Premature Ejaculation

What is Premature Ejaculation ?

Premature ejaculation or early ejaculation is a common sexual disorder that one out of three men face in their lifetime. Premature ejaculation is characterized by early ejaculation or emission of semen that leads to subsequent loss of erection. This leads to partner dissatisfaction and poor self esteem. Many patients would want to postpone sexual intimacy because of this problem just to avoid embarrassment.

In realitythis is not a disease but just a variation. Just like different people have different heights and varying weights, time to ejaculation also varies from person to person. Sometimes this time is so less that the patient is not able to even penetrate before ejaculation occurs and this normal phenomenon becomes distressing for the couple. This problem has little to do with the penis and is mainly a disorder of coordination. In some patients premature ejaculation may arise due abnormal serotonin receptor sensitivity which is essentially genetic.

How does ejaculation occur normally ?

Normally the ejaculation occurs once the brain perceives that it has reached the climax of sexual pleasure. Ejaculation is all about how and when the brain perceives that the climax has reached. Once the climax is reached signals run from the brain to cause the muscles to contract and release the semen. Along with this the signals for erection are also withdrawn and ejaculation is always followed by complete loss of erection.

What causes Premature Ejaculation ?

Premature Ejaculation can occur because of:

  • Mental stress
  • Anxiety
  • Fear of performance during intercourse
  • Guilt
  • Sexual Abuse
  • Previous Unpleasant Sexual Experiences
  • Associated erectile dysfunction
  • Hormonal disturbances

Is premature Ejaculation Treatable ?

Early Ejaculation is completely treatable in most patients. In fact it is not a disease in the first place. Treatment involves a few exercises or maneuvers, oral medicines and locally applied creams. In some patients where the serotonin mechanisms are altered due to genetic concerns, it is possible to control this problem if not treat it.

When does one need treatment for Premature Ejaculation ?

One should go for the treatment of premature ejaculation when there is:

  • Inability to perform sexual intercourse
  • Inability to satisfy the partner

What are the general tips for reducing premature ejaculation and lasting longer in bed ?

Premature ejaculation management is all about delaying the climax in such a way that the ejaculation is also delayed. Here are the list of things you can do to control PE:

  1. Wear an extra thick protection: With a wide variety of condoms available in the market you can choose a thicker condom that can help reduce the sensitivity of the glans and the glands on the prepuce. Reduced sensitivity means that you can last longer without ejaculating.
  2. Use the Stop-Squeeze Method: Ask your partner to squeeze your penis when you are about to reach the climax. A two to four second pause may be enough to let the moment pass and you can start back again without loosing much erection.
  3. Follow the Start Stop Technique: Alternative to squeezing you can stop for 20-30 seconds before you reach the climax and start again.
  4. Ejaculate an hour or two before coitus: Prior ejaculation makes the sensations refractory for further action up to a certain time period. You need to figure out your refractory period and use it to your benefit.
  5. Initiate pelvic floor rehabilitation: There is some evidence that Kegels exercises can help control premature ejaculation. You can learn about these exercises here.

What are the medical therapies available for Premature Ejaculation ?

Medical therapy works by either increasing serotonin in the brain or helping the glans to become numb. For this we have SSRIs, Topical Anesthetic agents and pain medications like tramadol. Based on your need Dr. Raman can prescribe you a single or combination therapy. There are a number of other agents like Silodosin, Modafinil and Phosphodiesterase inhibitors that may be added to increase effectiveness of therapy on subsequent follow up visits.

Are there any Surgeries available for premature ejaculation ?

Dr. Raman Tanwar has performed selective dorsal neurectomy for refractory cases of PE and Glans augmentation with Hyaluronic acid. He also performs chemical neurectomy with Botulinum Toxin. Before surgery the protocol at our centre is to assess the effectiveness with prior temporary nerve block. If the patient is satisfied with the effects of the nerve block further permanent therapy is undertaken. We also perform ultrasound guided Dorsal nerve block in association with the radiologist.

Why choose Dr. Raman Tanwar for management of Premature Ejaculation?

Premature ejaculation is a common problem and treatment can often be frustrating.

  • While most experts have only a handful of drugs to offer, Dr. Raman Tanwar is fellowship trained in surgical management as well.
  • He is always in touch with the latest and even experimental therapy for Premature Ejaculation.
  • He has a wide experience in management of thousands of cases of Premature ejaculation with good success

Our Treatment Protocol

To get the best results it is recommended that you be in regular follow up with the doctor. It is imperative to share your feelings, success and failures with his therapy so that the next line of therapy can be offered. Dr. Raman Tanwar follows the underlaid protocol:

Assessment of PE and Stressors → Behavioral and Solitary Medical Therapy → Combination therapy of SSRI with Opioid Analgesics → Addition of Topical Acting agents → Newer SSRI → Temporary block with Anesthetics → Chemical Neurectomy → Selective Dorsal Neurectomy / PGA (Hyaluronic Acid)

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