Tips And Techniques To Delay Premature Ejaculation Pdf

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How to Use the Squeeze Technique, the Stop-Start Technique, and More

A Pubmed search from the year to the present was performed to retrieve publications related to management or treatment of premature ejaculation. Behavioral techniques have been the mainstay of premature ejaculation management for many years, although evidence of their short-term efficacy is limited. Topical therapies for premature ejaculation act by desensitizing the penis and do not alter the sensation of ejaculation. Selective serotonin reuptake inhibitors SSRIs , commonly used in the treatment of depression, are often used to treat premature ejaculation, based on the observation that delayed ejaculation is a frequent side effect of this drug class.

Dapoxetine is a short-acting SSRI formulated to treat premature ejaculation, and results seem very promising. Historically, attempts to explain the etiology of PE included a diverse range of biological and psychological theories.

Most of these proposed etiologies are not based on evidence and are speculative at best. Psychological theories include the effect of early experience and sexual conditioning, anxiety, sexual technique, the frequency of sexual activity, and psychodynamic explanations. Biological explanations include evolutionary theories, penile hypersensitivity, central neurotransmitter levels and receptor sensitivity, degree of arousability, speed of ejaculatory reflex, and level of sex hormones.

There is little empirical evidence to suggest a causal nexus between PE and any of the factors thought to cause PE 2. A Pubmed search from the year to the present was performed to retrieve publications related to management or treatment of PE, or male sexual dysfunction. The publications were included if they reported the impact of PE on man, his partner or the relationship, or the impact of male sexual dysfunction and included PE in the analysis. Older references were used in case of relevance.

Waldinger et al. Different sexual activities may thus have significantly different physical and tactile characteristics, which may in turn be differently associated with the ejaculatory reflex. When making a diagnosis, physicians should also consider the frequency of PE episodes and the time over which PE has been a problem 5. Age has traditionally been considered as a causal factor of PE with younger men having presumably more problems with PE 7 , but more recent research has suggested that this effect of age was vastly exaggerated, or that age may even be negatively associated with PE.

Recent data demonstrate that almost half of men with erectile dysfunction ED also experience PE 9. This may be compounded by the presence of high levels of performance anxiety related to their ED which serves only to worsen their prematurity.

In the absence of a thorough sexual history, these men may be incorrectly diagnosed as suffering from PE and not from the underlying ED 9. There is, however, limited correlation evidence to suggest that lifelong PE is due to altered sensitivity of central 5-HT serotonin receptors and acquired PE is due to high levels of sexual anxiety, ED or lower urinary tract infection 2.

Men with a very high set-point may experience delayed or absent ejaculation despite achieving a full erection and prolonged sexual stimulation 2. There is strong evidence that long duration of physical effort in men leads to a decrease in extracellular magnesium concentration due to a transient shift between extracellular and intracellular magnesium components and a simultaneous increase in urinary excretion This transient hypomagnesaemia may be manifested by uncontrolled contractility of the male genital tract, causing emission and ejaculation Behavioral techniques have been the mainstay of PE management for many years, although evidence of their short-term efficacy is limited.

Some men use self-help approaches gained through personal experience, bibliotherapy books , or online research. These techniques include masturbation just prior to intercourse, the use of multiple condoms to reduce penile sensitivity, or engaging in distraction techniques mental exercises during foreplay, intercourse, or both.

Anxiety was reported as a cause of PE by multiple authors and is entrenched in the folklore of sexual medicine as the most likely cause of PE despite scant empirical research evidence to support any causal role Several authors suggested that anxiety activates the sympathetic nervous system and reduces the ejaculatory threshold as a result of an earlier emission phase of ejaculation The causal nexus between anxiety and PE is speculative, is not supported by any empirical evidence and is, in fact, contrary to empirical evidence from some researchers These involve engaging in sexual foreplay until just before the point of ejaculation and then either squeezing the head of the penis or stopping sexual activity until the urge to ejaculate subsides, at which point sexual activity may be resumed and the techniques repeated as necessary.

