Premature Ejaculation

The definition for premature ejaculation has been debated over the years but many experts in the field currently rely on the International Society of Sexual Medicine (ISSM) definition which identifies the following criteria:

• Ejaculation which occurs always or nearly always before or within one minute of vaginal penetration.
• Failure to delay ejaculation during nearly all episodes of vaginal penetration.
• Personal distress, bother, frustration and/or the avoidance of sexual encounters.

Premature ejaculation may be classified as 'lifelong' (primary) or 'acquired' (secondary): 

• Lifelong premature ejaculation is characterised by onset from the first sexual experience and remains a problem during life.
• Acquired premature ejaculation is characterised by a gradual or sudden onset with ejaculation being normal before onset of the problem. Time to ejaculation is short but not usually as fast as in lifelong premature ejaculation.

The European Association of Urology (EAU) points out that the ISSM definition only applies to men with lifelong premature ejaculation who have vaginal intercourse. The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) is due to publish a new definition in May 2013.

Epidemiology

• The prevalence of premature ejaculation varies according to definition and is difficult to assess in view of many men not wanting to seek help or even discuss the problem.
• The EAU reports a prevalence of 20-30% whilst a Cochrane review quoted a prevalence of 3-20%.

Risk factors

• Premature ejaculation may be anxiety-related. It is therefore more common in young men and early in a relationship. In these situations, the problem usually resolves with time. 
• Iatrogenic causes include amfetamine, cocaine and dopaminergic drugs. Although effective for the treatment of premature ejaculation in some men, sildenafil may also be a cause of premature ejaculation in others.
• Urological causes - eg, prostatitis.
• Neurological causes - eg, multiple sclerosis, peripheral neuropathies.

Management

Management should be tailored to the needs of the individual. The condition may be more of an issue in some relationships than others and patient expectation should be explored. Psychosexual counselling may be sufficient.

• General advice:
  • More frequent sex (or masturbation): premature ejaculation is more likely if there is a longer gap between sexual intercourse.
  • Using a condom to decrease sensation.
  • Sex with the woman on top reduces the likelihood of premature ejaculation.
  • Squeeze and stop-go techniques: stimulating the penis almost to the point of ejaculation and then stopping. These techniques are often effective but may take a few months to produce any benefit and relapse is common..
  • Behavioural treatments are useful for secondary premature ejaculation but are not recommended first-line for lifelong premature ejaculation. They are time-intensive and require commitment from the partner.
• Drug therapy:
  • Selective serotonin reuptake inhibitor (SSRI) antidepressants are the most commonly used (off-label use) but need to be taken daily for 12 weeks before the maximum effect is achieved. Paroxetine, clomipramine, sertraline and fluoxetine have all been shown to be effective. Reduced response to treatment has been recorded after 6-12 months.
  • In patients who cannot tolerate the side-effects of SSRIs, on-demand treatment with clomipramine may be a suitable alternative.
  • Daproxetine is an SSRI which has been specifically developed for the treatment of premature ejaculation and is proving highly effective. 
  • Sildenafil is an effective alternative, especially in older men and when associated with erectile dysfunction. Studies suggest that It improves intravaginal latency times, reduces performance anxiety and improves sexual satisfaction. It is thought to act by down-regulating the ejaculation threshold. There is some evidence that a combination of sildenafil with SSRI is better than SSRI monotherapy.
  • Anaesthetic creams may be effective and may show an additive effect when combined with sildenafil. Aerosol sprays are proving popular and novel preparations are being developed. Topical preparations may be the preferred therapy for some patients. 
  • Tramadol has been found to have beneficial effect in the treatment of premature ejaculation but further studies of long-term safety are required before this treatment can be recommended as a viable option.
• Psychosexual therapy:
  • The evidence base for the effectiveness of psychological interventions.is limited and randomised trials with larger sample sizes are needed.
• Surgery:
• One study reported that a short frenulum was found in 43% of individuals affected by lifelong premature ejaculation. Frenulectomy was effective in relieving the problem and the authors recommended excluding short frenulum in all patients with lifelong premature ejaculation.

Complications

Premature ejaculation may have a significant adverse effect on both self-confidence and the relationship. One study reported that premature ejaculation can lead to sexual dissatisfaction, a feeling that something is missing from the relationship and an impaired sense of intimacy. If the condition remains untreated it can lead to increased irritability, interpersonal difficulties and deepening of an emotional divide.

http://www.patient.co.uk/doctor/premature-ejaculation-pro

Why Sex Is Good For You

10 Ways More Sex Can Improve Your Health

From burning calories to cancer prevention, the benefits of an active love life go beyond the obvious. Ready to get some?

