Premature ejaculation
Premature ejaculation: Excerpt from Professional Guide to Diseases (Eighth Edition)
Premature ejaculation refers to a male’s inability to control the ejaculatory reflex during intravaginal containment, resulting in persistently early ejaculation. This common sexual disorder affects all age-groups; however, it’s more common in younger males and in college-educated males.
Causes
Premature ejaculation may result from anxiety and is typically linked to immature sexual experiences. However, the true cause is undetermined. Other psychological factors may include anxiety or guilt regarding sexual intercourse, unconscious fears about the vagina, and negative cultural conditioning.
However, psychological factors aren’t always the cause of premature ejaculation because this disorder can occur in emotionally healthy males with stable, positive relationships. Rarely, premature ejaculation may be linked to an underlying degenerative neurologic disorder, such as multiple sclerosis, or an inflammatory process, such as posterior urethritis or prostatitis.
Signs and symptoms
Premature ejaculation may have a devastating psychological impact on some males, who may exhibit signs of severe inadequacy or self-doubt in addition to general anxiety and guilt.
The patient may be unable to prolong foreplay, or he may have prolonged foreplay capacity but ejaculates as soon as intromission occurs. In other cases, however, premature ejaculation may have little or no psychological impact. In such cases, the complaint lies solely with the sexual partner, who may believe that the male is indifferent to her sexual needs.
Diagnosis
Physical examination and laboratory test results are usually normal because most males with this complaint are quite healthy. However, a detailed sexual history can aid immeasurably in diagnosis. A history of adequate ejaculatory control in the absence of precipitating psychological trauma should suggest an organic cause.
Treatment
Masters and Johnson have developed a highly successful, intensive program synthesizing insight therapy, behavioral techniques, and experiential sessions involving both sexual partners. The program is designed to help the patient focus on sensations of impending orgasm.
The therapy sessions, which continue for 2 weeks or longer, typically include:
❑ mutual physical examination, which increases the couple’s awareness of anatomy and physiology while reducing shameful feelings about sexual parts of the body
❑ sensate focus exercises, which allow each partner to caress the other’s body, without intercourse, and to focus on the pleasurable sensations of touch
❑ Semans squeeze technique, which helps the patient gain control of ejaculatory tension by having the woman squeeze his penis, with her thumb on the frenulum and her forefinger and middle finger on the dorsal surface, near the coronal ridge. At the male’s direction, she applies and releases pressure every few minutes during a touching exercise to delay ejaculation by keeping the male at an earlier phase of the sexual response cycle.
The stop-and-start technique helps delay ejaculation. With the female in the superior position, this method involves pelvic thrusting until orgasmic sensations start and then stopping and restarting to aid in control of ejaculation. Eventually, the couple is allowed to achieve orgasm.
Special considerations
❑ Encourage a positive self-image by explaining that premature ejaculation is a common disorder that doesn’t reflect on the patient’s masculinity.
❑ Assure the patient that the condition is reversible.
❑ Refer the patient to appropriate resources for therapy.
Book Source Details
- Book Title: Professional Guide to Diseases (Eighth Edition)
- Author(s): Springhouse
- Year of Publication: 2005
- Copyright Details: Professional Guide to Diseases (Eighth Edition), Copyright © 2005 Lippincott Williams & Wilkins.
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Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.
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