Talk:Premature ejaculation

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The PE diagnostic tool[edit]

Dear Editors. I eould like to add the link to the Premature Ejaculation test. This is a test, with references, that was developped by leading experts in this area. It is a great service to all patients. The test is available at the pehomepage.com. The site has NO commercial advertuisements what so ever, and is just a reasource for information!!! Please keep the link as an exeption. Best Regards, Ronny Hashmonay MD

here is the link: http://www.pehomepage.com/premature_ejaculation_test_pfizer.asp

can someone add it? —Preceding unsigned comment added by Rhashmo2 (talkcontribs) 16:20, 27 October 2009 (UTC)

The references to the PE diagnostic tool[edit]

1. Development and validation of a premature ejaculation diagnostic tool. Symonds T, Perelman MA, Althof S, Giuliano F, Martin M, May K, Abraham L, Crossland A, Morris M. Eur Urol. 2007 Aug;52(2):565-73. Epub 2007 Jan 16.

2. Development and validation of a new questionnaire to assess sexual satisfaction, control, and distress associated with premature ejaculation. Althof S, Rosen R, Symonds T, Mundayat R, May K, Abraham L. J Sex Med. 2006 May;3(3):465-75. —Preceding unsigned comment added by Dr. Ronny Hashmonay (talkcontribs) 06:37, 21 May 2009 (UTC)

PE Test[edit]

I have added and extremely important new tool to diagnose PE. I did not know how to put a legitimate link to the test that is available at http://www.pehomepage.com/premature_ejaculation_test_pfizer.asp if someone knows how to do it I think it is a major milestone in helping patients know where they stand, and a great tool for physicians. The fact that it was developed by leading experts in the field adds to its credibility. —Preceding unsigned comment added by ד"ר רוני חשמונאי (talkcontribs) 07:15, 20 May 2009 (UTC)

Deleted the last advertisment[edit]

I've deleted the last link, which was nothing but shameless advertisment of one of the worst websites ever seen. —Preceding unsigned comment added by 88.217.26.219 (talk) 05:47, 22 June 2008 (UTC)

It was the site I posted[edit]

SexLifeHelp is simply a resource to help men find the most benificial self help websites on the web today. It was intended to help the readers with the most beneficial self help treatment available without wasting their hard earned money on a scam site. —Preceding unsigned comment added by 24.247.235.217 (talk) 01:19, 7 October 2008 (UTC)

SiobhanHanse; removal of LULU links[edit]

Dear SiobhanHansa.

You deleted the giannivenice link. Yet, there is extensive new information on medical references published on Giannis homepage. These new medical references of 2008 can be checked by everyone. Yes, in addition, the self-published book is mentioned, too. I think it's only fair, since Giannivenice's is a real author of advice books. I, thus, indeed challenge the removal of his lulu links. Lulu is a real publishing house. Everyone can check these books. Often, there are extensive previews. LULU indeed is transparent! He who wants to know, can inform himself. Referencing, doesn't mean peer review! Referencing means, that the source is open and accessible. That is the fact with lulu books. Why should a lulu book be different from a random house book. In my opinion, there is none. So, please, don't delete lulu links. Thanks. —Preceding unsigned comment added by Gianna 61 (talkcontribs) 16:49, 12 March 2008 (UTC)

I encourage you to add encyclopedic information citing those medical references directly to the article. However the link itself - which is to self published information by someone who is not a well respected authority on the subject and which advertises a book for sale, is not appropriate.
Lulu books are not the same as books from more traditional publishing houses like Random House because anyone can publish anything making them far less reliable. However even a Random House book is only appropriate if it is actually representative of significant expert opinion (for example a link to a Random House book about some college woman's experiences with men with PE would likely be inappropriate as well). -- SiobhanHansa 17:04, 12 March 2008 (UTC)

Dear SiobhanHansa

You seem to overestimate random house. Often there is just one person who likes a book. OR not. Why should that be any better than a lulu link? Also at lulu, there is one guy who publishes, or not.

Also. Who are you to judge if someone is an expert. I tell you, most experts are just farts that had the luck to be appointed to an institution. That is why they are experts. Often their advice is rubbish.

I think transparency is the key word. Yet, that is exactly why I really start to dislike Wikipedia. Wikipedia is ABSOLUTELY INTRANSPARENT. You are a e.g. a guy, for me out of the blue, who judges other peoples entries. You decide what to put in, and what not. You delete entries at the touch of your fingertip. You have an enormous "self-established" power. You stay in the shade just like a grey eminence in a Foucault control scheme.

Wiki is not really a place where everyone can put in his knowledge. It's just like any other social system. Some people do the work, others sit in their chairs and judge the work.

Oh, how I start to hate Wikipedia.

