A man’s struggle with premature ejaculation rears its head again when he starts a new relationship

Dear Dr G,

I am a 44-year-old divorcee who is venturing into a new sexual relationship, but an old problem of sexual dysfunction between the sheets is rearing its head again.

I suffer from premature ejaculation, which caused a lot of distress and discord with my ex-wife.

This problem was not so bad initially, but I ejaculate even with minimal penile stimulation with my new partner.

I finally built up the courage to see a doctor, who told me it’s a common condition associated with the derangement of a chemical in my brain called serotonin.

The doctor suggested I take anti-depression medication, which apparently helps with the serotonin.

However, I am reluctant to take medication for some “bedroom action”.

What exactly is the cause of premature ejaculation and how common is it?

Is premature ejaculation related to depression?

I always assumed premature ejaculation was caused by a sensitive penis, so wouldn’t numbing my manhood solve the problem?

Numbing Nathan

Premature ejaculation (PE) occurs when a man experiences an orgasm and expels semen too rapidly with minimal penile stimulation.

This is arguably the most common male sexual dysfunction, affecting up to one in three men. Experts from the International Society of Sexual Medicine consolidated the criteria for a PE diagnosis, where sufferers ejaculate within one minute after vaginal penetration. In severe cases, some men ejaculate just prior to or shortly after penetration. Other criteria also include the inability to control the ejaculation and this causes distress for the men and their partners.

PE issues have been documented even in the Kama Sutra, dating back more than 1,500 years ago. It described it as “women love the man whose sexual energy lasts a long time but resent a man whose energy ends quickly because he stops before they reach a climax!”

The real etiology of PE is unknown but its causes are complex as it can affect men in different stages of life. When PE bothers men from the first sexual activity, it is considered primary PE. On the other hand, if it affects men at later stages of life, it is generally considered acquired PE.

From a neuroscience viewpoint, several mechanisms have been postulated to contribute to PE. These include genetic predisposition (imagine trying to ask your dad if he ejaculates too early), penile nerve sensitivity and serotonin neurotransmitter deficiency.

The involvement of serotonin brain signalling was discovered when men treated with antidepressants such as paroxetine and clomipramine were noted to have prolonged penile stimulation before ejaculation. Hence, medication such as serotonin reuptake inhibitors (SSRIs) are utilised for men with PE, despite the absence of depression. The treatment can typically prolong the interval of ejaculation by six to 20 times, compared to the initial state of prematurity. Sometimes, there can be prolonged sex, without any outcome!

Penile sensitivity is also well-recognised to cause PE. The use of a local anaesthetic such as lignocaine gel to numb the penis has been practiced for many decades. The drawbacks of such practice include undesirable skin allergy and over-numbing of the genitalia for both partners. Another more acceptable numbing agent includes SS cream. This lotion is a mixture of nine natural products believed to have local desensitising effects and enhance penile blood flow.

The prevalence of PE increasing may be due to increased awareness of such sexual dysfunction and perhaps the stress of modern life. In recent years, scientific research has been conducted to understand the pathophysiology and treatment of PE. Although the recognised treatment is medical manipulation such as antidepressants, such intervention may not be acceptable for all couples. Under such circumstances, the use of numbing agents such as lignocaine and SS cream may be an alternative. When men contemplate numbing their prized asset in the pants to overcome the sorrow of premature ejaculation, Dr G’s view is consistent with the American author Clementine Wamariya, who once said: “When you are in survival mode, you numb yourself!”

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