The document discusses premature ejaculation (PE), defining it as ejaculation occurring within about one minute of penetration, which impacts a man's quality of life. PE can be primary, occurring since the start of a man's sexual activity, often due to performance anxiety in young, inexperienced men, or secondary, developing after a period without issues. Treatment involves both behavioral sex therapy techniques to help men control arousal levels, like start-stop methods, and pharmacological treatment using serotonin reuptake inhibitors to delay ejaculation and motivate patients. An ideal approach combines these treatments while involving partners for support.

1. Dr. P K Gupta
Consultant Sexologist

2.  The last twenty years have seen an advance in evidence-based medical knowledge
regarding Premature Ejaculation (PE). Let's see what is happening with this
problem and its treatment.

3.  Why do we need to treat PE?
 Premature ejaculation is the most common male sexual dysfunction. It affects
about a third of men at various times in their lives, with little variation depending
on age and continent. Many studies have shown that it causes very significant
suffering in men of course, but also in the partner and the couple. PE has a very
strong impact on the quality of life of men in general, in particular on sexual
satisfaction which is greatly reduced. Premature ejaculation also has a strong
impact on self-confidence and self-esteem.

4.  Why do we need to treat PE?
 This problem also impacts on female sexuality. Moreover, men with premature
ejaculation often feel immense guilt vis-à-vis their partner. Communication
difficulties can appear in the couple as the two partners find it difficult to approach
the problem: the woman because she is afraid of plunging her man into an anxiety
of failure, of hurting and upset him and man because he chooses instead denial and
avoidance. Intercourse becomes less frequent (“you're still going to ejaculate too
fast,what's the point of trying?”), which further increases the speed of ejaculation
and can lead the couple into a seizure, explains sex specialist in Delhi.

5.  How to define PE?
 It is defined as follows by the best sexologist in Delhi: PE is a male sexual
dysfunction characterized by ejaculation which always or almost always occurs
before or at most about one minute after vaginal penetration, by an inability to
delay ejaculation during all or almost all vaginal penetrations and through
negative personal consequences,such as pain, hassle, frustration and / or
avoidance of sexual intimacy.

6.  How to define PE?
 There are two main clinical forms: primary PE where ejaculation is very rapid,
following shortly or sometimes preceding penetration, almost systematic for all
sexual relations, with all partners, since the start of sexual activity. Concretely, most
frequently, they are men, mainly young and inexperienced, experiencing strong
performance anxiety.They are under 30, and they have an obvious lack of
learning.These young men often have a guilty masturbation, and they are used to
quickly release their tensions by masturbation.

7.  How to define PE?
 Secondary PE occurring after a period of sexual life when ejaculation was not a
problem.This change can be due to life events affecting private life (for example
the arrival of a child), to psychological, relational or medical problems. In this case,
it is often linked to an erectile dysfunction. (The man then seeks maximum
excitement to obtain and maintain an erection that he is afraid of losing and,
therefore, he precipitates the onset of his ejaculation).

8.  How to define PE?
 Besides these two main clinical forms, there are also men who complain that
everything is normal in terms of their ejaculation delay.These are men who have in
mind performances disconnected from sexual reality. Perhaps it is necessary to
look on the side of pornography with its actors "delayed ejaculators or
ejaculators". In this sense, porn movies would lead to pressure to conform to an
imaginary standard.

9.  What are the causes of PE?
 All the research carried out highlights two dimensions that can explain this
pathology.The first is sexological and the other neurochemical.
 The sexological dimension is based on a lack of sexual skills to manage sexual
arousal. Concretely, the patient cannot keep his excitement at levels lower than that
which triggers the ejaculatory reflex and he is then unable to prolong the duration
of the penetration.
 The neurochemical dimension is based on work concerning the key role of a
cerebral neurotransmitter: Serotonin. PE is linked to the fact that we do not find
enough active serotonin in the intersynaptic spaces.

10.  How to treat PE?
 The therapeutic management of PE derives from these two dimensions. Of course,
its modalities vary depending on the individual and the situation, but most often,
PE will respond to a combined treatment, combining sexological therapy with
pharmacological treatment.

11.  How to treat PE?
 Several behavioral sex therapies exist aimed at making the patient acquire skills in
his sexual choreography allowing him to modulate his arousal.The most classic
protocols are “Stop and go” or “stop-start” (The principle is to break down the
excitation into stages and stop at these stages), compressions or “Squeeze” (The
principle is to '' teach the man, through various compressions, to reduce his arousal
when he is about to ejaculate) and sex-functional therapy (The principle is to
manage the intensity of the stimulation that the man receives and changes caused
by excitement, especially breathing and muscle tension).

12.  How to treat PE?
 Pharmacological premature ejaculation treatment in Delhi is based on the use
of a Serotonin reuptake inhibitor which allows rapid efficacy on the symptom useful
to motivate the patient, essential in the event of severe PE (less than a minute) for
set up a possibility of skills acquisition or when the couple is in crisis and the
demand for a quick result.

13.  Conclusion
 Every patient with PE has the opportunity to treat it. For this, he must overcome the
embarrassment and shame to consult with a sexologist in Delhi. PE is most often a
pathology that concerns the couple and the inclusion of the partner in the care
process is most often useful. Each patient should be able to benefit from basic
psychosexual education.The sexologist doctor in Delhi now has different
treatments and can offer each patient and each couple an appropriate
psychosexological intervention, alone or in addition to pharmacotherapy.