Bye Gianna —Preceding unsigned comment added by Gianna 61 (talkcontribs) 19:04, 12 March 2008 (UTC)

Gianna, I'm sorry you've found this difficult. It seem you are trying to use Wikipedia for a purpose that it is not intended for and that can lead to disappointment. We use sources that experts in the field consider reliable - experts in the field gain their appointments because they are judged to be better than others by people in a position to do so. It's not a perfect system, but it's pretty much the only way we've found to keep the quality of information reasonably high. -- SiobhanHansa 23:22, 12 March


Despite being thrilled to read the discussion regarding the ethical use of Internet references in encyclopediac material it might first be a good idea to run over the article again and check spelling and grammar. English is not my first language, but I'm certain that "brain" is spelled with only one 'n'. I would love to edit the mistake myself but I am not sure if wiki affords editing rights to China based users. Many thanks. Hanli

External links to books[edit]

It should be fine to give external links to books. In the case of Gianni V. it is a personal story from an affected. GV reports his private story and published the book by lulu.com. There is no obligation to buy, on the contrary. There is a 20 page free preview of the book (about 1/3 of the story) for people to check. —Preceding unsigned comment added by Gianna 61 (talkcontribs) 16:51, 19 February 2008 (UTC)

It's not fine to add links to self published books when they aren't already recognized as reliable and respected sources. And personal stories are rarely encyclopedic unless there is a verifiable significance for the particular story. So I really don't think the link is appropriate.
(Note: We also specifically ask people not to add links to sites they are connected with directly to articles without first gaining a consensus for inclusion on the article's talk page - See our external links guidelines. I'm assuming from your user name that this applies in this case.) -- SiobhanHansa 15:49, 12 March 2008 (UTC)

Copy righted text[edit]

I reverted the insertion of yoinked copyrighted text, and added an external link to the apparent source. -- Infrogmation 22:24, 20 Dec 2004 (UTC)

I removed more copyrighted text ("Inability to constantly control the ejaculatory reflex...") from the Armenian Medical Network. -- Kslays 18:48, 2 August 2006 (UTC)

SSRI[edit]

The article makes it sound as if SSRIs (selective serotonin reuptake inhibitors) reduce prematue ejaculation through reducing anxiety. I am not at all an expert, but my impression was that SSRIs just make orgasm more difficult as a "side effect", i.e. not by way of reducing anxiety. Can anyone who knows the facts confirm? -- Bayle Shanks

SSRI's will reduce anxiety, that is for sure. They will also make it harder for both man and women to get aroused, and, once aroused, they will make it harder, or even impossible in some cases, to achieve an orgasm. So there is probably some of both of these effects.

heterocentric?[edit]

I think this article should be changed, at the moment it implies that only straight men have ejaculatory problems. this could just be remedied by simply changing the language from female to just partner.

WP:BB. Or: {{sofixit}}. JFW | T@lk 22:31, 16 February 2006 (UTC)


Okay, changed! just wanted to see if anyone had some objections first :D

Explain this to me: Women need vaginal stimulation to climax which can take time, whereas with two men having sex the "catcher" is not going to climax by having a penis in his bum. So trying to include gay sex in here is moot. I'm changing it back because I don't think it's normal for a man having a penis in his bum to orgasm due to having a penis in his bum.
On top of that, I think peoople get the picture without having to list every type of sex out there. If you include sexual positions that deviate from functional sex that can produce offspring (i.e. inserting the penis into a non-functional cavity such as an anus) then you also have to list mouth, boobs, hand, chicken, cow, sheep, etc... People get the picture when you list the normal method and if they want to translate that to other types of sex then that is their business. JettaMann 15:54, 27 July 2006 (UTC)
JettaMann I agree with your point, bravo for putting the PC monster back in its cage. But in fact it is possible for a male "receiver" to orgasm (by internal stimulation of the prostate.) Even some women can climax anally, go figure the human body is an amazing contraption. You may want to read up on a few homosexual articles, if you can stomach it :) --Jquarry 12:19, 15 August 2006 (UTC)
Um, women don't necessarily need vaginal stimulation to climax; we need clitoral stimulation. 70% of women do not reach orgasm from plain old vaginal intercourse, so Master and Johnsons' definition (man climaxes before woman more than 50% of the time) does not make a whole lot of sense to me. Rosemary Amey 23:14, 17 November 2006 (UTC)
Maybe we should incorporate this information into the article considering it is relevent? I'm pretty sure it'd be safe to point out the obvious flaw in this research provided citation. Duroes 08:44, 2 March 2007 (UTC)
Premature ejaculation is not a matter of being unable to cause a partner to climax (although both your point about men not reaching orgasm from anal penetration and your point about women needing vaginal stimulation are misinformed). The issue with premature ejaculation is of an emotional nature. If an individual feels sexually unsatisfactory due to early ejaculation and suffers psychological distress because of it then they suffer from premature ejaculation reguardless of whether they are having sex with a woman, man, hand, chicken, cow, sheep, etc. changing "woman" and "female" to "partner" does not explicity denote any orifice. Neither is it a move for political correctness. All the change serves to do is make the article encompass a broader spectrum of the various conditions under which premature ejaculation might occur by removing impertinent details. kwertykwert 08:55, 22 March 2007 (UTC)

SSRIs[edit]

SSRIs do alleviate PE, but this is not to do with increasing the level of seratonin in the synapse. If that were the case, more straightforward seratonin boosters (such as l-tryptophan or 5-htp) would also alleviate PE, which they do not - at least, not to anywhere near the same extent. A better explanation is the fact that SSRIs block re-uptake of seratonin - the male orgasm involves a huge re-uptake of seratonin (this is what creates the "whooshing" sensation as a man goes past the point of no return), and by blocking this, SSRIs prevent uncontrolled ejaculation. This also explains why many men taking SSRIs have to concentrate quite hard in order to orgasm at all (and thus override the drug effect), and why some men on SSRIs cannot orgasm at all. This would also explain why St John's Wort (which does block re-uptake) is more effective for PE than 5-htp / l-tryptophan.

