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Current evidence supports an average [[intravaginal ejaculation latency time]] ('''IELT''') of six and a half minutes in 18–30 year olds.<ref>{{cite web |url=http://www.medicine.ox.ac.uk/bandolier/band137/b137-4.html |title=Ejaculation delay: what's normal? [July 2005; 137-4] |accessdate=2007-10-21 |work=}}</ref><ref>{{cite journal |author=Waldinger MD, Quinn P, Dilleen M, Mundayat R, Schweitzer DH, Boolell M |title=A multinational population survey of intravaginal ejaculation latency time |journal=The journal of sexual medicine |volume=2 |issue=4 |pages=492–7 |year=2005 |pmid=16422843 |doi=10.1111/j.1743-6109.2005.00070.x}}</ref> If the disorder is defined as an IELT percentile below 2.5, then premature ejaculation could be suggested by an IELT of less than about 2 minutes.<ref>{{cite journal |author=Waldinger MD, Zwinderman AH, Olivier B, Schweitzer DH |title=Proposal for a definition of lifelong premature ejaculation based on epidemiological stopwatch data |journal=The journal of sexual medicine |volume=2 |issue=4 |pages=498–507 |year=2005 |pmid=16422844 |doi=10.1111/j.1743-6109.2005.00069.x}}</ref> Nevertheless, it is possible that men with abnormally low IELTs could be "happy" with their performance and do not report a lack of control. Likewise, those with higher IELTs may consider themselves premature ejaculators, suffer from detrimental side effects normally associated with premature ejaculation, and even benefit from treatment.
Current evidence supports an average [[intravaginal ejaculation latency time]] ('''IELT''') of six and a half minutes in 18–30 year olds.<ref>{{cite web |url=http://www.medicine.ox.ac.uk/bandolier/band137/b137-4.html |title=Ejaculation delay: what's normal? [July 2005; 137-4] |accessdate=2007-10-21 |work=}}</ref><ref>{{cite journal |author=Waldinger MD, Quinn P, Dilleen M, Mundayat R, Schweitzer DH, Boolell M |title=A multinational population survey of intravaginal ejaculation latency time |journal=The journal of sexual medicine |volume=2 |issue=4 |pages=492–7 |year=2005 |pmid=16422843 |doi=10.1111/j.1743-6109.2005.00070.x}}</ref> If the disorder is defined as an IELT percentile below 2.5, then premature ejaculation could be suggested by an IELT of less than about 2 minutes.<ref>{{cite journal |author=Waldinger MD, Zwinderman AH, Olivier B, Schweitzer DH |title=Proposal for a definition of lifelong premature ejaculation based on epidemiological stopwatch data |journal=The journal of sexual medicine |volume=2 |issue=4 |pages=498–507 |year=2005 |pmid=16422844 |doi=10.1111/j.1743-6109.2005.00069.x}}</ref> Nevertheless, it is possible that men with abnormally low IELTs could be "happy" with their performance and do not report a lack of control. Likewise, those with higher IELTs may consider themselves premature ejaculators, suffer from detrimental side effects normally associated with premature ejaculation, and even benefit from treatment.


