The most common sexual problem in a male is premature ejaculation or ejaculation praecox. In this condition, the patient is unable to hold back his orgasm and ejaculates too quick for satisfactory sex. There is no single cause or basis of this problem, and in a number of cases there is some kind of functional problem associated with it. Some of the other causes can be a reduction in the stimulation level of the ejaculatory reflex, or a reduction on the sensoric genital feedback and at times it could be related to hyperthyroidism or prostatis.
Such patients display an intravaginal ejaculatory latency time (ELT) of lesser than or equal to 2 and this has been authenticated in more than three fourths of the results during an interval of two weeks in majority of the studies.
Natural Remedy for Premature Ejaculation
The “squeeze technique” initially originated by Masters and Johnson, still remains the basic form of treatment. Just before the beginning of ejaculation, if the area of frenulum is firmly pressed for three to four seconds, it leads to minor decrease in the erection which in turn reduces the want of ejaculation. According to Masters and Johnson, as the patient continues to practice this technique, he gains better control of not only his erection but of his ejaculation too. Studies show that the success rate of this therapy is nearly 95%.
Topical and Oral Treatments
Another popular practice is the application of local anesthesia, either in aerosol or in gel form, to the glans. The negative aspect of this practice is the numb feeling that the patient gets which may be to the level of anorgasm and it may also be felt by the partner in absence of a condom.
Selective serotonin re-uptake inhibitors are likely to give better outcomes. Flu- oxetine (20mg) or chlomipramine and sertaline (25–50 mg) especially paroxetine and escitalopram are very useful materials when taken at a dosage of 20-40mg on a day-to-day basis or as and when required, but 4 to 6 hours before having intercourse. They also help in prolonging IELT when seen in comparison with placebo. The sensoric threshold in the genital area increases due to the intake of these medicines and that as a result helps in gaining more control of ejaculation.
One disadvantage of these medications is their slow perfusion and daily usage could produce side effects. The heading that these materials come under is “off label” use, which means that the patient must be given complete information about all the factors associated with its use.
Dapoxetine (brand name – Priligy), a new rapidly resorbed serotonin re-uptake inhibitor has shown the most promising results. As per the current trial observations, this new substance shows great improvement with men exhibiting increased ejaculation time. This medicine is in markets of Finland, Sweden and Austria since February 2009. It has a license as an on demand medication for males falling in the age group of 18 and 64 years. It has to be taken one to three hours before intercourse and its dosage is 30 and 60mg.
Year 2007 saw some big doubts regarding the various serotonin re-uptake inhibitors originated by the FDA according to which the suicidal tendencies in young men could increase with the usage of drugs belonging to the class of antidepressants like dapoxetine. As of now, there are no such reports for dapoxetine, but it is important to keep this in mind so that the patients in the starting phases of this therapy can be observed with complete vigilance.
Interestingly some studies show that the oral opioids such as tramadolol can also be effective when taken in low dosage such as 25-50mg.