I'd add this myself, but I don't have a citation to hand, so it could be considered original research - the role of seratonin re-uptake in male orgasm, the effect of SSRIs on seratonin re-uptake, and the efficacy of SSRIs in treating PE are all common knowledge, but I've yet to read a detailed, peer-reviewed scientific article connecting the three. Then again, I've certainly never read one which makes the case that SSRIs achieve this effect by increasing seratonin in the synapse! Perhaps someone could dig up citations for the three points made above, and present the idea that way. It's certainly a more scientifically credible idea than the one currently in the article MrBronson 19:42, 24 October 2006 (UTC)


Remark on top of page about anxiety: Studies have shown the link to seratonin re-uptake. But PE is more complex. For those men were PE is linked to seratonin, SSRI's will work, already in (very) low dosis. These men will benefit from anti-anxiety medication or selective serotonin reuptake inhibitors, such as sertraline or paroxetine. But the causes of PE can also be very different then seratonin linked. On SSRI's, look at http://prematureejaculation.sohosted.com/non-fda-medication.php So... PE can also be anxiety linked, stress, physical,... For instance, patients with prostatitis may report changes in ejaculatory latency, with a trend toward earlier ejaculation, difficulty maintaining an erection, or both. Although typically a transient phenomenon, opioid withdrawal has also been associated with PE Premaposts 11:44, 10 May 2007 (UTC)

Merge from Drugs specifically targeted to treat premature ejaculation[edit]

Is anyone here sufficiently knowledgeable to help with merging Drugs specifically targeted to treat premature ejaculation into this article? Drugs specificially... is basicly a spam container. / edgarde 04:39, 5 July 2007 (UTC)

The Role of the Foreskin[edit]

I would not be surprised if men who are natural have more control over their ejaculation time. I'm circumcised and it feels like I have no control. I'm doing foreskin restoration and have grown a tiny bit of skin. I feel like I have more control when the tiny bit of skin rubs across the glans rather than direct contact. I would like to have this mentioned in this article that foreskin restoration may help men who have trouble. This would also help end male genital mutilation whereby infant males have their genitals cut without their consent (impossible since they are infants).

see this paragraph:

"Premature ejaculation. Lakshmanan & Prakash (1980) report that the foreskin impinges against the corona glandis during coitus.15 The foreskin, therefore, tends to protect the corona glandis from direct stimulation by the vagina of the female partner during coitus. The corona is the most highly innervated part of the glans penis.19 Zwang argues that removal of the foreskin allows direct stimulation of the corona glandis and this may cause premature ejaculation in some males.32 O'Hara & O'Hara (1999) report more premature ejaculation in circumcised male partners.41 The presence of the foreskin, therefore, may make it easier to avoid premature ejaculation, while its absence would make it more difficult to avoid premature ejaculation. Masood et al. report that circumcision is more likely to worsen premature ejaculation than improve it.64 The Australian Study of Health and Relationships found that "26% of circumcised men but 22% of uncircumcised men reported reaching orgasm too quickly for at least one month in the previous year."65 Kim & Pang (2006) reported decreased ejaculation latency time in circumcised men but the decrease was not considered statistically significant.66

Inability to ejaculate or delayed ejaculation. While some circumcised males may suffer from a tendency toward premature ejaculation, others find that they have great difficulty in ejaculating.50 The nerves in the foreskin and ridged band are stimulated by stretching,18 57 amongst other movements. If those nerves are not present, Money (1983) argues that excision of these stretch receptors by circumcision may make ejaculation take longer.18. Some circumcised males may have to resort to prolonged and aggressive thrusting to achieve orgasm.40 49 Shen et al. (2004) reported that 32.6 percent of the men in his study reported prolonged intercourse after circumcision.59 Senkul et al. (2004) reported an appreciable increase in ejaculatory latency time (time to ejaculate).60 Thorvaldsen & Meyhoff (2005) reported that circumcised males have more difficulty with ejaculation and orgasm.63 Kim & Pang (2006) reported that circumcised men have more difficulty with masturbation.66" http://www.cirp.org/library/sex_function/ areseepee 10 September 2007

A disorder?[edit]

In the greater scheme of things, perhaps it was highly advantageous to the species in some way for primitive man to efficiently be able to ejaculate. Only when it is placed in the context of a sexual relationship does it seem to turn into a disorder. -Rolypolyman 14:07, 4 November 2007 (UTC)

I see it exactly as rolypolyman. Early ejaculation makes perfect sense in an evolutionary way. If 40% of men have it, then one could also say, that a big nose is a defect, or brown hair. We should not simplye repeat that PE is a medical disorder. It is simply a nuisance in a relationship. It is more social than medical. —Preceding unsigned comment added by Giannivenice (talkcontribs) 11:09, 12 November 2007 (UTC)