==Diagnostic issues==
==Treatment==
When deciding the appropriate treatment, it is important for physician to distinguish PE as a "complaint" versus PE as a "syndrome".<ref name="ReferenceA">{{cite web|last=Waldinger|first=MD|title=Changing paradigms from a historical DSM-III and DSM-IV view toward an evidence based definition of premature ejaculation. Part II: Proposals for DSM-V and ICD-11|work=Proposals for DSM-V and ICD-11|publisher=J Sex Med}}</ref> About 20 years ago, PE was classified into "lifelong PE" and "acquired PE".<ref>{{cite web|last=Godpodinoff|first=ML|title=Premature ejaculation: clinical subgroups and etiology|publisher=J Sex Marital Ther. Vol15:130|accessdate=1989}}</ref> Recently, a new classification of PE was proposed based on controlled clinical and epidemiological stopwatch studies,<ref name="ReferenceA"/> and it included 2 other PE syndromes: "natural variable PE" and "premature-like ejaculatory dysfunction". Only individuals with lifelong PE with IELT <1 to 1.5 minutes should require medication as a first option, along with or without therapy. For those who fall into one of the other categories, treatment should consist of patient reassurance, behavior therapy, and/or psychoeducation to explain irregular early ejaculation is a normal variation.<ref>{{cite web|last=Waldinger|first=Marcel D.|title=New Insights in Premature Ejaculation|url=http://www.psychiatrictimes.com/dsm-5/content/article/10168/54676|work=Psychiatric Times Vol. 24 No. 9|publisher=Psychiatric Times|accessdate=1 August 2007}}</ref><ref>{{cite journal|last=Serefoglu|first=EC|coauthors=Yaman O, Cayan S, et al.|title=Prevalence of the complaint of ejaculating prematurely and the four premature ejaculation syndromes|journal=J Sex Med|year=2011|issue=8|pages=540–8}}</ref>
When deciding the appropriate treatment, it is important for physician to distinguish PE as a "complaint" versus PE as a "syndrome".<ref name="ReferenceA">{{cite web|last=Waldinger|first=MD|title=Changing paradigms from a historical DSM-III and DSM-IV view toward an evidence based definition of premature ejaculation. Part II: Proposals for DSM-V and ICD-11|work=Proposals for DSM-V and ICD-11|publisher=J Sex Med}}</ref> About 20 years ago, PE was classified into "lifelong PE" and "acquired PE".<ref>{{cite web|last=Godpodinoff|first=ML|title=Premature ejaculation: clinical subgroups and etiology|publisher=J Sex Marital Ther. Vol15:130|accessdate=1989}}</ref> Recently, a new classification of PE was proposed based on controlled clinical and epidemiological stopwatch studies,<ref name="ReferenceA"/> and it included 2 other PE syndromes: "natural variable PE" and "premature-like ejaculatory dysfunction". Only individuals with lifelong PE with IELT <1 to 1.5 minutes should require medication as a first option, along with or without therapy. For those who fall into one of the other categories, treatment should consist of patient reassurance, behavior therapy, and/or psychoeducation to explain irregular early ejaculation is a normal variation.<ref>{{cite web|last=Waldinger|first=Marcel D.|title=New Insights in Premature Ejaculation|url=http://www.psychiatrictimes.com/dsm-5/content/article/10168/54676|work=Psychiatric Times Vol. 24 No. 9|publisher=Psychiatric Times|accessdate=1 August 2007}}</ref><ref>{{cite journal|last=Serefoglu|first=EC|coauthors=Yaman O, Cayan S, et al.|title=Prevalence of the complaint of ejaculating prematurely and the four premature ejaculation syndromes|journal=J Sex Med|year=2011|issue=8|pages=540–8}}</ref>


