The Tribune

By DR GREGGORY PINTO

Premature ejaculation is by far the most prevalent sexual dysfunction faced by men. It is defined as a man ejaculating before or very soon after vaginal penetration, or the inability to delay ejaculation.

There are two classifications of premature ejaculation: primary and secondary.

Primary or lifelong premature ejaculation involves every sexual experience ending too soon.

Secondary or acquired premature ejaculation is suffered by men who only sparingly suffer from premature ejaculation and have a history of sexual episodes without the disorder.

It is estimated that one in three men worldwide experience premature ejaculation.

Tens of thousands of Bahamian men last one, two or three minutes and they have profound disappointment in their sexual lives.

This affliction provides frustration and anguish to both partners. Men often suffer from low self-esteem and even depression due to their unsatisfactory sexual experiences.

Every sexual escapade that ends too soon leaves these men feeling like a failure.

Mammals in general experience very short sexual interludes, whether it be lions, tigers, monkeys or bears. Men are the only mammals on earth that attempt to prolong the sexual experience.

Multiple studies have estimated that American men last on average 13 minutes and European men last 10 minutes, whereby German men last on average seven minutes.

An United Kingdom study involving five hundred couples found that men in this study lasted on average five and a half minutes during sexual intercourse.

Premature ejaculation is such a common issue seen by urologists worldwide that a quantitative measurement tool was developed to assess premature ejaculation, so as to assess the severity.

The premature ejaculation diagnostic tool

The premature ejaculation diagnostic tool (PEDT) is a self-evaluation of a man’s various aspects of sexual dysfunction. The questionnaire includes a man’s ability to control the timing of ejaculation, the length of the sexual episode and the degree to which the premature ejaculation affects their sexual life. The total score on the PEDT questionnaire predicts the likelihood of a man experiencing premature ejaculation.

Men are usually very reluctant to seek the consult of an urologist for their often deeply disturbing premature ejaculation, due to embarrassment.

One in three men experience premature ejaculation, thus if you unfortunately have this frustrating and potentially devastating issue then take solace in the fact that you are far from alone.

The physiological control of a man’s ejaculation is dictated by two neurological domains; the central and the peripheral nervous systems. Peripheral tactile stimulation can trigger the spinal cord driven ejaculatory reflex.

The central nervous system of the brain can be stimulated by visual or emotional stimuli that leads to a physiological climax. The physiological basis for the peripheral and central nervous system driven ejaculatory response differs widely.

Medication can be prescribed to dampen either the central or peripheral nervous system’s input in the ejaculatory response and therefore prolong the period before ejaculation.

Medications such as selective serotonin reuptake inhibitors (SSRIs), such as Dapoxetine, Prozac or Paxil, are used primarily to treat depression or anxiety, increase neurotransmitters sent to the brain, and have the wanted side effect of delaying ejaculation and prolonging a man’s sexual experience.

Modafinil (Provigil) is a medication used to treat the sleeping disorder narcolepsy but it has the wanted side effect of delaying ejaculation.

Silodosin (Rapaflo) is used in the medical management of urinary symptoms associated with benign prostate hyperplasia and it also leads to delayed ejaculation.

Certain analgesics such as Tramadol can also potentially prolong the period before ejaculation, but Tramadol can be habit-forming and have side effects such as nausea, headaches and vomiting.

Some men who suffer from premature ejaculation benefit from the use of phosphodiesterase five inhibitors such as Viagra or Cialis.

The peripheral nerve endings of the penis can be dampened by local anaesthesia sprays or applied creams that reduce the tactile stimulation and delay the ejaculatory response.

These local anaesthesia agents unfortunately could potentially reduce the pleasure of the sexual experience for the man and possibly be transferred to the female and reduce her level of tactile stimulation and lower the pleasure of sexual intercourse.

The use of condoms, particularly thick, desensitising condoms can reduce the tactile stimulation of the penis.

Pelvic floor physiotherapy with Kegel exercises have shown to aid a man’s ability to delay ejaculation. Behavioural therapy can also provide beneficial results regarding premature ejaculation.

Men in the Bahamas have a one in three chance of having premature ejaculation ruin their sexual relationships and their self-esteem.

Seek compassionate and comprehensive urology care to solve your erectile dysfunction, whether it is premature ejaculation or difficulty achieving a strong erection or maintaining an erection.

The real tragedy is continuing to live with a correctable sexual problem.

• Dr Greggory Pinto is a board certified Bahamian urologist and laparoscopic surgeon trained in South Africa, Germany, and France. He can be reached at the Urology Care Bahamas at the Surgical Suite, Centreville Medical Centre, # 68 Collins Avenue/Sixth Terrace, Nassau. Call (242) 326-1929, e-mail welcome@urologycarebahamas.com or visit the website, www.urologycarebahamas.com.