Premature ejaculation is the most prevalent medical condition recognised under the banner of male sexual disorders. It has been identified among as many as 20–30% of the male population worldwide. Severe forms of premature ejaculation are known to alter a person’s quality of sexual life adversely.
Apart from disturbing the marital relationship due to reduced libido, it has often been strongly associated with increased mental stress and anxiety, along with a sense of low self-esteem. Being a sensitive issue, a majority of men feel hesitant about discussing premature ejaculation with their doctors. This necessitates the use of an efficacious and well-coordinated approach to tackling this form of sexual dysfunction.
Broadly speaking, premature ejaculation is considered a fairly normal finding among males having sexual intercourse for the first time since they have no prior experience of timing their semen ejaculation. This condition is often classified as a clinical symptom rather than a separate disease entity. Medical experts are of the view that premature ejaculation must be characterised with respect to the degree of time lapse between the beginning of the sexual encounter and the male orgasm.
The World Health Organisation (WHO) has defined premature ejaculation as an inability to control ejaculation, with a cut-off time set at less than 15 seconds from the beginning of coitus, where the male partner’s sexual performance fails to gratify his female counterpart.
Premature ejaculation is typically treated with an interdisciplinary approach involving general practitioners, urologists, and psychiatrists. The efficacy of medical therapy is judged on the basis of a relative improvement in the ejaculation timing of an individual. The improvement could be as minuscule as a single second. Still, however, an efficient therapeutic approach can lead to an improvement of at least 75%. The following are a few possible treatment options in this regard:
- Modulation of sexual practice: It has been suggested that male sexual behaviour can be modulated through two important measures: the “start-stop technique” and the “squeeze method.” These two manoeuvres are substantially helpful when it comes to mastering the timing of ejaculation response by suppressing the emotional parameters of male sexual function.
- Neuropsychiatric therapy: Selective serotonin reuptake inhibitors (SSRIs: fluoxetine, escitalopram, and sertraline) and serotonin-norepinephrine reuptake inhibitors (SNRIs: venlafaxine) have been utilised in the treatment of this form of sexual dysfunction since they boost the levels of serotonin, a substance directly implicated in the inhibition of ejaculation. In this way, sexual intercourse can be sufficiently prolonged. In addition, tricyclic antidepressants, or TCAs, have also been indicated in the treatment of ejaculatory dysfunction.
- Other major interventions: Some other therapeutic measures which are worth mentioning include the following: tramadol, alpha-1 adrenergic receptor blockers, phosphodiesterase enzyme inhibitors, folic acid supplementation, caffeine, and other experimental sexual devices.
With an ever-evolving treatment strategy, premature ejaculation can be effectively eliminated in the majority of males. However, there still remains a need to devise a uniform, standardised treatment plan that can adequately address the sexual dysfunction of an individual.