Even evolutionarily, couldn't you still make the argument that a man who suffers from PE is less likely to enjoy or have as much sex (especially when in a relationship situation, due to the depression the situation creates) as a man who does not suffer from PE? Thus, PE can easily get in the way of reproductive function, and it is then properly termed a disorder. How many jokes (in American culture) are out there involving a lack of desire for sleeping with someone with PE? Insensitive though they may be, there certainly seem to be lots of them (especially on sit-coms), showing PE directly prohibiting reproductive opportunities. Even if you want to relegate it to the realm of social disorder, it's still a social disorder with reproductive repercussions. 64.89.151.114 (talk) 19:01, 23 December 2007 (UTC)

I agree with the views expressed here. "Premature ejaculation" is ejaculation that is premature in the eyes of the ejaculator, ideally. Unfortunately, it is more and more defined as "ejaculation before a woman wants the man to ejaculate," which betrays the fact that it is a (possibly sexist) social norm, not a medical one. All this is of course our own views; what are needed are more reliable sources expressing these views, balancing the for-profit "medical" perspective and the for-pleasure female perspective. Blackworm (talk) 20:08, 5 September 2008 (UTC)

It is called a "disorder" because women are somehow wronged by a man's lack of performance. Tough. Trumpy (talk) 13:24, 25 June 2011 (UTC)

Writing for The Conversation website, Post-doctoral Psychology/Logopedics researcher, Patrick Jern (from Abo Akademi University in Finland) argued the same as above: "What we may have done is to slap a “dysfunction” tag on what is likely a perfectly normal variation in the function of a neurobiological mechanism – variation that may actually have been genuinely advantageous in not too distant history!" 128.250.195.161 (talk) 23:57, 8 August 2011 (UTC)

culture-bound[edit]

this is culture-bound, not a real illness. No animal has voluntary control over ejaculation. —Preceding unsigned comment added by 76.85.197.151 (talk) 03:39, 8 March 2008 (UTC)

Definition[edit]

New definition by IISM(International Society for Sexual Medicine) mentioning time limit is to be announced this Saturday. [1] It can be included in lead section. Xzoiecxokws (talk) 05:53, 16 May 2008 (UTC)

Huh?[edit]

The phrase "...modulated through the PGI system in the brain" is apparently meaningless. I know of no "PGI system", but it's possible that this is referring to prostaglandins (rather unlikely, though). Fuzzform (talk) 03:45, 3 October 2008 (UTC)

Dissambiguation[edit]

Musican Rozz Williams had a sound project under the name PE. I would like to write an article so if you wouldn't mind, cold you guys inform the site admins or message me telling me what I have to do? —Preceding unsigned comment added by Velheim (talkcontribs) 19:46, 11 December 2008 (UTC)

Jizz in My Pants[edit]

I thought I would like to inform editors interested in premature ejaculation that the article Jizz in My Pants is currently up for deletion. Thanks!!!Peter Napkin Dance Party (talk) 22:10, 13 December 2008 (UTC)

Copyright problems with diagnostic criteria[edit]

The American Psychiatric Association has not released its Diagnostic and Statistical Manual of Mental Disorders into public domain, but claims copyright. The Wikimedia Foundation has received a letter of complaint (Ticket:2010030910040817, for those with access) about the use of their diagnostic criteria in this and a number of other articles. Currently, this content is blanked pending investigation, which will last approximately one week. Please feel free to provide input at the copyright problems board listing during that time. Individuals with access to the books would be particularly welcome in helping to conduct the investigation. Assistance developing a plan to prevent misuse of the APA's material on Wikipedia projects would also be welcome. Thank you. Moonriddengirl (talk) 14:04, 11 March 2010 (UTC)

TREATMENT: Masters & Johnson "Squeeze Technique"[edit]

SOURCE: http://www.netdoctor.co.uk/sex_relationships/facts/prematureejaculation.htm

The Masters-Johnson method This method cures the vast majority of men, provided that both partners are keen to co-operate (which isn't always the case). It is based on a special 'penis grip' developed by the American therapists Masters and Johnson.

The finger-grip abolishes the desire to climax, so if, under careful instruction, the couple use it over a period of weeks, they can usually re-train the man so he can last much longer.

What does it involve? Your partner places her hand so that her thumb is on one side of the man's erect penis (the nearer side to her when she is facing him). Her index and middle fingers are on the other side. The index finger is just above the ridge of the glans (the 'head'), while the middle finger is just below the ridge. When the man feels that he's near to a climax, he tells his partner. She then squeezes his shaft firmly between her thumb and the other two fingers. (Don't worry: it's painless!) The program and the grip can work for male couples as well as for heterosexual ones.

To paraphrase: The goal of this method is to teach the man to become aware of the sensations leading up to orgasm and then to control and delay his orgasm on his own. The squeeze method technique begins with the manual stimulation of the penis, progresses to motionless intercourse and then to intercourse with both partners moving. This technique, created by Masters and Johnson, requires that the partner stimulate the man's penis until he is close to ejaculation. When the man is about to ejaculate, the partner squeezes just below the head of the penis hard enough to make him partially lose his erection. Masters and Johnson reported that 76 percent of couples who learned and used these techniques had success treating premature ejaculation.

