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Premature ejaculation (PME)
By Dr. Sumit Sharma
Urologist, Uro-oncologist,
sexologist and Kidney Ttrasplant
surgeon(Gurgaon)
http://drsumiturologist.com/
CROSS-SECTIONAL DIAGRAM OF THE PENIS
NEUROANATOMY OF PENILE ERECTION
THE MECHANISM OF PENILE ERECTION
MALE SEXUAL DYSFUNCTION
EJACULATORY
DYSFUNCTION
ERECTILE
DYSFUNCTION
HYPOACTIVE SEXUAL
DESIRE DISORDER
PREMATURE EJACULATION (PME)
“Premature ejaculation is defined as persistent or
recurrent ejaculation with minimal sexual
stimulation before, upon, or shortly after
penetration and before it is wished by the man or
his partner”
(Neil Baum, Bradly Speiler et al, Medical aspects of human sexuality, May
2001:15-25)
(AUA guidelines on PME, 2004)
PREVALENCE
• The most commonly experienced male sexual
dysfunction in American men.
• 1/3rd of all sexually active men suffer from PE.
• A prevalence of 21% (10-30%) in men ages 18
to 59 in the United States
(Lauman EO, Paik A et al,JAMA 281:537,1999)
PSYCHOLOGICAL CAUSES
• Early sexual experiences,
• Performance anxiety,
• Low arousal levels, or
• Decreased sexual desire
• Psychological stress (fear, guilt, anxiety) with
sexual activity
• Relationship or partner issues
BIOGENIC CAUSES
• Hypersensitivity of the penile skin
• Hyperexcitable ejaculatory reflex
• Hyperarousability
• Endocrinopathy
• Genetic predisposition
• 5-HT-receptor dysfunction
MEDICAL CONDITIONS THAT CAN
CONTRIBUTE TO PREMATURE EJACULATION
• Arteriosclerosis
• Benign prostatic hyperplasia
• Cardiovascular disease
• Diabetes
• Injury to the sympathetic nervous system
• Pelvic injuries
• Prostate cancer
• Prostatitis
• Urethritis
• Urinary incontinence
• Polycythemia
• Polyneuritis
TREATMENT
Erectile Dysfunction (ED)
treatment
• If PE is associated with
ED, treat the primary
cause
(e.g.PDE5inhibitors)
BEHAVIOURAL TECHNIQUES
• ‘Stop-start’ and ‘squeeze’ techniques
• Extended foreplay
• Pre-intercourse masturbation
• Cognitive distractions
• Alternate sexual positions
• Interval sex and increased frequency of sex
PSYCHOSEXUAL COUNSELLING
• Address the issue that has created the anxiety or
psychogenic cause
• Address methods to improve ejaculatory control.
Therapy options
- meditation/relaxation
- hypnotherapy
- neurobiofeedback
ORAL PHARMACOTHERAPY
• Delayed ejaculation a common
side-effect of SSRI and TCA
• SSRIs are now commonly prescribed for PE.
• Premature ejaculation can be treated effectively
with several serotonin reuptake inhibitors (SRIs)
(AUA Guidelines on PME, 2004)
OVERVIEW OF MEDICAL MANAGEMENT
• Primary PE:
• 1st line: SSRI, reducing penile sensation
• 2nd line: Behavioural techniques, counselling
• Most men require ongoing treatment to
maintain normal function
Secondary PE
• Secondary to ED: Manage the primary cause
or
• 1st line: Behavioural techniques, counselling
• 2nd line: SSRI, reducing penile sensation
• Many men return to normal function
following treatment
OTHER ORAL MEDICATIONS FOR PE
• Role of PDE5 inhibitor ?
• SSRI + PDE5 inhibitors
-down-regulation of receptors involved in
somatosensory latency times
-reduction in performance anxiety
• Role of α-blockers ?
Beretta G et al, Acta Eur Fertil,17:43,1996

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Premature ejaculation (pme)

  • 1. Premature ejaculation (PME) By Dr. Sumit Sharma Urologist, Uro-oncologist, sexologist and Kidney Ttrasplant surgeon(Gurgaon) http://drsumiturologist.com/
  • 4. THE MECHANISM OF PENILE ERECTION
  • 5.
  • 7. PREMATURE EJACULATION (PME) “Premature ejaculation is defined as persistent or recurrent ejaculation with minimal sexual stimulation before, upon, or shortly after penetration and before it is wished by the man or his partner” (Neil Baum, Bradly Speiler et al, Medical aspects of human sexuality, May 2001:15-25) (AUA guidelines on PME, 2004)
  • 8. PREVALENCE • The most commonly experienced male sexual dysfunction in American men. • 1/3rd of all sexually active men suffer from PE. • A prevalence of 21% (10-30%) in men ages 18 to 59 in the United States (Lauman EO, Paik A et al,JAMA 281:537,1999)
  • 9. PSYCHOLOGICAL CAUSES • Early sexual experiences, • Performance anxiety, • Low arousal levels, or • Decreased sexual desire • Psychological stress (fear, guilt, anxiety) with sexual activity • Relationship or partner issues
  • 10. BIOGENIC CAUSES • Hypersensitivity of the penile skin • Hyperexcitable ejaculatory reflex • Hyperarousability • Endocrinopathy • Genetic predisposition • 5-HT-receptor dysfunction
  • 11. MEDICAL CONDITIONS THAT CAN CONTRIBUTE TO PREMATURE EJACULATION • Arteriosclerosis • Benign prostatic hyperplasia • Cardiovascular disease • Diabetes • Injury to the sympathetic nervous system • Pelvic injuries • Prostate cancer • Prostatitis • Urethritis • Urinary incontinence • Polycythemia • Polyneuritis
  • 12. TREATMENT Erectile Dysfunction (ED) treatment • If PE is associated with ED, treat the primary cause (e.g.PDE5inhibitors)
  • 13. BEHAVIOURAL TECHNIQUES • ‘Stop-start’ and ‘squeeze’ techniques • Extended foreplay • Pre-intercourse masturbation • Cognitive distractions • Alternate sexual positions • Interval sex and increased frequency of sex
  • 14. PSYCHOSEXUAL COUNSELLING • Address the issue that has created the anxiety or psychogenic cause • Address methods to improve ejaculatory control. Therapy options - meditation/relaxation - hypnotherapy - neurobiofeedback
  • 15. ORAL PHARMACOTHERAPY • Delayed ejaculation a common side-effect of SSRI and TCA • SSRIs are now commonly prescribed for PE. • Premature ejaculation can be treated effectively with several serotonin reuptake inhibitors (SRIs) (AUA Guidelines on PME, 2004)
  • 16. OVERVIEW OF MEDICAL MANAGEMENT • Primary PE: • 1st line: SSRI, reducing penile sensation • 2nd line: Behavioural techniques, counselling • Most men require ongoing treatment to maintain normal function
  • 17. Secondary PE • Secondary to ED: Manage the primary cause or • 1st line: Behavioural techniques, counselling • 2nd line: SSRI, reducing penile sensation • Many men return to normal function following treatment
  • 18. OTHER ORAL MEDICATIONS FOR PE • Role of PDE5 inhibitor ? • SSRI + PDE5 inhibitors -down-regulation of receptors involved in somatosensory latency times -reduction in performance anxiety • Role of α-blockers ? Beretta G et al, Acta Eur Fertil,17:43,1996