TCAS 05. New insights into premature ejaculation
Premature ejaculation (PE) is one of the most common male sexual disorders, and has been estimated to occur in 20% to 40% of men in the general community. Surveys of populations in the Asia-Pacific region have indicated that the prevalence of self-reported PE ranges from 8% to 22%. Currently there is no universally accepted clinical definition of PE. The American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, fourth edition, text revision (DSM-IV-TR) Provides a conceptual framework and defines PE as "persistent or recurrent ejaculation with minimum sexual stimulation before, upon, or shortly after penetration and before the person wishes it "that" causes marked distress or interpersonal difficulty"and" is not due exclusively to the direct effects of a substance". Most definitions of PE encompass three key factors. These are a diminished intravaginal ejaculatory latency time (IELT), the loss of voluntary control over ejaculation and the presence of marked distress or bother for the patient and / or partner. The currently accepted criteria, recently outlined by the International Society of Sexual Medicine (ISSM), describe lifelong PE based on an IELT of about 1 minute or less, the inability to delay ejaculation, and negative personal consequences. Recent proposals recommend that these measures (ie, IELT, Control over ejaculation, and distress) be used to evaluate the efficacy of an agent in treating PE. Measurement of the IELT by stop-watch is the best method to diagnose PE and the response to treatment.
PE has been subclassified into two forms: a lifelong (primary) and acquired (secondary) form. Lifelong PE is characterized by early ejaculation in the majority of intercourse attempts with nearly every partner from the first sexual encounter onwards, wheras acquired PE develops at some point in a man's life after he has previously experienced normal ejaculation and may be linked to urological or psychological problems. The exact etiology of PE is unknown. Psychological / behavioristic (anxiety, early sexual experience, infrequent sexual intercourse, poor ejaculatory control techniques, psychodynamic) and biogenic (penile hypersensitivity, hyperexcitable ejaculatory reflex, hyperarousability, endocrinopathy, genetic predisposition, 5-HT-receptor dysfunction) etiologies have been proposed. The treatment of PE has encompassed psychological, behavioral, and pharmacologic interventions. Current treatments are largely based upon logical solutions (decreasing sensory input), behavior modification therapies, and observations of drug side effects (those with serotonin reuptake inhibiting activity).
The negative impact of PE on both the man and his partner can be significant. The man may often feel ashamed and embarrassed at not being able to satisfy his partner; subsequently, low self-esteem, anxiety , and feelings of inferiority are common. Satisfaction with sexual life and the sexual relationship may be reduced while personal distress and interpersonal difficulty may be increased in men with PE. Despite the high prevalence of PE, very few men seek treatment. In the Premature Ejaculation Prevalence and Attitudes (PEPA) survey of more than 12,000 men, only 9 % of men with self-reported PE sought help from a physician. Factors discouraging men from seeking treatment included doubts regarding the effectiveness of medication , concerns about becoming reliant on medication to perform sexually , and discomfort or embarrassment in discussing their PE. Of the men who had sought treatment for their PE, 92 % reported little or no improvement in their condition. These findings emphasize the need for an effective, well-tolerated and acceptable treatment for PE.