However, subsequent trials reported high failure rates with these techniques Cognitive or sex therapy focuses on perceptions and feelings, improving communication between partners, increasing sexual skills and self-confidence, and reducing anxiety associated with sexual activity Short-term improvement with these behavioral approaches was observed; however, there are limited data concerning the efficacy of these methods in the long run More recently, sex therapists combined psychotherapy with behavioral exercises with more success.

Therapy focuses on the emotional implications of PE, in relationship dynamics, and in performance anxiety management. Therapy is limited by cost, local availability of trained therapists, and willingness of patients and partners to participate. As might be expected, the best results were seen in men who were motivated, were hopeful, and were in a stable monogamous relationship with a cooperative partner Topical therapies for PE act by desensitizing the penis and do not alter the sensation of ejaculation Korean researchers have developed a topical cream SS-cream from natural products, which has local anesthetic properties and is applied on the penis 1 hour before sexual contact In two randomized, double-blind clinical trials, SS-cream a g dose achieved a mean IELT of approximately 11 minutes, compared with 2.

Selective serotonin reuptake inhibitors SSRIs are commonly used in treatment of depression and often used to treat PE, based on the observation that delayed ejaculation is a frequent side effect of this drug class. The extent of ejaculatory delay may vary widely in different men according to the dosage and frequency of administration of SSRI and the genetically determined ejaculatory threshold set-point Cessation of treatment results in re-establishment of the previous set-point within 5 to 7 days in men with lifelong PE A key limitation of therapy for PE with currently available SSRIs is that in addition to delaying ejaculation, this class of drugs has been associated with a number of unwanted sexual side effects.

Other systemic treatments that were evaluated for management of PE include phosphodiesterase-5 PDE-5 inhibitors, currently licensed to treat ED. Despite the success of PDE-5 inhibitors in treating ED, there are limited data to suggest that these agents are effective in men with no ED. Treatment with PDE-5 inhibitors may be effective in men with associated ED and PE, and these two conditions commonly occur together In preclinical models, the drug was shown to significantly inhibit ejaculatory expulsion reflexes, acting at supraspinal level Similar to other SSRIs, dapoxetine exerts its effects primarily through inhibition of serotonin reuptake transporter, with minimal inhibitory activity at the norepinephrine and dopamine reuptake transporters However, unlike long-acting SSRIs, which are typically administered in a chronic daily fashion and may take days or weeks to reach steady-state plasma concentrations 28 , dapoxetine is a short-acting SSRI, which may be better suited to treat PE In several studies dapoxetine was shown to significantly improve the intravaginal ejaculatory latency time as compared with baseline and placebo, that is, 1.

When taken 3 to 4 hours prior to intercourse, the IELT was 1. Similar improvements were observed for the female partner's perception of the man's control over ejaculation Despite this prevalence rate, few men receive effective medical or psychological treatment for PE, although men reported self-treatment with a variety of behavioral approaches, creams, or herbal products Failure to seek treatment may be attributable to personal sensitivity about the problem, failure of men or their primary care physicians to discuss sexual issues, and perceptions that there are no effective interventions.

A team approach involving a psychotherapist and a physician may best help those couples who suffer more distress or who do not respond to initial therapy. The concept of coaching is within the reach of primary care providers who are sensitive and have time, interest and knowledge to offer the patient brief and targeted psychoeducational interventions. These basic sexual counseling sessions, together with drug therapy, should include efforts to gain feedback on efficacy of self-help and behavioral techniques in the context of the couple sexual relations.

These efforts should focus on reducing performance anxiety and bolstering the patient's self-esteem and the couple's communication. Premature ejaculation is a condition that affects men of all ages. It is the most frequent male sexual dysfunction and has significant effects on quality of life for both man and his partner.

