FIGHTING BACK AGAINST PREMATURE EJACULATION

"CLIMAXING TOO SOON" and "COMING TOO FAST" are two of the most common ways men describe a very common problem-premature ejaculation (PE). This is the most frequent sexual complaint reported by men younger than age 40 years. If you thought that you were the only guy in the world who has a problem with PE, think again. PE affects many men. Help is available. Approximately %25 to %30 of men report having PE at some time in life. Premature ejaculation is more common than impotence, or erectile dysfunction (ED), a condition that receive much more publicity. Premature is much more likely to affect younger men, while ED strikes older men, many of whom may also have heart disease or diabetes. We'll talk about ED later, because it can sometimes be confused with PE. MORE ABOUT PE The problem of PE has been written about for centuries. In books that are thousands of years old, we can read about the frustration that men experience with PE and the tension that often when one or both of them thinks that intercourse is completed too quickly. During the 20th century, a tremendous amount of active research was conducted on the causes of PE. Some of this research progress includes these topics: How long does it "normally" take to reach ejaculation during intercourse? Is PE a physical or psychological problem? What causes PE? Are there different kinds of PE? How does PE affect relationships? How to talk to your doctor about PE? What to expect during the physical examination? What kinds of treatments are available for PE? WHAT IS A "NORMAL" TIME TO EJACULATION?

The American Urological Association, an organization of doctors dedicated to treatment of problems of the kidneys, bladder an genitals, defines PE as "ejaculation that occurs sooner than desired, either before or shortly after penetration, causing distress to either one or both partners." Certainly, it's unsatisfactory if ejaculation occurs before you even enter your partner. Some recent studies suggest that the average time from penetration to ejaculation in normal couples is 5 minutes or more.

NO DEFINITION OF PE SPECIFIES THAT A CERTAIN NUMBER OF MINUTES SHOULD NORMALLY ELAPSE BEFORE EJACULATION.

This is where the definition gets tricky. If you have a sense that you can control your ejaculations so that your partner climaxes or until you can both agree that intercourse was satisfactory, you probably don't have PE. Similarly, if you have a sense of self-confidence and sexual satisfaction, you probably don't have PE. But if intercourse is usually brief, and you have no sense of control over the situation, it may be worthwhile mentioning the problem to your doctor.

IS THIS PE OR SOMETHING ELSE?

It's not always easy to determine if a man has PE or another form of sexual dysfunction. Sometimes the problem isn't physical, but involves personal issues or couple issues. Although it's difficult to define PE on a time-to-ejaculation doctors agree that three conditions must be evident before a man can receive a diagnosis of PE:

• Too short a time between the time you enter your partner and ejaculation
• A sense that you have no control at all over ejaculation
• Emotional distress in you and/or your partner because you ejaculate too quickly.

	Facts About PE
Approximately 25% to 30% of men experience premature ejaculation (PE) at some point in their lives. The cause or causes of PE are unknown. Premature ejaculation is not a symptom of a serious disease or illness. Treatment for PE is likely to go better if you involve your partner. You should not hesitate to bring up the subject of PE with your doctor. Help is available for PE.

Erectile dysfunction can sometimes be mistaken for PE, and the conditions sometimes occur simultaneously. For example, a man with problems getting an erection may rush to finish intercourse before he loses the erection. This isn't an example of PE, but instead seems to be a result of trying to deal with erectile dysfunction, also called ED or impotence. Occasionally a man has both, PE and ED. He has difficulty gaining and maintaining an erection. When he finally gets one he then has trouble controlling the timing of his ejaculation. Sometimes personal issues with a partner can be mistaken for PE. If you can make your erection last for 7 minutes, and your partner climaxes in about 6 minutes, both of you will consider this a good outcome. On the other hand, if you and your partner typically have intercourse only for 2 to 3 minutes before climaxing, and you're both happy with this outcome, then you don't have PE. But what if your partner needs 20 minutes to climax, and you can't prolong an erection for more than 12 minutes?

Do you have PE? Probably not. The problem may be delayed orgasm in your partner. Many women seem unable to reach orgasm with vaginal intercourse, no matter how long her partner can prolong it. Although you can certainly ask your doctor questions about this situation, it may be more appropriate for your partner to discuss it with her doctor.

And finally, sexual function can be disrupted if the two of you aren't getting along well in other aspects of the relationship.

WHAT CAUSES PE?

Here's some good news PE is not a symptom of illness or disease. Some believe it is a physical not an emotional condition while other researchers believe that PE is a result of anxiety or other psychological issue. Sometimes the environment, in which people have sex, such as in a rushed manner or without enough privacy, may be at fault. There is a theory that early sexual experiences may predispose to PE. And some men may have a hyper excitable penis or ejaculatory reflex, hormonal imbalances, or chemical imbalances that cause them to have poor control of ejaculation. No one agrees on what causes PE.

Research is being done to define the ejaculatory reflex and the brain areas, which control it.

