I have a 61-year old friend who says he's got a problem with premature ejaculation. What exactly causes this? - A, Whangarei
Even the experts can't agree on a precise definition of premature ejaculation, also known by its less pathological name: "rapid ejaculation".
In practical terms, it's when a man ejaculates
sooner than he or his partner would have preferred. Contrary to the movies, in the real world the average male ejaculates within two to 10 minutes of penetration. When you consider that most women take longer than men to reach orgasm, and that some women can never achieve orgasm with vaginal intercourse alone, it becomes clear that premature ejaculation is a real and common issue in the lives of many couples.
At its simplest, if a man (or his partner) feel distressed that ejaculation happened too soon, it's premature ejaculation. If he (and his partner) are comfortable with the duration of intercourse, it's not.
We should also distinguish between occasional and chronic premature ejaculation. Under conditions of extreme arousal, premature ejaculation is common, and not a cause for concern. Chronic or recurrent episodes, however, can be psychologically debilitating.
Premature ejaculation can occur at any age, but is more common in younger men, and is frequently related to anxiety and poor communication between partners. Most cases respond to some form of treatment, whether medical or psychological.
The highest success rates are with the SSRIs, a class of antidepressants that increase serotonin levels in the brain, delaying ejaculation by an average of two to five minutes. Other ways of delaying ejaculation include perineal muscle-strengthening exercises, using a start-and-stop technique during intercourse, or masturbating prior to intercourse to increase the latency period.
But before he jumps into treatment, you should encourage your friend to see his GP or a sexual health specialist for a formal evaluation. When it comes to taboo issues like sexual health, having an honest talk is half the cure.
Gary Payinda MD is an emergency medicine consultant in Whangarei.
Have a science, health topic or question you'd like addressed? Email: drpayinda@gmail.com
(This column provides general information and is not a substitute for the medical advice of your personal doctor.)
