Premature Ejaculation

After impotence, premature ejaculation is the male sexual problem that receives the most attention. Some estimates indicate that as many as 30 million men have at some WTI experienced at least a single premature ejaculation episode. When such episodes become increasingly common and reach a point where they take place about 25 percent of the time, it makes sense to consult an urologist. This advice is especially relevant in the case of an older man who has previously never found premature ejaculation to be a problem.

As discussed, premature ejaculation may be caused by a prostate infection (prostatitis). How to recognize whether you have such an infection was also discussed. Prostate infections, however, can be quite difficult to detect, and any symptoms that you may observe may be actually only that of a low-grade urinary tract infection. It is also a fact that a man can harbor a low-grade infection without knowing it. Such men may feel generally rundown but may exhibit little in the way of overt symptoms. Actually, premature ejaculation may be the only symptom. As a consequence, it is a good idea, especially for older men, to have frequent prostate examinations to detect a possible prostate infection or a more serious problem.

A full examination requires the physician to probe the gland through the anus, and also to exert pressure, with mas-sage, to force a small quantity of fluid through the penis. The fluid is then examined in the laboratory to make a definitive determination of infection. The laboratory procedure includes looking for the presence of any bacteria and puslike areas under the microscope and the culturing of the fluid in a nutrient-rich medium to determine the type of microorganism causing problems. As the process is unpleasant to many men, ultrasonic devices are being developed to permit noninvasive scanning of the prostate. Ultrasonic scanning, while potentially useful, will not substitute for the fluid-collecting process.

One reason why the prostate is subject to persistent infection is that its internal structure allows any disease causing microorganisms that manage to reach the gland to collect and build up in numbers. Due to the lack of good drainage, the body’s natural immune system can-not easily overcome the invasion. Frequent massage of the prostate gland encourages drainage, but it is obviously impractical.

There are things, however, that you can do to prevent prostate infections from taking place in the first place. The conform bacteria that cause most prostate infections most often reach the gland by traveling through the urethra. Such bacteria are normally present in large numbers in the colon and therefore are present in fecal matter. It follows that you can minimize the chances of infection by carefully washing your hands following a bowel movement. Coliform bacteria can also be transmitted during sexual relations. This is an-other reason for practicing safe sex.

Most prostate infections are easily cured by antibiotics. Bactrim and Septra are the trade names of the sulfa medications most commonly used. During treatment, the prescribed drug must be taken for the full amount of time specified, and alcohol should be avoided, as it often interferes with the action of many antibiotics. If it does not cause discomfort, sex is actually helpful while being treated for a prostate infection. You should, however, wear a condom to avoid passing the infection back and forth with your partner. Treatment re-quires a follow-up prostate examination to make sure the infection has been fully eliminated.

After treatment, premature ejaculation should disappear, assuming the infection was the real cause of the problem. As a by-product, after treatment many men feel much healthier, as they have eliminated something that had been adversely affecting their overall system. Curing a prostate infection, however, may have no effect on an impotence problem.

If a physical problem does not exist, sex therapy or more psychotherapy can be tried. In treating premature ejaculation with sex therapy, a variety of approaches are used, depending upon the therapist, including masturbation exercises. The Masters and Johnson approach for the treatment of premature ejaculation, in its early stages, is identical to the one used for treating impotence. At some point in the treatment, the female partner is directed to assume a “training” position. In this position, the woman is seated with her legs apart and her back pressed against the headboard of the bed. Her partner lies on his back with his pelvic area facing upward between her legs. In this position, she has easy access to her partner’s penis and can conveniently employ a penile “squeeze” technique designed to retard ejaculation.

Unfortunately, the squeeze and other techniques often do not work. Too-frequent use of such techniques may also result in prostate irritation. In such cases, penile injection therapy may be helpful. With the injection and subsequent extended erection, the patient with a psychological premature ejaculation problem is able to achieve vaginal penetration regardless of when ejaculation actually occurs. As success of this nature raises the patient’s confidence and helps to overcome performance anxiety, the problem may eventually disappear.

In the last few years, fluoxetine, a drug sold under the trade name Prozac and used mainly for treating depression, has been shown to be highly effective in treating premature ejaculation. At the Morganstem Clinic, Atlanta, Georgia, over 90 percent of the men that we have treated with Prozac for premature ejaculation has been greatly helped. Prozac is known to work on serotonin, a substance found in the brain that acts as a neurotransmitter. A link exits between serotonin nerve pathways and the nerve receptors for the female sex hormones that control menstruation in women. It is, therefore, revealing that Prozac has been shown in some recent studies to help women with premenstrual syndrome. It could be that Prozac works in a similar manner in connection with the physical mechanism that controls ejaculation in men.

Warning! A variety of quack remedies for premature ejaculation, such as “numbing creams,” are available. These remedies are by and large useless—some potentially dangerous—and they should be avoided.

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