==Pharmacological treatments==
[[Dapoxetine]] (Priligy) is a short-acting [[selective serotonin reuptake inhibitor]] (SSRI) marketed for the treatment of premature ejaculation.<ref name="pmid18360636">{{cite journal |author=Kendirci M, Salem E, Hellstrom WJ |title=Dapoxetine, a novel selective serotonin transport inhibitor for the treatment of premature ejaculation |journal=Ther Clin Risk Manag |volume=3 |issue=2 |pages=277–89 |year=2007 |month=June |pmid=18360636 |doi= 10.2147/tcrm.2007.3.2.277|url= |pmc=1936309}}</ref> Dapoxetine is the only drug with regulatory approval for such an indication. Currently, it is approved in several European countries, including Finland, Sweden, Portugal, Austria and Germany.<ref>[http://www.presseecho.de/vermischtes/NA3731393429.htm PRILIGY (Dapoxetin) erhält die Zulassung für die Behandlung der Ejaculatio praecox in Deutschland]</ref><ref name="tmnews">[http://www.tradingmarkets.com/.site/news/Stock%20News/2170588/ Janssen-Cilag EMEA announces receipt of first regulatory approvals for Priligy for PE in Finland and Sweden], February 11, 2009</ref> Dapoxetine is currently waiting for [[U.S. Food and Drug Administration]] (FDA) approval after concluding the [[Phase III]] study, which included participants from 25 other countries, including the United States. In this diverse population, dapoxetine significantly improved all aspects of PE and was generally well tolerated.<ref>{{cite journal|last=McMahon|first=CG|coauthors=Althof, SE, Kaufman, JM, Buvat, J, Levine, SB, Aquilina, JW, Tesfaye, F, Rothman, M, Rivas, DA, Porst, H|title=Efficacy and safety of dapoxetine for the treatment of premature ejaculation: integrated analysis of results from five phase 3 trials.|journal=The journal of sexual medicine|date=2011 Feb|volume=8|issue=2|pages=524–39|doi=10.1111/j.1743-6109.2010.02097.x.|pmid=21059176}}</ref>
[[Dapoxetine]] (Priligy) is a short-acting [[selective serotonin reuptake inhibitor]] (SSRI) marketed for the treatment of premature ejaculation.<ref name="pmid18360636">{{cite journal |author=Kendirci M, Salem E, Hellstrom WJ |title=Dapoxetine, a novel selective serotonin transport inhibitor for the treatment of premature ejaculation |journal=Ther Clin Risk Manag |volume=3 |issue=2 |pages=277–89 |year=2007 |month=June |pmid=18360636 |doi= 10.2147/tcrm.2007.3.2.277|url= |pmc=1936309}}</ref> Dapoxetine is the only drug with regulatory approval for such an indication. Currently, it is approved in several European countries, including Finland, Sweden, Portugal, Austria and Germany.<ref>[http://www.presseecho.de/vermischtes/NA3731393429.htm PRILIGY (Dapoxetin) erhält die Zulassung für die Behandlung der Ejaculatio praecox in Deutschland]</ref><ref name="tmnews">[http://www.tradingmarkets.com/.site/news/Stock%20News/2170588/ Janssen-Cilag EMEA announces receipt of first regulatory approvals for Priligy for PE in Finland and Sweden], February 11, 2009</ref> Dapoxetine is currently waiting for [[U.S. Food and Drug Administration]] (FDA) approval after concluding the [[Phase III]] study, which included participants from 25 other countries, including the United States. In this diverse population, dapoxetine significantly improved all aspects of PE and was generally well tolerated.<ref>{{cite journal|last=McMahon|first=CG|coauthors=Althof, SE, Kaufman, JM, Buvat, J, Levine, SB, Aquilina, JW, Tesfaye, F, Rothman, M, Rivas, DA, Porst, H|title=Efficacy and safety of dapoxetine for the treatment of premature ejaculation: integrated analysis of results from five phase 3 trials.|journal=The journal of sexual medicine|date=2011 Feb|volume=8|issue=2|pages=524–39|doi=10.1111/j.1743-6109.2010.02097.x.|pmid=21059176}}</ref>


Revision as of 23:47, 25 April 2013

This article is about the condition. For the music group, see Premature Ejaculation (band).
Premature ejaculation
SpecialtyPsychiatry, psychology Edit this on Wikidata

Premature ejaculation (PE) occurs when a man experiences orgasm, expels semen sooner than he would like. It has also been called rapid ejaculation, rapid climax, premature climax, or early ejaculation. Exact definitions vary, and there is no consensus regarding any specific amount of time as a cut-off defining "premature." A common guideline if when ejaculation occurs within two minutes of penetration.[1]

Several possible subclassifications have been discussed, but none is in universal usage. Primary premature ejaculation refers to lifelong experience of the problem (since puberty), and secondary premature ejaculation reference to the problem beginning later in life. It has also been subdivided into global premature ejaculation, when it occurs with all partners and contexts, and situational premature ejaculation, when it occurs in some situations or with specific partners.[2]

Most men experience premature ejaculation at least once in their lives. Because there is great variability in both how long it takes to ejaculate and how long both partners want sex to last, if at all, an accurate prevalence rate is hard to determine—estimates range from as low as 5% to as high as 30%.[1]

Possible physical factors

Mechanism of ejaculation

Main article: Ejaculation

The physical process of ejaculation requires two actions: emission and expulsion.

