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I
am not impotent. I have premature ejaculation or delayed ejaculation.
What will the evaluation include?
(more
FAQs below)
At one time it was believed that premature ejaculation was completely
psychological. We now know that there are significant, if not primary,
physical problems that contribute to premature ejaculation, and it is
a legitimately recognized medical problem that needs a thorough medical
evaluation.
In many cases, sex therapy can also be very helpful in solving this particular
problem, and it is sometimes recommended that patients be treated by both
a physician and a sex therapist concurrently.
A first appointment should typically be between 45 and 60 minutes. It
should include:
History: Your physician will take
a thorough medical history as he will need to place your premature ejaculation
in the context of this history. This may include questions such as:
How long do you last prior to ejaculation? Some men ejaculate during foreplay.
Some even ejaculate while in the process of getting undressed and before
significant contact has occurred. Others penetrate, but ejaculate almost
immediately, with minimal thrusting. Others may last 1-5 minutes, but
do ejaculate much earlier than they would like and spend most of their
time while inside attempting not to ejaculate.
- What is the quality of your erections?
- What happens when you try to have intercourse?
- Do you have decreased rigidity?
- Do you have difficulty maintaining your erection?
- If so, at what point do you lose it?
- Do you wake up at any point in the morning or while sleeping with
an erection?
- How rigid is it then?
- What is your sexual interest level (libido) like?
- Does your penis have a curve, a bend, or a twist in it when it is
rigid?
- Is your ejaculation normal?
- Is it early (premature or delayed)?
- He will ask you about the status of the relationship you are in. Are
you married, divorced, single, gay, etc.?
- How is the relationship going?
- How is the erectile dysfunction affecting it?
If erectile dysfunction and premature ejaculation both exist, it is very
important to determine which came first. Many men with erectile dysfunction
have difficulty maintaining their erections even prior to ejaculation.
Since they feel consciously or subconsciously pressured during intercourse
to ejaculate prior to losing their erections, they can sometimes get into
the habit of having premature ejaculation.
In general, when the erectile dysfunction preceded the premature ejaculation,
the erectile dysfunction should be dealt with as the primary issue. Often
when these men can achieve successful and long-lasting erections, they
will not ejaculate as quickly. However, if at that time, the premature
ejaculation remains a significant problem, it must then be addressed separately.
· After ejaculation, how long does it
take you to have a second erection and to reach an orgasm?
Some men have have had long standing premature ejaculation, but their
habit has been to ejaculate quickly (either through masturbation or with
their partner) for the first ejaculation and then to have more leisurely
intercourse as they often last longer before ejaculating the second time.
Many of these men come to the physician when they get older or have other
medical problems and lose the ability to get a rigid second erection in
the same lovemaking session. At this point, the premature ejaculation
interferes significantly with their lovemaking. It is also important to
know how long it takes you to get a second erection since it will be useful
in determining treatment options.
· How often do you ejaculate?
This can be either through masturbation or with a partner. Many men who
develop premature ejaculation do not have satisfying sexual experiences.
Because of this, they become somewhat avoidant of sexual situations, even
in the context of a relationship or marriage and have decreased frequency
of intercourse and ejaculation. With decreased frequency and longer time
periods between ejaculations, many men will ejaculate more quickly. The
premature ejaculation can then become a vicious cycle. One of the ways
of breaking the cycle is to encourage a man to ejaculate at some point
prior to intercourse so that he will then last longer during intercourse.
· How has the premature ejaculation affected
your relationship? Often, premature ejaculation is a chronic
problem. For many couples, this has caused significant disturbance in
their sexual relationship. Many women harbor significant resentment, especially
if this is a problem that the man has refused to address for a number
of years. Usually a partner is very grateful that the man has sought treatment.
It shows that he understands there is a problem and that he would like
to be able to satisfy his partner more completely.
· Have you had prior treatments?
If you have been placed on medication, it is important to know which medication
and the dosage. If you have done any behavioral modifications, it is important
to let the physician know this as well.
The Physical Examination:
Your physician will do biothesiometry to check the threshold for sensation
of vibrations. Recent studies have shown that men with premature ejaculation
have a tendency to have a decreased threshold for sensation. In other
words, their penises are more sensitive. Since ejaculation is a reflex,
(one that is modified to some degree by conscious thought) these men will
ejaculate more quickly as it takes much less stimulation to trigger this
reflex. Your physician will also examine your penis and testes. Most physicians
will draw blood for a basic hormonal screen.
Discuss Treatment Options:
Treatment options include behavior modification, and there are several
good books available. There are also useful exercise videotapes available.
There are also medical options available. There are medications which
may significantly delay your ejaculation, enabling you to last longer.
There are also medications and treatments that may enable you to maintain
your erection even after ejaculation. You can continue thrusting even
after ejaculating and more completely satisfy your partner. Some men may
ejaculate again prior to losing their erection
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