It probably won't take much convincing to follow this general rule, but you should know it, anyway—the more sex you have, the healthier you'll be. Not only can it help your general mood (thereby reducing stress), but studies show there are tangible ways sex slows down the aging process, fights disease and even heals wounds. Here, a full breakdown of the ways getting it on can save you a trip to the ER.

1. Sex promotes heart health.
A study in the American Journal of Cardiology suggests that men who have sex twice a week have a lower risk of cardiovascular disease (CVD) than men who have less frequent sex. And this was true even after researchers adjusted for erectile dysfunction. Analyzing the health records of 1,165 men who were monitored for 16 years as part of the Massachusetts Male Aging Study, epidemiologists at the New England Research Institutes found that men who had sexual activity once a month or less were at 50 percent greater risk of cardiovascular disease than the men who had sex more than once a week.

"Our research found that a low frequency of sexual activity predicted new cardiovascular events," says Susan Hall, PhD. Hall says a number of possible factors could have contributed to the study's finding: The psychical capacity to have sex might be a marker for overall health, or the physical exercise from sex might directly protect against CVD. Or it might be that men who have regular sex enjoy improved health through stress reduction from a supportive relationship. Whatever the reason, it appears that sex is good for your ticker.

2. Doing it burns calories.
Due to its brevity, having an orgasm fries only two or three calories. But the prelude can burn quite a bit more, depending on your weight and the length and vigor of the lovemaking session. For example, a raucous romp uses about 5 METs (metabolic equivalents), a system for gauging the intensity of physical activity. (Sitting quietly, for comparison, is equal to 1 MET.) So, a 190-pound man would burn 413 calories in an hour of vigorous sexual activity. But since the average lovemaking session is about 20 minutes, you're talking about only around 150 calories. Still, that's more than double the caloric expenditure of sitting alone on the couch.
Try these tips from the Men's Health Big Book of Sex to unleash your power where it matters the most – in bed!

3. Sex is a natural sleeping pill.
As women know all too well, orgasm is a rather effective sleep aid for most men.

4. Sex stifles stress.
Research at the University of the West of Scotland shows that sex, like exercise, releases anxiety, lowers stress hormones, and can help people cope with mental pressure for at least a week. In the study, 46 men and women were put in a stressful situation involving speaking and working math problems in front of a tough audience. Participants were also asked to keep a diary of their sexual activity for two weeks prior to the test. Those who had sex were the least stressed out, and their blood pressures returned to normal faster after the public speaking test. "People who had penile-vaginal intercourse did twice as well as people who only masturbated or had no sex at all," says psychologist and lead researcher Stuart Brody.

5. A roll in the hay keeps the doctor away.
People who have sex once or twice weekly have stronger immune systems than people who have sex less than once a week, according to a study at Wilkes University in Pennsylvania by psychologists Carl J. Charnetski, PhD, and Francis X. Brennan Jr., PhD. In their book, Feeling Good is Good for You: How Pleasure Can Boost Your Immune System and Lengthen Your Life, they describe their study in which they took saliva samples from 111 college students and asked them about their frequency of sex over the course of a month. Analysis showed that the saliva of the students who had sex once or twice a week had 30 percent more of the antigen immunoglobulin A (IgA) than the saliva of students who had sex less often. "IgA is the body's first line of defense against colds and flu," says Charnetski. Other studies show that happy relationships are good for health. In one experiment reported in the New England Journal of Medicine, University of Pittsburgh scientists shot live cold viruses up the noses of volunteers. Those who reported having strong ties with lovers, friends, and family were the least likely to catch a cold.

6. Good love is better than a bandage.
Researchers at Ohio State University Medical Center inflicted minor blister wounds on the arms of 45 married couples during 24-hour visits on two different occasions. On the first visit, the couples were prompted to engage in a positive, supportive discussion. Two months later they returned and new wounds were administered, the couples were prompted to argue. Results showed that wounds healed nearly two times faster after the positive interaction.

7. More sex may turn back the clock.
Can having sex keep wrinkles away? British neuropsychologist David Weeks, MD, of Royal Edinburgh Hospital believes so. In a 10-year-long study, he interviewed 3,500 adults in England and the United States, and found that people who reported having sex four times a week looked about 10 years younger than they actually were. Pleasure derived from having loving sex releases hormones, including human growth hormone, that are crucial in preserving youth, he says.

8. Frequent orgasms may protect against cancer.
Several studies have suggested that frequent ejaculation over many years may decrease risk of prostate cancer. In one US study, 29,000 men, ages 46 to 81, were asked their history of sexual intercourse and masturbation between the ages of 20 and 49. Researchers at the National Cancer Institute analyzed the data and determined that the group of men who reported 21 orgasms per month was much less likely to have prostate cancer than men who averaged seven or fewer ejaculations per month. The researchers speculated that several protective factors may contribute: ejaculation may clear the prostate of carcinogenic secretions and the stress-reduction benefit from orgasm may limit potential harmful substances that could trigger cancer.

