|
|
Physical Causes Of Premature Ejaculation (PE) In MenIn recent years there has been a lot of speculation about the role of physical factors and neurobiology in the etiology of premature ejaculation. The truth is, however, that as yet there are no clear indications of how the central nervous system may or may not play a mediating role in the speed with which a man reaches orgasm and ejaculates during intercourse. This is in direct contrast to erectile dysfunction, where the mechanism of smooth muscle relaxation in the penis, mediated by nitric oxide, has been very well defined, and pharmacological agents have been developed to aid in the development of erection. It is true that one pharmaceutical company has developed an SSRI, or selective serotonin reuptake inhibitor, for this purpose, but this is a controversial drug which has not been licensed for use in the treatment of rapid ejaculation in the United States by the Federal Drug Administration. In fact, its use is based on the observation that men with depression who are treated with SSRI antidepressants sometimes develop slower ejaculation speeds or even total anorgasmia. Since it's clearly unethical to conduct investigations into the neurophysiology of human brain mechanisms around orgasm and ejaculation, it's unlikely that any clarity is going to emerge in the immediate future about the role of the sympathetic nervous system in the cerebral cortex as a cause of PE. So where are we left then? Just what can men do if they wish to learn how to last longer during sex? For one thing, even though the precise mechanisms remain unknown, it is theoretically going to be possible to categorize rapid ejaculation by different criteria depending on its origin at some point in the future. For example, it has been proposed that there is a genetic factor behind a man's tendency to show little ejaculatory control during intercourse; but further evidence will be needed before we can categorically state a man's inability to delay ejaculation is due exclusively to biological factors. The most promising indicators of a biological or "organic" cause of the problems has emerged from research conducted on serotonin receptors, some rather thin evidence on genetic predisposition to PE, and a number of studies which purport to demonstrate increased levels of penile sensitivity in rapid ejaculators. As has been recorded elsewhere, Waldinger and others have observed that activation of the 5HT2c neuro-receptor delays ejaculation, and by contrast activation of the 5HT1a receptor speeds it up. On the basis that the mechanism of ejaculation is the same in rats and humans, Waldinger speculates that differences in function of the serotonin receptors may be the cause of variation in ejaculatory latency time in men. Another question, of course, that arises in connection with physical theories like this is whether or not they would explain all cases of early ejaculation. The truth is that they probably would not, since very few sexual dysfunctions have an origin that lies only in one particular area of physiology. You can see this very clearly when you consider the influence of anxiety on the speed of a man's climax – it is both a cause and effect of sexual dysfunction, and also causes relationship issues which apparently result from the dissatisfaction of both partners with the man's performance in bed. In any event what we do know is that both genetic and serotonin receptor theories of PE will relate only to the lifelong form of the condition. Penile Sensitivity As A Cause Of PEStudies on penile sensitivity, or more accurately penile hypersensitivity, have always been controversial. Furthermore they also been contradictory, in that some studies appear to support the idea of heightened sensitivity in the nerves of the penis, while others do not. Some studies even demonstrate a supposed rapidity or hypersensitivity of the bulbocavernosus reflex, but there is very little substantive evidence to support this, and investigations into this reflex as a potential cause of rapid climax in men seem to have been abandoned. One interesting study by Roland et al showed that there is a difference in the IELT (time between intercourse starting - the moment of penetration, in fact - and ejaculation) in men with PE when you compare ejaculatory latency time in masturbation and intercourse. Men with PE tend to last three times longer when they masturbate – an average of 4.5 minutes – compared to only 1.5 minutes when they engage in intercourse. This difference is not seen in men who do not have rapid ejaculation issues. Clearly this is significant in examining why a man may not be able to delay his ejaculation..... It's also interesting that men who come quickly say they report less enjoyment from their orgasms, and are more sensitive to penile stimulation by a vibrator, although there are no differences between men with PE and men without PE when they are sexually aroused by visual stimulation alone. The conclusion of this work is that men who ejaculate rapidly are doing so either before they are fully sexually aroused - or may be underestimating their level of bodily arousal. In either case, these issues are important as far as treatment is concerned. One of the primary treatment modalities for PE has always been based on the assumption that men who ejaculate too soon do so because they are unaware of their level of bodily arousal and therefore do not have an opportunity to intervene in their sexual activities to reduce their arousal before reaching the point of ejaculatory inevitability.
|
