Premature Ejaculation Flashcards
How common is premature ejaculation?
Very - about 20-25% of men in some studies suffer from it
What is the medical definition of premature ejaculation?
Poor ejaculatory control
Associated bother - patient, partner, or both
Ejaculation within 2 minutes of penetration
What are the types of premature ejaculation?
Lifelong - since first sexual activity
Acquired - a new pattern develops
Why does distinguishing between acquired and lifelong premature ejaculation matter?
Lifelong requires no testing - just counseling and treatment
Men with acquired PE are often overweight, have HTN, sexual desire disorder, diabetes, chronic prostatitis, and ED. Many of the things listed above are associated with ED -PE may be an adaptive response to men with ED who are concerned about maintaining an erection for entire duration of intercourse
What are some possible causes of premature ejaculation
Erectile dysfunction - as a coping mechanism
High or low testosterone - ask about supplements
Prostatitis, LUTS, - ask about painful ejaculations - about 30-60% of men with acquired PE have prostatitis
Is circumcision an effective treatment for premature ejaculation?
There is no research showing a benefit nor has any correlation between circumcision and EJ been shown in the research
What are the major categories of treatment for premature ejaculation?
Cognitive and behavioral
Sensation reduction strategies
Medications
What are some cognitive behavioral treatments of premature ejaculation
Cognitive - work with therapist on thoughts and feels around performance and sex
Behavioral
-masterbate before sex/dates
-Bring partner to orgasm during foreplay before starting intercourse
-Trying different sexual positions and speeds
-Stop start technique
-Squeezed technique
-Sensate focus exercises
What are strategies to reduce sensation in men with premature ejaculation
Wear condoms until the woman has orgasmed
Use topical anesthetic
What medications are available for premature ejaculation
Paroxetine is first line - this is best, though other SSRIs are effective too
With clomipramine being second choice
In men with ED a phosphodiesterase inhibitor is often used
Some meds can be used PRN 1-2 hours before sex - SSRIs, tramadol
What is the stop start technique
You engage in penis stimulation until just before orgasm and then stop until the urge to orgasm goes away.
Repeat this several times - this teaches better awareness and control
What is the squeeze technique for premature ejaculation?
begin sexual activity with the penis
Continue until almost ready to ejaculate
Stop and squeeze the penis between the head and shaft until the urge to ejaculate stops
What are sensate focus exercises for premature ejaculation
This is a process that a sexual therapist guides a couple through to reduce performance anxiety and enhance trust and communication in sexual activity