Mechanism of Ejaculation

The emission is the first phase. It involves deposition fluid from the ampullary vas deferens, seminal vesicles, and prostate gland into the posterior urethra.[3] 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 external urethral sphincters.[4]

It is believed that the neurotransmitter serotonin (5HT) plays a central role in modulating ejaculation. Several animal studies have demonstrated its inhibitory effect on ejaculation. Therefore, it is perceived that low level of serotonin in the synaptic cleft in these specific areas in the brain could cause premature ejaculation. This theory is further supported by the proven effectiveness of selective serotonin reuptake inhibitors (SSRIs), which increase serotonin level in the synapse, in treating Premature Ejaculation.

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.[5][6]

Several areas in the brain, and especially the nucleus paragigantocellularis, have been identified to be involved in ejaculatory control.[7] Scientists have long suspected a genetic link to certain forms of premature ejaculation. In one study, ninety-one percent of men who have had premature ejaculation for their entire lives also had a first-relative with lifelong premature ejaculation. Other researchers have noted that men who have premature ejaculation have a faster neurological response in the pelvic muscles. Simple exercises commonly suggested by sex therapists can significantly improve ejaculatory control for men with premature ejaculation caused by neurological factors[citation needed]. Often, these men may benefit from anti-anxiety medication or SSRIs, such as sertraline, paroxetine or Dapoxetine, as these slow down ejaculation times.[8] Some men prefer using anaesthetic creams; however, these creams may deaden the partner's sensations, also, and are not generally recommended by sex therapists.

Intromission time

The 1948 Kinsey Report reported that three quarters of men ejaculate within two minutes of penetration in over half of their sexual encounters.[9]

Current evidence supports an average intravaginal ejaculation latency time (IELT) of six and a half minutes in 18–30 year olds.[10][11] If the disorder is defined as an IELT percentile below 2.5, then premature ejaculation could be suggested by an IELT of less than about 2 minutes.[12] Nevertheless, it is possible that men with abnormally low IELTs could be "happy" with their performance and do not report a lack of control. Likewise, those with higher IELTs may consider themselves premature ejaculators, suffer from detrimental side effects normally associated with premature ejaculation, and even benefit from treatment.

Diagnostic issues

When deciding the appropriate treatment, it is important for physician to distinguish PE as a "complaint" versus PE as a "syndrome".[13] About 20 years ago, PE was classified into "lifelong PE" and "acquired PE".[14] Recently, a new classification of PE was proposed based on controlled clinical and epidemiological stopwatch studies,[13] and it included 2 other PE syndromes: "natural variable PE" and "premature-like ejaculatory dysfunction". Only individuals with lifelong PE with IELT <1 to 1.5 minutes should require medication as a first option, along with or without therapy. For those who fall into one of the other categories, treatment should consist of patient reassurance, behavior therapy, and/or psychoeducation to explain irregular early ejaculation is a normal variation.[15][16]

Pharmacological treatments

Dapoxetine (Priligy) is a short-acting selective serotonin reuptake inhibitor (SSRI) marketed for the treatment of premature ejaculation.[17] Dapoxetine is the only drug with regulatory approval for such an indication. Currently, it is approved in several European countries, including Finland, Sweden, Portugal, Austria and Germany.[18][19] Dapoxetine is currently waiting for U.S. Food and Drug Administration (FDA) approval after concluding the Phase III study, which included participants from 25 other countries, including the United States. In this diverse population, dapoxetine significantly improved all aspects of PE and was generally well tolerated.[20]

Tramadol (Ultram or Tramal) is an FDA approved atypical oral analgesic for mild pain. It is atypical because it is similar to an opioid, is an agonist at the mu receptor, but also is similar to an anti-depressant in that it increases levels of serotonin and norepinephrine. Tramadol also has few side effects, low abuse potential, and increases (IELT) 4-20 fold in greater than 90% of men.,[21][22]

Clomipramine (Anafranil) is sometimes prescribed to treat PE. One side effect of the drug can help delay ejaculatory response. The side effect is described by the Mayo Clinic as "Increased [sic] sexual ability, desire, drive, or performance."[23]