	What Your Doctor May Ask
WHAT YOUR DOCTOR MAY ASK ABOUT PE When did this start? What was the situation? Does it happen all the time, or just in certain situations? Does it come and go, or is premature ejaculation a problem each time you have sex? Have you tried anything (medicine, certain techniques) to deal with the problem? Has it worked at all? WHAT YOUR DOCTOR MAY ASK ABOUT YOUR SEXUAL HISTORY What were your earliest sexual experiences like? Have you had any negative sexual experiences other than the problem with PE, such as abuse? Is the quality of erections good? Is the quality the same when/if you masturbate? Are you having sex as frequently as you and your partner would prefer? How would you describe the following: (good; could be better; bad) Ejaculatory control Stress and anxiety during sex Your satisfaction Your partner's satisfaction.

TALKING TO YOUR DOCTOR

Now you know that many men have had at least some brief trouble with PE, and that the problem is ongoing for many men. You also know that what seems to be PE might actually be another problem involving you, your partner, or both of you. It's time to discuss this with your doctor. Premature ejaculation may not be an "illness" in the way that we usually think of it, but it can have serious consequences, including the following:

• Distress between you and your partner
• Lower self-esteem
• Hesitance to start a new relationship
• Anxiety
• Embarrassment.

Some doctors even think that some cases of depression may get started as a reaction to PE and other sexual difficulties. This is a problem you need to discuss.

WHAT YOUR DOCTOR MAY ASK

When you tell your doctor about your ejaculation problems he or she may ask you some questions. FIRST, is PE a new problem for you, or did it start when you began having sex?

SECOND, have you experienced PE with all of your sex partners, or only with some of them? Perhaps most important, the doctor will ask you how much time usually passes between entry and ejaculation. The doctor may also ask to see your current partner, as she may be able to shed some light on the problem. This may be particularly useful if she is unable to reach orgasm, which could be contributing to your problem. The doctor will also ask some or all of the questions shown in the box on this page. In addition, he or she may do a physical exam. Depending on your situation and the doctor's assessment, some lab tests may be ordered.

GETTING TREATMENT FOR PE

	Treatments for PE
Behavioral Stop/start technique Squeeze technique Other sexual positions/ techniques Relationship Counseling Drug therapy Creams and gels SSRIs New products

Once your doctor has determined that PE is the right diagnosis for the sexual problems you've been experiencing, you can discuss some possible treatments. The goal is to help you and your partner achieve greater sexual satisfaction. Be patient. This process often involves some trial-and-error, and it takes time to find an approach that works. Beware of the quick-fix solutions that are advertised on the Internet or in magazines and newspapers

These products may help someone else get rich, while you get little or no relief from your PE. Treatments for fall into three of the following categories:

• "Retraining " programs
• Medications
• Anesthetic creams.

Some men find that one method works for them, while others need a combination of treatments.

RETRAINING

Retraining techniques include the "stop/start" method and the "squeeze" method. In the stop/start method, your partner stimulates your penis to the point that you tell her that you are about to ejaculate. She stops and starts again only when you tell her that the urge to ejaculate has passed. Then she begins the stimulation again. You repeat this process again and again until that period of stimulation without ejaculation lasts for many minutes, giving you a sense of control. Practicing with a lubricant on the tip of you penis will provide some additional experience. Eventually, you may be able to exert the same kind of control during intercourse. In the squeeze technique, which also helps give you control, your partner places her fingers so that her thumb is on one side of your erect penis and her index and middle finger are on the other side. Her index finger should be just above the ridge, and the middle finger should be just below it. When you feel that you're about to climax, you tell your partner to squeeze the shaft firmly between her thumb and the other two fingers until the urge passes. Other techniques include having the woman on top during intercourse to help you gain control. You could also try having your partner stop moving as you approach climax and start moving again when the urge passes. Some young men masturbate prior to intercourse as a means of desensitizing the penis and delaying ejaculation during intercourse later. This technique was made famous by the movie There's Something About Mary. Unfortunately older men may take 12 to 24 hours to be ready for sex again.

CREAMS AND GELS

Certain anesthetic creams and gels have been designed to yes on the penis before intercourse. These creams and gels make the penis less sensitive and give you more

Control over ejaculation. The drawback is they may make your partner's vagina numb, possibly decreasing her pleasure. Either a condom will have to be used or excess cream washed off after the numbing benefit begins and before penetration.

ORAL MEDICATIONS ED DRUGS

Drugs that are used to treat ED have been used in attempts to treat PE. This strategy seems to work only in men who develop PE as a complication of erectile dysfunction. These medications do not seem to be the answer for men whose only problem is PE.

Cialis, Levitra, and Viagra may benefit men with combined PE and ED or men with PE secondary to ED.

ORAL MEDICATIONS - SSRIs

Selective serotonin reuptake inhibitors (SSRIs) are the most popular class of tablets used to treat depression. Both men and women being treated for depression often experience delay in orgasm or become an orgasmic. This notorious SSRI side effect may help men with PE. When SSRIs work, ejaculation is delayed for a suitable amount of time. But SSRIs don't work in all men, and they can have side effects. These include nausea, dry mouth, fatigue, low sex drive, and failure to ejaculate. This isn't the end of the story. New drugs to teat PE are in development. The key to fighting back at PE is communication. Talk to your partner. Talk to your doctor. And when one strategy doesn't work, look for others.