The real explanation[edit]

This might be original research but there are a couple of factors to consider.

1) Maybe it's an evolutionary imperative to come fast in contrast to the pleasing your partner aspect that came into being much later. 2) The female orgasm is inferior evolution wise to the male because it serves no purpose except nest building. 3) There is a strict correlation towards men ejaculating faster when in coitus with a desirable partner vs. an undesirable one suggesting lesser imperative to mate with such as one might consider ugly. So highly desirable people that are considered experts on matters penetration wise are held in higher esteem that the less desirable partners thus giving undue weight to the opinions on pretty ladies complaining that men ejaculate too fast with them. Not to mention the preconcieved notion of 'pretty girls' to be 'fucked good' vs. the less pretty that seem to complain less.

Trying to locate a source[edit]

Can someone find the source cited about a woman's cycle affecting her parnter's IELT? The sentece is "One study of young married couples (Tullberg, 1999) reported that the husband's IELT seems to be affected by the phases of the wife's menstrual cycle, the IELT tending to be shortest during the fertile phase." The content was added by an IP user in a revision dated 16:00 22 November 2007 with oldid=172494376. I want to read this source; the citation is not enough for me to find it. If you find the source, please add a full citation to the references. Thanks. 96.25.92.119 (talk) 00:56, 5 November 2010 (UTC)

Found it, but the report is actually on the loss of signs of overt ovulation in human females versus other primates. The study uses the frequency of sexual encounters and reported 'attractiveness' as they relate the menstrual cycle to ascertain what effect the loss of these overt signs has on reproductive viability.
The problem is that this report and others which associate sex and menstruation consider only the number of times sex has been preformed, rather than how long sex took. The report mentions the length of intercourse only once, hypothesizing that it could be used as a measure of the 'attractiveness' of a female if attractiveness implied longer sex.
In short, the source doesn't support the sentence. I'm removing it. Sklifnir (talk) 13:31, 18 December 2011 (UTC)
I also removed the sentence after it, the one about higher premature ejaculation in men with older partners, out of a suspicious intuition. Haven't been
able to find a source for or against it.Sklifnir (talk) 13:36, 18 December 2011 (UTC)

Guidelines[edit]

doi:10.1111/j.1743-6109.2010.01975.x JFW | T@lk 22:46, 7 January 2013 (UTC)

Proposed Edits to "Desensitizing creams ..." paragraph under Treatments[edit]

Dear Editors - There have been recent advances in topical medications for PE that deserve more attention in the medical community. I believe the current two-sentence "Desensitizing creams" paragraph in the Treatments section could use an upgrade. Below is a proposed replacement to that section.

"Desensitizing topical medications that are applied to the tip and shaft of the penis can also be used to treat premature ejaculation. These topical medications are applied on an "as needed" basis 10-15 minutes before anticipated sexual activity and have fewer potential systemic side effects as compared to pills taken orally(1). However, use of these topical medications have in the past been associated with loss of penile sensation, and reduction of sensation for the partner due to exposure.[27] Penis insensitivity and transference to the partner are practically eliminated when using new topical anesthetic sprays based on absorption technology(2) which enable the active ingredient to penetrate through the through the surface skin of the penis(ie stratum corneum) to the sensory nerves which reside in the dermis. Any residual surface cream can be wiped off before sexual activity to further reduce partner concerns."

(1) An overview of pharmacotherapy in premature ejaculation. Porst H. J Sex Med. 2011 Oct. 8 4:335-41. doi: 10.1111/j.1743-6109.2011.02451.x. (2) Preparation and characterization of two-phase melt systems of lidocaine. Kang L. Jun HW, Mani N. Int J Pharm 2001 Jul 3; 222(1)35-44.

Please comment if you have concerns. Drllevine (talk) 18:58, 10 February 2013 (UTC)Dr. Laurence Levine, Professor of Urology, Rush University Given no comments from the editors, I have now made this live Drllevine (talk) 14:50, 23 February 2013 (UTC) Dr. Laurence Levine

I think it's important that physicians (and patients) have more awareness of the absorption technology for which you are referring and the access to products which use this technology. I propose the following additional paragraph:

"Absorption of the anesthetic can be achieved with a eutectic system. Two products with eutectic systems have been shown to be effective in treating premature ejaculation, EMLA[1], available by prescription, and PSD502 [2]. Both products contain both lidocaine and prilocaine. At the time of this entry, PSD502 has not obtained FDA approval in the United States. A third product, Promescent, achieves a eutectic formula with lidocaine only and is therefore available in the U.S., over the counter, by way of FDA monograph 21 CFR 348.10[3]." Dr.martin.miner (talk) 17:50, 26 March 2013 (UTC)Dr. Martin Miner, Clinical Associate Professor, Brown University and co-director of the Men's Health Center at the Miriam Hospital in Providence, Rhode Island

  1. ^ Atan, A. Comparison of efficacy of sildenafil-only, sildenafil plus topical EMLA cream, and topical EMLA-cream-only in treatment of premature ejaculation, Urology, 2006 Feb; 67(2):388-91
  2. ^ Carson, C. Improved ejaculatory latency, control and sexual satisfaction when PSD502 is applied topically in men with premature ejaculation: results of a phase III, double-blind, placebo-controlled study; J Sex Med 2010 Sep 7(9):3179-89. doi: 10.1111/j.1743-6109.2010.01913.x
  3. ^ http://www.fda.gov/downloads/Drugs/DevelopmentApprovalProcess/DevelopmentResources/Over-the-CounterOTCDrugs/StatusofOTCRulemakings/UCM078147pdf

Replacement of most of the current article[edit]

Fellow Editors: I am Michael Castleman.