Desensitizing topical medications that are applied to the tip and shaft of the penis can also be used to treat premature ejaculation. These topical medications are applied on an "as needed" basis 10–15 minutes before anticipated sexual activity and have fewer potential systemic side effects as compared to pills taken orally.[24] However, use of these topical medications have in the past been associated with loss of penile sensation, and reduction of sensation for the partner due to exposure.[25] Penis insensitivity and transference to the partner are greatly reduced when using new topical anesthetic sprays based on absorption technology[26] which enable the active ingredient to penetrate through the surface skin of the penis (stratum corneum) to the sensory nerves which reside in the dermis. Any residual surface medication can be wiped off before sexual activity to further reduce partner concerns. Absorption of the anesthetic can be achieved with a eutectic system. Two products with eutectic systems have been shown to be effective in treating premature ejaculation, EMLA,[27] available by prescription (off-label use), and PSD502.[28] Both products contain both lidocaine and prilocaine. At the time of this entry, PSD502 has not obtained FDA approval in the United States. A third product, Promescent, achieves a eutectic formula with lidocaine only and is therefore available in the U.S., over the counter, by way of FDA monograph 21 CFR 348.10.[29]

Another method, intracavernous pharmacotherapy, involves injecting a vasodilator drug directly into the penis to help men control premature ejaculation and maintain their erection. It has been proven to be effective in over seventy percent of test patients.[citation needed] This method is used by companies such as Florida Men's Medical Clinic, Boston Medical Group and others.[30]

