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PREMATURE EJACULATIONPremature ejaculation is an extremely common condition. Kinsey, in his landmark report, had stated that it affects as m

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PREMATURE EJACULATION

Premature ejaculation is an extremely common condition. Kinsey, in his landmark report, had stated that it affects as many as 75% of all men. In today's context, premature ejaculation (PE) becomes especially relevant because of the increasing emphasis on female sexual gratification. Today's woman will not take anything lying down unless it is good enough (pun intended, of course). However, premature ejaculation seems to be nature's original design. The Kama Sutra has classified PE as one among many normal ejaculatory patterns.

From the standpoint of procreation of the species, prematurity of ejaculation seems to confer an evolutionary advantage. Early man lived in dangerous environs and had to finish mating in a hurry. He therefore had very little time in which to deposit his semen in the female's vagina and ensure propagation of the species. The continuation of this primitive PE streak in humans perhaps explains the preponderance of the condition in modern man.

PE is hard to define because its spectrum is so vast. Some men ejaculate at the mere thought of coitus. Others seem to be able to last long enough by average standards but are yet unable to gratify their partners. Hence, attempts have been made to quantify PE objectively on the basis of timing of intercourse up to the point of ejaculation, the number of pelvic thrusts until ejaculation, partner satisfaction, etc.. Researchers have actually placed stop-watches and thrustometers in patients' bedrooms.

None of these methods, however, is ideal. The current working definition of PE is the one published in the fourth edition of the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders - the DSM-IV. Briefly, the DSM-IV defines PE as "persistent or recurrent ejaculation with minimal stimulation before, during or shortly after penetration and before the person wishes it". Even this hasn't been standardized. Many additional parameters need to be looked at, and the importance of physical factors (increasingly incriminated in PE) needs to be incorporated (see Table below).

PHYSICAL (NON-PSYCHOLOGICAL) CAUSES Injury to sympathetic nervous system (e.g. following surgery for abdominal aortic aneurysm) Pelvic fractures Prostatic hypertrophy and prostatitis Urethritis Diabetes Arteriosclerosis Cardiovascular disease Local genitourinary disease Local sensory impairment Polycythemia Polyneuritis

Definitions notwithstanding, PE, despite many claims to the contrary, is a difficult condition to treat. Since PE has been a human concern for centuries, every system of medicine and every culture boasts its own unique `cures' for the condition. Many of these have acquired a reputation for efficaciousness because of their strong placebo effect. Since PE is often a psychological disorder, even substances without any real pharmacological effect on the ejaculatory apparatus can work by the power of suggestion (placebo).

Some decades ago, psychosexual methods of treatment gained tremendously in popularity. One such was the `start-stop' method, which was propounded by Semans and then popularized by Helen Singer Kaplan. The other was the `squeeze' technique described by Masters and Johnson. These techniques held sway for many decades, largely because of the unavailability of other treatment methods. However, it soon became clear that the initial success rates claimed with these were not sustainable and that, over time the success rates had dwindled to 25%. Besides, these techniques are very tedious to employ and unsuitable for today's space age. Today, research is centered on understanding the central and peripheral neurological control of the ejaculatory process and regulating it with drugs.

The various treatment options for PE are summarised in the Table below. The current treatment of choice seems to be medication with the SSRI (Selective Serotonin Reuptake Inhibitors) and allied groups of drugs. TREATMENTOFPREMATUREEJACULATION Pharmacological therapy dopamine antagonists antidepressants anxiolytics others Topical anesthetics Microsurgery Psychological treatment Miscellaneous agents

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