Premature Ejaculation

DR. PETER GUNAWAN TANDEAN, M.KES., SP.AND

 ISSM definition of PE
(International Society of Sexual Medicine)

• Ejaculation which always or nearly always

occurs prior to or within about 1 minute of
vaginal penetration
• Inability to delay ejaculation on all or nearly
all vaginal penetrations
• Negative personal consequences, such as
distress, bother, frustration &/or the
avoidance of sexual intimacy
 Definition PE
• Lack of control of ejaculation
• Dissatisfaction of sexual experience
• Distress to man and his partner
• Latency times (IELT)

• Often associated with a secondary

performance anxiety
• Erectile dysfunction is often secondary to
long term PE
Intra-vaginal ejaculation latency time (IELT)

• PE level of distress depends if mild or severe

• IELT median time 5.4 minutes (range 1-45 min)
• IELT < 1 minute – definite PE
• IELT 1-1.5 minutes – probable PE
 Stages of normal ejaculatory
physiology
• Emission (sympathetic T10-L2)
– Bladder neck closure
– Deposition of seminal fluid into posterior urethra
• Ejection (parasympathetic S2-S4)
– Expulsion of seminal fluid from the urethra
– Relaxation of the external sphincter
– Co-ordinated pelvic floor, bulbospongiosis contraction
• Orgasm
– A sensory experience via pudendal nerve associated
with all these events
Arousal
Pudendal nerves

Spinothalamic tract

Thalamus/limbic system

Hypothalamus: MPOA, D1 & D2

Reticulospinal tracts

Sympathetic T10-L1

Parasympathetic S2,3,4

Ejaculation
Normal
ejaculation
time

Faster
ejaculation
 PE SYNDROME
Marcel Waldinger
• Primary or lifelong (younger men)
• Secondary or acquired (older men)
• Natural Variable PE
• PE like ejaculation syndrome
 TREATMENT OF PREMATURE
EJACUALTION
• Behavioural techniques - stop/start, squeeze
• Oral medication - SSRI, clomipramine, PDE5i
• Intra-cavernosal injections
• Anaesthetic cream
• Pelvic floor exercises
• Surgery to dorsal nerve (Brazil)
• Psychotherapy
THANK YOU