See also

References

  1. ^ a b Waldinger M.D., Berendsen H.H., Blok B.F., et al. Premature Ejaculation and Serotonergic Anti-Depressants - Induced Delayed Ejaculation: The Involvement of the Serotenergic System Behavioural Brains Res. 1998 92(2):111-118
  2. ^ Godpodinoff M.L. Premature Ejaculation: Clinical Subgroups and Etiology Journal of Sex and Marital Therapy 1989; 15(2):130-134
  3. ^ Böhlen D, Hugonnet CL, Mills RD, Weise ES, Schmid HP (2000). "Five meters of H(2)O: the pressure at the urinary bladder neck during human ejaculation". Prostate. 44 (4): 339–41. doi:10.1002/1097-0045(20000901)44:4<339::AID-PROS12>3.0.CO;2-Z. PMID 10951500.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  4. ^ Master VA, Turek PJ (2001). "Ejaculatory physiology and dysfunction". Urol. Clin. North Am. 28 (2): 363–75, x. doi:10.1016/S0094-0143(05)70145-2. PMID 11402588.
  5. ^ deGroat WC, Booth AM (1980). "Physiology of male sexual function". Ann. Intern. Med. 92 (2 Pt 2): 329–31. PMID 7356224.
  6. ^ Truitt WA, Coolen LM (2002). "Identification of a potential ejaculation generator in the spinal cord". Science. 297 (5586): 1566–9. doi:10.1126/science.1073885. PMID 12202834.
  7. ^ Coolen LM, Olivier B, Peters HJ, Veening JG (1997). "Demonstration of ejaculation-induced neural activity in the male rat brain using 5-HT1A agonist 8-OH-DPAT". Physiol. Behav. 62 (4): 881–91. doi:10.1016/S0031-9384(97)00258-8. PMID 9284512.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  8. ^ http://www.healthfinder.gov/newsletters/relation092506.asp
  9. ^ Kinsey, Alfred (1948), Sexual Behavior in the Human Male, Philadelphia: W. B. Saunders Co
  10. ^ "Ejaculation delay: what's normal? [July 2005; 137-4]". Retrieved 2007-10-21.
  11. ^ Waldinger MD, Quinn P, Dilleen M, Mundayat R, Schweitzer DH, Boolell M (2005). "A multinational population survey of intravaginal ejaculation latency time". The journal of sexual medicine. 2 (4): 492–7. doi:10.1111/j.1743-6109.2005.00070.x. PMID 16422843.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  12. ^ Waldinger MD, Zwinderman AH, Olivier B, Schweitzer DH (2005). "Proposal for a definition of lifelong premature ejaculation based on epidemiological stopwatch data". The journal of sexual medicine. 2 (4): 498–507. doi:10.1111/j.1743-6109.2005.00069.x. PMID 16422844.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  13. ^ a b Waldinger, MD. "Changing paradigms from a historical DSM-III and DSM-IV view toward an evidence based definition of premature ejaculation. Part II: Proposals for DSM-V and ICD-11". Proposals for DSM-V and ICD-11. J Sex Med. {{cite web}}: Missing or empty |url= (help)
  14. ^ Godpodinoff, ML. "Premature ejaculation: clinical subgroups and etiology". J Sex Marital Ther. Vol15:130. {{cite web}}: |access-date= requires |url= (help); Check date values in: |accessdate= (help); Missing or empty |url= (help)
  15. ^ Waldinger, Marcel D. "New Insights in Premature Ejaculation". Psychiatric Times Vol. 24 No. 9. Psychiatric Times. Retrieved 1 August 2007.
  16. ^ Serefoglu, EC (2011). "Prevalence of the complaint of ejaculating prematurely and the four premature ejaculation syndromes". J Sex Med (8): 540–8. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help)
  17. ^ Kendirci M, Salem E, Hellstrom WJ (2007). "Dapoxetine, a novel selective serotonin transport inhibitor for the treatment of premature ejaculation". Ther Clin Risk Manag. 3 (2): 277–89. doi:10.2147/tcrm.2007.3.2.277. PMC 1936309. PMID 18360636. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link) CS1 maint: unflagged free DOI (link)
  18. ^ PRILIGY (Dapoxetin) erhält die Zulassung für die Behandlung der Ejaculatio praecox in Deutschland
  19. ^ Janssen-Cilag EMEA announces receipt of first regulatory approvals for Priligy for PE in Finland and Sweden, February 11, 2009
  20. ^ McMahon, CG (2011 Feb). "Efficacy and safety of dapoxetine for the treatment of premature ejaculation: integrated analysis of results from five phase 3 trials". The journal of sexual medicine. 8 (2): 524–39. doi:10.1111/j.1743-6109.2010.02097.x.. PMID 21059176. {{cite journal}}: Check |doi= value (help); Check date values in: |date= (help); Unknown parameter |coauthors= ignored (|author= suggested) (help)
  21. ^ Herrera (2011-10-28). "Scientific Studies/Articles: Premature Ejaculation and Successful Tramadol Treatment". Retrieved 2011-11-15.
  22. ^ Kaynar, M. & Abdel-Hamid, I.A. On-Demand Tramadol Hypochloride Use in Premature Ejaculation Treatment. Journal of Urology 2012; 71(31):145-149
  23. ^ "Clomipramine Side Effects". Mayo Clinic. Retrieved 28 October 2011.
  24. ^ An overview of pharmacotherapy in premature ejaculation. Porst H. J Sex Med. 2011 Oct. 8 4:335-41. doi: 10.1111/j.1743-6109.2011.02451.x
  25. ^ MacCarty E.J. & Dinsmore W.W. Premature Ejaculation: Treatment Update International Journal of STD AIDS 2010; 21:77-81
  26. ^ Preparation and characterization of two-phase melt systems of lidocaine. Kang L. Jun HW, Mani N. Int J Pharm 2001 Jul 3; 222(1)35-44
  27. ^ Atan, A. Comparison of efficacy of sildenafil-only, sildenafil plus topical EMLA cream, and topical EMLA-cream-only in treatment of premature ejaculation, Urology, 2006 Feb; 67(2):388-91
  28. ^ Carson, C. Improved ejaculatory latency, control and sexual satisfaction when PSD502 is applied topically in men with premature ejaculation: results of a phase III, double-blind, placebo-controlled study; J Sex Med 2010 Sep 7(9):3179-89. doi: 10.1111/j.1743-6109.2010.01913.x
  29. ^ http://www.fda.gov/downloads/Drugs/DevelopmentApprovalProcess/DevelopmentResources/Over-the-CounterOTCDrugs/StatusofOTCRulemakings/UCM078147pdf
  30. ^ Vasoactive intracavernous pharmacotherapy for the treatment of erectile impotence in men with spinal cord injury. BioMedSearch, 14. A A Sidi; J S Cameron; D D Dykstra; Y Reinberg; P H Lange, (2007)

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