft) in attempt to help men with RE.

While these medications are effective, there are problems with these medications including a slow onset of action and side effects such as drowsiness, decreased libido and nausea. These medications work best when either taken on an every day basis or when taken daily for several weeks before beginning to use the medications on an "only when needed (PRN)" basis. So while the medicines work best when used daily, there are more side effects with daily use. When these medicines are not used every day, it is necessary to take the medications at least four hours in advance of intercourse. Just as is the problem with some ED medications, it can be difficult to guess the timing of intercourse, on any particular day. Thus, men may take medications and suffer side effects even though they may not have intercourse or they may unexpectedly find themselves in a position where the medication is needed sooner than it is possible for it to work. So while these medications represent a significant advancement over sex therapy alone, there is still work to be done.

... dapoxetine is a new SSRI medication specifically

developed for men who suffer with RE.

Along those lines, dapoxetine is a new SSRI medication which has been specifically developed for men who suffer with RE. The medication shows great promise. Its onset of action is relatively rapid at about 1.5 hours and it is quickly cleared from the blood stream. The most common possible side effect of dapoxetine use is nausea, which is lessened when the medication is taken with food. It has no known interactions with alcohol or popular ED medications like Viagra. Currently dapoxetine is under review by the FDA and approval is expected soon.

Several other medications, some similar dapoxitien and other antidepressants, are under study. It appears that rapid progress is being made with regard to the problem of rapid ejaculation. It appears that real help is on the horizon.

... men remain interested ...

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(You may also visit the "Make-the-Call" ED Help Line, Sexual Function Health Council of AFUD , Peyronies Disease)

If you would like additional information you may find Dr. Watson's book, Impotence -- Its Reversible, in most Louisiana public libraries. If your library does not have enough copies of this publication, contact us.

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