Topic
My lifelong battle with premature ejaculation
I am a 52 year old computer soft ware engineer, married for 15 years to a beautiful woman who is easily orgasmic. Without Viagra, I have poor spontaneity of the erection, difficulty sustaining the erection, and diminished rigidity of the erection. With Viagra I am fine. I have lifelong premature ejaculation. The premature ejaculation weighs on me. It is always present and I feel my wife is being cheated. I always had premature ejaculation, but in the past I could usually get a second erection. The premature ejaculation symptoms have worsened and now the tim,e time from penetration to ejaculation is usually always less than 1 minute. I recently saw Dr. Irwin Dolstein in San Diego. During the office visit, we reviewed the physiology of ejaculation and the pathophysiology of premature ejaculation. We discussed that sexual reflexes, like other reflexes, can have too many facilitator neurotransmitters or too few inhibitory neurotransmitters. In this case the sexual reflex can happen too quickly and this is called premature ejaculation. We discussed that the facilitory neurotransmitters are dopamine, oxytocin and noradrenaline, melanocortins. We discussed that the inhibitory neurotransmitters are serotonin, opioids, endocanabinoids, and prolactin. We discussed the following strategies for management of my premature ejaculation. 1) sex therapy, 2) condom and desensitizing agents (EMLA CREAM to be applied prior to sexual activity and then washed off or use a condom), 3) pre-intercourse PDE5 inhibitors (Viagra or Cialis or Levitra taken one hour or so before sexual activity, 4) pre-coital mu-opioid receptor agonists tramadol (taken 1 hour before sexual activity), 5) pre-coital SSRI agents (dapoxetine 30 or 60 mg 1 hour before sexual activity), 6) intracavernosal injections (I have had bad experiences with this and do not like these), 7) hormone therapy as needed).
After leaving the office I was so very excited to get going. I wanted to give feedback on my first experience with this treatment regimin. The experience was pretty interesting to say the least! I took viagra and tramodol and used emla cream approximately 60 mins before intercourse; washing off cream prior to the act. (I have yet to get dapoxetine.) The results were i lasted for me an incredibly long time; in fact not the desired result but i did not ejaculate. i outlasted my wife for probably the second or third time in our 17 years together. i must have been inside a good 3-4 minutes before my wife reach orgasm. i stayed erect for a long time and enjoyed the experience; but i did not have the same feeling sensation as i normally do when I’m in the act. I do not know if that is do to the EMLA cream, the tramodol or the combination of the two. My wife tried to relieve me afterwards ‘manually’ by hand but it wasn’t to be. Honestly i’m so used to ejaculating so quickly she’s not really used to touching me for extended period of time. \Frankly for this time i was ecstatic even given i did not reach my personal desired result. My wife was really in shock ; she told me she’s so used to getting herself charged up to reach orgasm quickly that next time she’ll just relax. So obviously i need to adjust what i do the next time and look to for advice on that. But i’m happy with the way things have started off post my visit.