Why this entry should be updated:

The previous entry dealt almost entirely with drug treatment of PE. Its writer(s) were unaware of:

(1) The several historical perspectives on PE.

(2) The effectiveness of the Masters and Johnson cognitive-behavioral treatment program.

(3) Contemporary sex therapists’ refinements of the M&J cognitive-behavioral treatment program to increase effectiveness.

(4) The potential side effects of drug treatment.

(5) The fact that drug treatment works best in conjunction with the sex therapy program.

In the following I have not demarcated sections, as I found that might create confusion. This more comprehensive substitute entry corrects these problems. Consider replacing the whole article with the following that incorporates both old and new text:

Premature ejaculation (PE) occurs when a man expels semen sooner than he or his partner would like. Men with PE often report emotional and relationship distress, and some avoid pursuing sexual relationships because of PE-related embarrassment.[1] Compared with men, women consider PE less of a problem[2], but several studies show that the condition also causes women distress.[3][4][5] However, few PE sufferers seek treatment, believing (mistakenly) that the condition is untreatable.[1]

Premature ejaculation is also known as rapid ejaculation, rapid climax, premature climax, early ejaculation, or coming too soon. Several researchers have timed lovemaking and discovered that 18-to-30 year-old men’s average time from vaginal insertion to ejaculation (intravaginal ejaculatory latency time, or IELT) is approximately 6.5 minutes.[6][7] It is possible that men with abnormally low IELTs could be happy with it and not report a lack of control. Likewise, those with high IELTs may still consider themselves premature ejaculators.

But duration of sex as measured with a stopwatch is beside the point. The real issue is voluntary vs. involuntary ejaculation.[8] Men with PE ejaculate involuntarily. Fortunately, most men can learn to ejaculate voluntarily and last as long as they’d like, no matter whether it’s five minutes or two hours.[9][10][11][8][12]

Because of the great variability in the time required to ejaculate and both partners’ desired duration of sex, PE prevalence is difficult to determine. However, the consensus of available research shows that premature ejaculation is men’s most prevalent sexual dysfunction. In the landmark “Sex in America” surveys (1999 and 2008), University of Chicago researchers showed that from adolescence through age 59, approximately 30 percent of men reported experiencing PE at least once during the previous 12 months, while only about 10 percent reported erectile dysfunction (ED).[13]. After age 60, ED becomes men’s most prevalent sex problem, however premature ejaculation remains a significant concern affecting 28 percent of men age 65 to 74, and 22 percent from 75 to 85.[13] Other studies report PE prevalence ranging from 3 percent to 41 percent of men over age 18, but the large majority estimate a prevalence of 20 to 30 percent—making PE men’s most common sex problem.[14][15][16][17][18][1][19]

History

Ejaculatory control issues have been documented for more than 1,500 years. The Kamasutra, the 4th century Indian sex handbook, declares: “Women love the man whose sexual energy lasts a long time, but they resent a man whose energy ends quickly because he stops before they reach a climax.”[20]

In Western culture, women’s sexual pleasure was also important—but only until the 17th century, when male doctors decided that women were not sexual. By 19th century Victorian era, men—and most women—believed that women were little more than fleshy receptacles for men’s lust who endured sex to retain husbands and have children. Modern sex research has thoroughly debunked this idea, showing that men and women are equally capable of sexual arousal, pleasure, and orgasm.[21][22][23][24][25]

During the era when women were considered non-sexual, ejaculatory control was not an issue for men. Because women were incapable of sexual pleasure, men were under no obligation to last long enough to provide it.

Pioneering sex researcher Alfred Kinsey did not consider rapid ejaculation a problem, but viewed it as a sign of masculine vigor [21]. Other mammals ejaculate quickly during intercourse, prompting biologists to declare that rapid ejaculation had evolved into men’s genetic makeup to increase their chances of passing their genes.[12]

Well into the 20th century, sexuality authorities considered rapid ejaculation normal. In 1948, when Alfred Kinsey, the first modern American sex researcher, released Sexual Behavior in the Human Male he noted that 75 percent of men said they ejaculated within two minutes of vaginal insertion. Kinsey did not view this as a problem.[26] More recent surveys suggest that for men aged 18 to 30, the average time from vaginal insertion to ejaculation ranges from one to six minutes,[27] but many men wish they could last longer. How much longer? As countless popular songs say, “all night long.”

As Victorian notions about sexuality faded, Westerners returned to the ancient view that women are as sexual as men, and men came to believe that it was their responsibility to provide women with erotic pleasure. Rapid ejaculation interfered with this, and after World War I, it began to be viewed as a problem.

