Premature Ejaculation India

What is premature ejaculation?

premature ejaculation is a male sexual dysfunction characterized by ejaculation which always or nearly always occurs prior to or within about one minute of vaginal penetration; and, inability to delay ejaculation on all or nearly all vaginal penetrations; and, negative personal consequences, such as distress, bother, frustration, and/or the avoidance of Sexual Intimacy

Incidence of premature ejaculation

Incidence of premature ejaculation India
Our experience – 10%
So PE is a common problem

Grading Severity of premature ejaculation

  • Orgasm before entry
  • Orgasm on entry
  • Orgasm after thrusting
    • Genuinely affecting sexual satisfaction
    • Not really a problem, patient has misconceptions

    Grading Severity of premature ejaculation India
    classification of premature ejaculation India

    premature ejaculation – Etiological Classification

    • Situational: Only during certain situations, otherwise normal
    • Global : Primary- Inherent Secondary- Psychogenic Organic.

    Two types of Global premature ejaculation

    • Primary (lifelong) premature ejaculation
      • Biological and genetic basis
      • Penile hypersensitivity
      • Hyperexcitable ejaculatory reflex
      • 5-HT receptor dysfunction
      • Genetic predisposition
    • Acquired PE
      • Develops after a period of normal control
      • Anxiety, stress
      • Increased sexual arousability
      • Infrequent sexual intercourse
      • Relationship problems
      • LUTS
      • Chronic prostatitis

    Treatment of premature ejaculation

    • Behavioural therapy
      • Stop-Start – Semans, 1956
      • Squeeze technique – Masters & J, 1970
      • BulboCavernosus Contractions exercises
    • Pharmacological
      • Topical – anaesthetic sprays, creams
      • Opioid – Tramadol
      • SSRI – long acting; short acting
    • PDE5-inhibitors
      • Intra-Cavernosal Injections

    Psychological Treatment of premature ejaculation

    • Stop-Squeez Method
    • developed by Semans, later adopted by Masters & Johnson
    • Stop-pause or stop-start method advocated by Kaplan
    • 3 Important factors –
      • Man’s attention to and awareness of sexual sensations must be heightened
      • Couple must de-emphasize the focus on coitus and develop other sexual expressions
      • Man must develop behavioral strategies to enhance ejac. control

    Treatment of premature ejaculation

    • Helpful Adjuvant Techniques
    • Bulbo Cavernosal Muscles (BSM) exercises
    • Pelvic floor muscles exercises

    Office Management of premature ejaculation

    Incidence of premature ejaculation India

    • Psychotherapy- Involve a clinical psychologist or sex therapist for the treatment of premature ejaculation
    • Pharmacotherapy- Choose a correct regimen, suitable for the patient
    • Adjuvant exercises
    • Topical applications- optional