The Tribune

By Dr Greggory Pinto

Premature ejaculation is the most common male sexual dysfunction, with 30 to 40 percent of adult men suffering from this frustrating and often depressing sexual disorder.

Premature ejaculation is defined as a man ejaculating before or very soon after vaginal penetration or the inability to delay ejaculation.

Delay ejaculation using an app-controlled electrical stimulation patch

A new single-use, square inch in size skin patch applied to the male's perineum and controlled by an app has shown promising evidence for treating premature ejaculation. The perineum is the area of skin beneath the scrotal sac and above the anus.

The patch, developed by the Israeli company Virility Medical Ltd, painlessly delivers a neuromuscular stimulation that can potentially delay the onset of ejaculation. This device represents the first innovation in the treatment of premature ejaculation in more than 20 years.

The patch contains a tiny battery and a wireless transdermal electric neuromodulation unit and is controlled by an app so the male or female partner can activate the device on their phone or android device and determine the intensity of the stimulation. The nerve stimulation created by this painless device, essentially dampens the transmission of nerve signals so that ejaculation is delayed.

Studies involving this Virility patch have shown that with its use, the time to ejaculation can be prolonged by a factor of four.

This wearable perineum patch technology is still in the trial phase with hopeful FDA approval during 2021.

Two types of premature ejaculation

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

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.

How does the body control ejaculation?

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.

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

This affliction often provides frustration and anguish to both partners.

Men often suffer from low esteem and even depression due to their unsatisfactory sexual experiences.

Every sexual escapade that ends too soon leaves the men involved often 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.

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

Diagnostic tool for premature ejaculation

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 (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.

Medical treatment of premature ejaculation

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 or Prozac or Paxil 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 5 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 are usually very reluctant to seek the consult of a 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 comfort in the fact that you are far from alone.

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.

You can always rise again.

• Dr Greggory Pinto is a board-certified Bahamian urologist and laparoscopic surgeon. He has trained in Germany, South Africa and France, and is a member of the European Association of Urology. He can be contacted at OakTree Medical Center, #2 Fifth Terrace & Mount Royal Avenue. Telephone: (242) 322-1145 (6) (7); e-mail: welcome@urologycarebahamas.com, or visit the website:www.urologycarebahamas.com.