The first Western clinicians to focus on this new sex problem were psychoanalysts, followers of Sigmund Freud. Freudian theory postulated that rapid ejaculation was a symptom of underlying neurosis. The man suffers unconscious hostility toward women, so he ejaculates rapidly, which satisfies him but frustrates his lover, who is unlikely to experience orgasm that quickly.[21] Freudians claimed that premature ejaculation could be cured using psychoanalysis. But even years of psychoanalysis accomplished little, if anything, in curing premature ejaculation.[21]

Freudian theory was mistaken on two counts. There is no evidence that men with premature ejaculation harbor unusual hostility toward women.[19] And while many women enjoy the closeness and intimacy of intercourse, only about 25 percent are consistently orgasmic from sexual intercourse, no matter how long it lasts.[25] To experience orgasm, most women require direct stimulation of the clitoris.[22][23][24]

The Masters and Johnson Program PE may be caused by prostatitis[17] or as a drug side effect, but William Masters, M.D., and his assistant, Virginia Johnson proved that in the vast majority of cases, it’s a bad habit that can be changed. Masters and Johnson pioneered laboratory research into human sexuality and sexual dysfunctions, initially in the Department of Obstetrics and Gynecology at Washington University in St. Louis (1957-1964), and later at the independent Reproductive Biology Research Foundation (1964-1978), eventually renamed the Masters and Johnson Institute (1978). Their studies of men’s and women’s sexual anatomy and physiology demonstrated that many sex problems—notably PE and women’s inability to experience orgasm (anorgasmia) —could be resolved with a combination of reassurance, sex information, whole-body erotic massage (“sensate focus”), and specific adjustments of sexual technique. Their approach proved very successful and invented sex therapy.

To treat premature ejaculation, Masters and Johnson developed the “squeeze technique.” Men were instructed to pay close attention to their arousal pattern and learn to recognize how they felt shortly before their “point of no return,” the moment ejaculation felt imminent and inevitable. Sensing the point of no return, they were to signal the partner, who squeezed the head of the penis between thumb and index finger, suppressing the ejaculatory reflex and allowing the man to last longer.[28][21][29]

Refinements of the Masters and Johnson Program

The squeeze technique worked, but many couples found it cumbersome. From the 1970s to the 1990s, sex therapists refined the Masters and Johnson approach, largely abandoning the squeeze technique and basing the program on a simpler and more effective technique, “stop-start.” During intercourse, as the man senses he’s approaching his point of no return, both lovers stop moving and remain still until the man’s feelings of ejaculatory inevitability subside, at which point, they are free to resume active intercourse. [30][31][32][33][34]

In addition to the stop-start technique, other sexual adjustments help men develop and maintain ejaculatory control, among them: masturbation exercises, deep breathing, and whole-body massage. Sex therapists estimate that the refined last-longer program teaches effective ejaculatory control to 90 percent of men.[35][36][37][38][39] The authors of one study concluded that sex therapy “has a remarkable therapeutic effect on premature ejaculation.”[40]

By the 21st century, most men with premature ejaculation could cure themselves, either solo or with a partner, using self-help resources, and only those with unusually severe problems had to consult sex therapists, who cured 75 to 80 percent.[41][40]

Mechanism of Ejaculation

Ejaculation requires two physiological actions—semen emission and expulsion.

Emission, controlled by sympathetic motor neurons, involves the transfer of fluid from the vas deferens, seminal vesicles, and prostate gland into the urethra.[42] Expulsion, controlled by somatic and autonomic motor neurons, involves closure of the bladder neck, followed by rhythmic contractions of the pelvic floor muscles (perineal and bulbospongiosus muscles) and intermittent relaxation of the external urethral sphincters.[43]The brain compound (neurotransmitter) serotonin plays a key role in ejaculation. Several animal studies have demonstrated serotonin’s impairment or complete suppression of ejaculation,[44] leading researcher to speculate that a low brain level of serotonin might cause premature ejaculation.;[45]

Drug Treatment

In 1987, the Food and Drug Administration approved Prozac, the first selective serotonin reuptake inhibitor (SSRI) antidepressant. Prozac and subsequently approved SSRIs (Paxil, Zoloft, Celexa, Luvox, Lexapro) elevate mood by increasing serotonin levels in the spaces (synapses) between brain cells. Confirming the animal studies, early male users of Prozac reported that the drug had an unusual side effect, delay or elimination of ejaculation.[32] By the early 1990s, physicians were prescribing low-dose SSRIs to treat PE.[46]

Recently, an SSRI was developed specifically to treat PE,[47] Priligy (dapoxetine). Approved in several European countries, including Finland, Sweden, Portugal, Austria and Germany,[48][49] the drug is currently awaiting U.S. Food and Drug Administration (FDA) evaluation after concluding final-phase (Phase III) studies, which included participants from 25 other countries, including the United States. In this diverse population, dapoxetine significantly improved PE and was generally well tolerated.[17]

