מיקום המרפאה: רחוב לוינסקי 108, בתוך התחנה המרכזית החדשה, בקומה 5 (מעל קווי דן 4,5)

Premature Ejaculation

The author of this text is Dr. Idan Milicher – a psychotherapist, sexual therapist, and couple therapist.

Premature Ejaculation (PE) is one of the most common problems in men’s sexual function, from which about 30% to 40% of men suffer. Premature ejaculation is characterized as a condition in which a man, regularly and repeatedly, reaches ejaculation with minimal stimulation before, during or immediately after penetration, a condition that often causes personal frustration and impairs interpersonal relationships.

The ejaculation is a complex process, and its ultimate goal is to transfer sperm from the male genitalia to that of the female. In this procedure, the sperm, which is located in the seminal vesicle, the Vas deferens and the posterior urethral valves, comes out of the urethra with intensity and is accompanied by a feeling of pleasure and satisfaction manifested in an orgasm. Any disorder in this procedure, such as premature ejaculation, ejaculation accompanied by pain or lack of ejaculation, can impair the quality of sexual function of the man and the couple.

The reasons for Premature Ejaculation can be:

Primary, that is, congenital (already from the first attempts at sexual intercourse).

Secondary (as a result of health changes such as diseases: diabetes, damage to the the spinal cord, chemotherapy treatments, etc., mental changes – stress and tension or a change in the relationship).

Or as a result of damage to the sensation of the head of the penis, which is the center of ejaculation process.

Treatment for premature ejaculation:

Over the years, premature ejaculation treatment has undergone many and extreme changes.

The classic treatments are individual psychotherapy or together with the partner; or behavioral therapy. For years these treatments were common, and in fact were the only treatments available, but they were disappointing, since three years after the end of the treatment more than 75% of the patients reported recurrence of the premature ejaculation. This finding taught that only psychological therapy is ineffective, and therefore new therapies were needed to be developed, while the psychological therapy remained periodic therapy for reinforcement of the initial treatment outcomes.

Once it became clear that one of the causes of ejaculation was hypersensitivity in the head of the penis, local or systematic development was initiated that would lower the sensitivity of the head of the penis, thus allowing prolonging duration of intercourse and postponing ejaculation. Over the years there have been partially successful attempts to treat premature ejaculation by sprays or various topical ointments. There are creams and sprays used for local anesthesia, which aim to reduce the sensation in the head of the penis and their effectiveness reaches 50%. However, in many cases these measures cause numbness in the head of the penis, a decrease in sexual satisfaction and even a weakening of the erection. In recent years, attempts have been made to treat premature ejaculation with many antidepressants and psychiatric medications, which aim to affect the ejaculation center in the brain. Treatments with some of the predicaments was partially successful, and others had a positive effect on ejaculation time, but at the same time the patients suffered from side effects that prevented them from continuing the treatment (such as Anafranil and Phenothiazine).

Additional patients took SSRIs, which inhibit serotonin reuptake in the brain. 75% -70% of patients treated with medicaments from this group reported a significant improvement in ejaculation, but these medicaments, which were originally intended to treat psychiatric problems, had significant side effects because of which patients and their partners preferred not to continue the proposed treatment. However, the relative success of the new treatments opened a new era of premature ejaculation research studies and methods.

A new study conducted at Tel Aviv Medical Center has shown that a combination of SSRIs with Viagra has significantly improved the duration of ejaculation. In addition, the Tel Aviv Medical Center operates a multidisciplinary service for the treatment of all aspects of ejaculation, especially in the area of premature ejaculation.

The new service is based on a multidisciplinary view, which examines all aspects of the problem: psychological, physiological, organic, environmental and within the couple. First, the patient answers a questionnaire about the history of the problem and special questionnaires are filled out, examining various aspects of ejaculation. In addition, a physical examination is performed.

If necessary, an additional test, pudendal nerve conduction (PNC), is performed, which may indicate the presence of increased or decreased sensitivity of the penis itself or the head of the penis. This method of treatment develops various skills for controlling the mechanisms of ejaculation, alongside topical treatment with ointments or sprays and pills, which inhibit the reuptake of serotonin into the brain.

 

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