9. Love longer, live longer.
An Irish study published in the British Medical Journal in 1997 tracked the mortality of 1,000 middle-aged men over the course of a decade and concluded that sexual activity may have a protective effect on health. By comparing men according to age and health, researchers found that men who had the highest frequency of orgasms had a death rate 50-percent lower than men who did not ejaculate frequently.

10. Men who have more sex are—surprise—happier!
An Australian survey of 5,000 people showed that married men are 135 percent more likely to report happiness than single men, while only 52 percent of married women are happier than unmarried women. Could it have something to do with the fact that sex is easier for cohabiting couples? According to a national sex survey conducted by the University of Chicago, sexual activity is 25 percent to 300 percent greater for married couples compared to non-married people, depending on age.

http://www.menshealth.com/sex-md/sex-health-benefits

Taking Care of Your Sexual Health

Sexual health, like emotional, mental, and physical health, is one important dimension of overall health.

Sexual health. For some people any sex topic is off-limits. But others, including the World Health Organization, consider sexual health an essential dimension of human health and well-being. 

From concern over how to have comfortable, enjoyable sex to questions about testing for sexually transmitted diseases (STDs) and their prevention, many important topics come under the broad umbrella of sexual health.

“Sexual health is an essential and beneficial dimension of being human,” emphasizes Michael McGee, MEd, a certified sexual health educator and adjunct professor at Montclair State University in Montclair, N.J.

“People have a right to sexual health, sexual health information including public policy that supports sexual health, and the right to pleasure.”

In addition to teaching and advocating about sexual health, McGee counsels individuals and couples on sexual health issues. He says the most common, fundamental question he encounters is, “Am I normal?”

This, he argues, is the best reason to be educated about sexual health: to have a realistic understanding of what sexual health is — what the wide range of “normal” is — as well as being better able to take care of your own health and pleasure and that of your partner.

Increase Your Sexual Health Awareness

Premature ejaculation and a woman’s ability to achieve orgasm are topics that McGee says his clients often worry about — and appreciate learning how to manage. Other aspects of sexual health that people should be educated about include:

Sex basics. Understanding the cycle of desire, stimulation, and response improves sexual health, says McGee.

Reproductive issues. Sexual health is intimately related to reproduction. Birth control choices to prevent pregnancy and the steps couples need to take to have a healthy pregnancy are all aspects of sexual health.

Vaginal dryness. As women go through changes in their lives, such as pregnancy and childbirth or menopause, they may experience a lack of vagina lubrication. This makes sexual intercourse unpleasant, but there are solutions to this problem.

Lack of desire. A frequent source of conflict between couples, says McGee, is a “discrepancy in desire — one partner wants sex more often than the other.”

Erectile dysfunction. There are various physical and emotional reasons why men may not be able to achieve an erection for the duration of sexual intercourse.

Physical challenges. Physical impairment, health concerns, and other conditions may require creative problem solving in order to have sexual intercourse.

Sexual Health: Guarding Against Infection.

Sex can be pleasurable, but it can also be risky. Sexually transmitted diseases (STDs) can be uncomfortable or painful; they can have severe, long-term effects that include the loss of fertility and have the potential to be life-threatening. Learning about sexual health means learning about STDs:

STD identification. Learn about the signs and symptoms of STDs as well as the consequences of infection.

Prevention.

Taking steps to prevent the spread of STDs protects your health and the health of others.

STD testing. STD testing is a crucial part of your sexual health plan. Finding out whether you have an STD enables you to start treating the infection and protecting your sexual partners.

Living with an STD. Some STDs will be with you for life, such as hepatitis, herpes, and HIV/AIDS. For people living with STDs, sexual health encompasses coping with these infections over the long term.

Intimate partner violence. Safety within sexual relationships continues to be a concern. Women may be particularly at risk for sexual violence.

How to Get Help for Intimate Issues. Unfortunately, many people wait a long time before seeking a solution to their sexual health concerns, notes McGee: 

“By the time they come to a professional, usually it has become a pressing need. And it is sometimes very difficult.”

McGee recommends seeking help as soon as you have concerns rather than waiting and hoping the problem will go away.

McGee is certified by the American Association of Sexuality Educators, Counselors, and Therapists (AASECT) as a sexual health educator. Depending on the problems you want to resolve, your sexual health team could include a variety of health professionals, such as:

• Primary care doctor
• Obstetrician-gynecologist
• Urologist
• Physical therapist
• Mental health professional

Whether it’s knowledge about your body or information about treating a specific condition, take the right steps to get education and any counseling you might need to protect your sexual health.

http://www.everydayhealth.com/sexual-health/basics.aspx