Drug treatment is often effective, but unlike the sex therapy program, it does not teach men ejaculatory control. When drug therapy ceases, PE returns.[17] Drug treatment is also costly, and may cause side effects, among them: nausea, diarrhea, headache, dizziness, fatigue, decreased libido, erectile dysfunction, and reduced fertility.[17][50]

Doctors generally prescribe drugs as first-line PE treatment,[17][51] however, after receiving comprehensive training in the condition, most recommend the behavioral sex therapy approach first, with drugs reserved for those who need additional help.[52] Even when drugs prove necessary, combination treatment with both sex therapy and drugs works significantly better than drug treatment by itself.[53]

Desensitizing Topical Medications (Delay Creams)

Before Masters and Johnson proved that most PE was a simply bad habit, some physicians believed that the penises of men who suffered it were overly sensitive to touch (“penile hypersensitivity”). They treated PE with ointments containing topical anesthetics, for example, lidocaine. However, Korean researchers showed that the penises of men with PE are no more touch-sensitive that those of men who enjoy good ejaculatory control.[54]

Nonetheless, several anesthetic ointments have been introduced to treat PE, and studies show that they provide modest benefit,[55][56] allowing men who ejaculated in less than one minute to last for as long as three minutes.[57]

However, many men want to last longer than that. Desensitizing products don’t teach ejaculatory control so they don’t cure PE. They must be applied 10 to 15 minutes before intercourse, which may interrupt lovemaking. Many men complain that topical anesthetics reduce the pleasure of sex. Finally, some women complain that desensitization products desensitize their genitals, and make fellatio less palatable.[58] Desensitizing creams are not recommended by sex therapists.


References[edit]

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Mcastleman.author (talk) 01:14, 25 April 2013 (UTC)

Comments on Michael's (User:Mcastleman.author's) proposal[edit]

  • Great to have you here Michael. I have no time today to think about this but I'll just point out for now: so that others may check our interpretation of sources, we are required to include page numbers in book citations. I know at this stage it may be quite a chore to track these down, but it is a very important part of our epistemological model, and an assertion citing only a book without page numbers is generally treated as an assertion with no cited source. I'll get back to this. I'll also leave a note at Wikipedia talk:WikiProject Medicine#Proposed rewrite of Premature ejaculation. --Anthonyhcole (talk · contribs · email) 03:40, 25 April 2013 (UTC)
  • Thanks, I'm on vacation, but will get on it when I return after May 12 Mcastleman.author (talk) 19:21, 25 April 2013 (UTC)
  • Concerns about this new version after first skim, starting with some inappropriate use of WP:PRIMARY sources and the content clearly steers the reader instead of just presenting the information. Also WP:WEIGHT problems. Will take a closer look later but not comfortable with it as is. Zad68 04:22, 26 April 2013 (UTC)

Feedback?[edit]

Hi, folks. I've done my best to integrate the re-write suggestions above, the comments on those suggestions, and information from relevant secondary sources. It still needs quite a bit of polishing, but I thought after so many edits, I should check for input/feedback on the bigger changes.— James Cantor (talk) 15:57, 30 April 2013 (UTC)

Sorry James, I know nothing about this topic. Hopefully you and Michael can work together when he's back from vacation.
Michael, you should appraise yourself of Wikipedia:Identifying reliable sources (medicine) for an understanding of how we use sources on health-related topics. If you need anything, the people at WT:MED (the medicine project) will be more than happy to help. --Anthonyhcole (talk · contribs · email) 03:53, 5 May 2013 (UTC)

Dear Editors - the section that I wrote in February is still perfectly valid (see Talk section directly above Michael's Talk entry about Desensitizing Creams), so I am going to add it back in. Dr. Laurence Levine, Professor of Urology, Rush University, Chicago, IL. Drllevine (talk) 22:45, 29 May 2013 (UTC)

Following up on Dr. Levine's edits, it's important that patients are aware of these new solutions for topical medications. I am adding my original comments back into the Medications section. Dr. Martin Miner, Clinical Associate Professor, Brown University and co-director of the Men's Health Center at the Miriam Hospital in Providence, Rhode Island Dr.martin.miner (talk) 12:25, 31 May 2013 (UTC)

Promescent as Treatment Option for PE[edit]

Promescent is becoming a more common treatment option for PE by urologists across the U.S. Numerous urologists are recommending it including some of the top physicians in sexual medicine such as Dr. Larry Lipshultz, Baylor College of Medicine http://www.larrylipshultz.com/about/dr-larry-lipshultz one of the leaders in sexual medicine in the U.S. His practice often recommends Promescent. At Brown University (my affiliation), Promescent is first-line therapy for PE. There are hundreds of urologists who now recommend Promescent for their patients, usually as first-line therapy. I think it's important to make the public be aware of this product.

However, Promescent has not yet gone through clinical trial and there are no other formal studies with the product that can satisfy Wiki's rules for medical products WP:MEDRS.

Any advice? Dr.martin.miner (talk) 16:27, 16 July 2013 (UTC)

Aminmale ??? means Mike Chase is a 2 pump chump, lol[edit]

Does anyone get this? aminmale - Mike Chase is 2 pump chump, lol — Preceding unsigned comment added by 67.174.44.171 (talk) 08:04, 27 December 2013 (UTC)