Premature Eja-culation

Overview

Couples are threatened by premature ejaculation (PE) (affecting some 30%men) if the man must take care to prevent a premature sexual climax whichwould interfere with successful termination of sexual intercourse.Causes and consequences of PE as well as therapeutic procedures are menti-oned.The relativity of the term PE makes evaluation of the therapeutic resultsdifficult.So far the most causal treatment is training. This is very pretentious asregards time, patience and the standard of cooperation of the couple. There-fore there exist so many parallel auxiliary approaches among which the mostpromising are, (if we omit the anticipated effects of sildenail or experiencewith invasive intracavernous injections of vasoactive substances) serotoner-gic preparations. It appears that in the treatment of PE we cannot onlyconsider the destructive (inhibitory) effect of the undesirable actions of these preparations on different components of sexuality but also the positive(active) acquisition of control of frictional movements within the frameworkof PE as one of the sub-groups of „dis-control-disorder“ (van Praag).The discrepancy between the high effectiveness of serotonergic preparationsin PE and the low percentage of erectile dysfunctions, as well as other com-ponents of sexual dysfunctions [2] and [11] seems to suggest that rather thanan undesirable effect a positive effect on „dis-control-disorder“ is involved.The low percentage of undesirable effects, i.e. erectile dysfunctions in thequoted paper [5] may moreover suggest that it is encountered more in de-pressive patients than in patients with PE and along with the time neededfor training, also another site of action of the preparation (perhaps the neu-ronal synaptic crevice in the peripheral reflex arch for ejaculation than ata central level with all consequences in the density and sensitivity of theappropriate receptors). There is the question to what extent in depressivepatients sexual dysfunctions are caused by depression and to what extent bydrugs.The authors present also the results of clinical observations of open studiesfrom which ensues also the possibility to change in sertraline and clomipra-mine from the troublesome daily medication to intermittent treatment „adhoc“.

Key words:
ejaculatio praecox, development, consequences, sex therapy andpharmacotherapy (intermittent?, continual?).