Several approaches have been used in its treatment, including cognitive and behavioral therapy, topical agents and drug therapy, such as PDE-5 inhibitors, as well as SSRIs.

Montorsi F. Prevalence of premature ejaculation: a global and regional perspective. J Sex Med. Waldinger MD.

The neurobiological approach to premature ejaculation. J Urol. Washington: American Psychiatric Association; Four measures of investigating ejaculatory performance. Defining premature ejaculation for experimental and clinical investigations.

Arch Sex Behav. Correlates to the clinical diagnosis of premature ejaculation: results from a large observational study of men and their partners. N Engl J Med. Klusmann D. Sexual motivation and the duration of partnership.

Sexual problems among women and men aged y: prevalence and correlates identified in the Global Study of Sexual Attitudes and Behaviors. Int J Impot Res. New experimental and clinical data on the relationship between magnesium and sport. Magnes Res. Williams W. Secondary premature ejaculation. Aust N Z J Psychiatry. The role of anxiety in premature ejaculation: a psychophysiological model. Human sexual inadequacy. Semans JH. Premature ejaculation: a new approach. South Med J. Hawton K.

Treatment of sexual dysfunctions by sex therapy and other approaches. Br J Psychiatry. Barnes T, Eardley I. Premature ejaculation: the scope of the problem. J Sex Marital Ther. McCabe M P. Evaluation of a cognitive behavior therapy program for people with sexual dysfunction.

Althof SE. Psychological treatment strategies for rapid ejaculation: rationale, practical aspects, and outcome.

Premature Ejaculation

Many males experience sexual concerns such as premature ejaculation. Premature ejaculation occurs when someone has an orgasm very quickly or orgasms without control. Males with premature ejaculation may also have very little warning before their orgasm, so they may not be able to delay it. Premature ejaculation may lead to lower sexual satisfaction for both the person experiencing it and their partner. Some home remedies and exercises may help delay ejaculation or help someone become more aware of their sensations and how to control them. Part of the reason that so many people experience this is because premature ejaculation can be complex, involving both mental and physical aspects. Some medical treatments may help with premature ejaculation, but there is no permanent cure for it.

It means you ejaculate very soon after putting your penis inside penetrating your partner, or even before penetration. It is not really known what causes premature ejaculation. Men with premature ejaculation should not be embarrassed about discussing it with their doctor, as it can be helped by a variety of means. Many men do not seek help from their doctor for this problem so it is not known how common it is. Surveys that have been done suggest it affects about one to three out of every one hundred men.

The stop-squeeze technique is one of several ways you can delay your orgasm and prolong masturbation or partner sex. It may also benefit people who experience premature ejaculation PE. The stop-squeeze technique is a form of ejaculatory control. It allows you to near the point of climax and then back off suddenly by holding the tip of the penis until the sensation subsides. Keep in mind that delaying your own orgasm might delay or reduce satisfaction for your partner. You should make sure you and your partner are on the same page before you begin.

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Premature ejaculation occurs when a man reaches orgasm and ejaculates too quickly and without control. In other words, ejaculation occurs before a man wants it to happen. It may occur before or after beginning foreplay or intercourse.

A Pubmed search from the year to the present was performed to retrieve publications related to management or treatment of premature ejaculation. Behavioral techniques have been the mainstay of premature ejaculation management for many years, although evidence of their short-term efficacy is limited. Topical therapies for premature ejaculation act by desensitizing the penis and do not alter the sensation of ejaculation. Selective serotonin reuptake inhibitors SSRIs , commonly used in the treatment of depression, are often used to treat premature ejaculation, based on the observation that delayed ejaculation is a frequent side effect of this drug class. Dapoxetine is a short-acting SSRI formulated to treat premature ejaculation, and results seem very promising.

Premature ejaculation occurs when a man ejaculates sooner during sexual intercourse than he or his partner would like.

Premature ejaculation causes

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