Dear Dr. G,

I am 35 year-old sexually active-man who has been having a lot of trouble with premature ejaculation.

As far I can recall, I experienced such a dysfunction from the moment I started having sex in my early twenties as I would ejaculate one minute after starting intercourse.

After seeing my family doctor, I have been treated with medication and it seems to have some impact in prolonging my ability to perform before ejaculation.

Sadly, the problem recurred as soon as I stopped the medicine.

Don’t get me wrong, I am very happy the medicine solved my problem temporarily. However, I am really looking forward to a long-term definitive solution and I have read that circumcised men can last longer in bed.

I would like to put Dr. G on the spot to verify this observation; why do I suffer from premature ejaculation, how does the medicine work and is it true that circumcised men will have less trouble with PE?

If so, how much of an improvement are we looking at?

I am very keen to “cut short my shortcomings” by going for the cut, but am I being completely over-optimistic?

Regards
Circumcision Chris

Early ejaculation is also known as premature ejaculation (PE), and it is a rapid climax that occurs when a man experiences an orgasm and expels semen quickly with minimal penile stimulation. The consensus of experts from the International

Society of Sexual Medicine have endorsed that the vast majority of PE sufferers have a tendency to ejaculate within one minute, but some men with severe PE may even ejaculate just prior to or shortly after vaginal penetration.

Premature ejaculation is often considered the most prevalent sexual dysfunction, as surveys have revealed that it affects as many as one in three sexually active men. When PE occurs in men from their earliest sexual activities, it is considered primary PE while it is called acquired PE if it affects a man at a later stage of his life.

Having said that, the cause of primary and secondary PE is completely unknown. From a psychological angle, one school of thought believes that PE can be linked to adolescent boys developing a fast climax due to masturbating too quickly to avoid being caught! Other theories implicated performance anxiety or guilt as the result of either having too little or too much sex when younger.

From a neuroscience viewpoint, several mechanisms have been put forward as the cause of PE, such as a genetic predisposition, penile nerve sensitivity and serotonin neurotransmitter deficiency.

Out of these, the over-sensitivity of penile nerves has been implicated, resulting in the use of numbing agents and the proposition of circumcision to desensitise the penis. On the other hand, the involvement of serotonin brain signalling was accidentally discovered when men treated with anti-depressants such as paroxetine and clomipramine were noted to have prolonged ejaculation. This prompted the use of medications such as serotonin reuptake inhibitors (SSRIs) for the treatment of PE. The medication is noted to prolong of the interval of ejaculation fourfold when measured using Intra-vaginal Ejaculation Latency Time (IELT), which is measured using a stopwatch.

When it comes to circumcision, it is still one of the most controversial and hotly debated topics even though it is a centuries-old practice, especially when the subject matter is whether circumcised or uncircumcised men make better lovers benefits of hygiene after circumcision are well documented in medical literature, the issue surrounding the differences in sexual pleasure are not so “clear-cut”.

As the moist glans penis in uncircumcised men can be sensitive; sex is arguably more pleasurable for uncut men. However in an overtly sensitive penis for a men suffering from PE, the heightened sensation is often counterproductive and unwelcoming.

Circumcision itself should not interfere with libido, erectile or ejaculatory functions. However scientific evidence has demonstrated some loss of fine touch neuro-receptors after the removal of the foreskin. Therefore, some clinicians have advocated circumcision as the definitive treatment for PE.

One study demonstrated the mean IELTs before and after circumcision were 104s and 123s respectively in men suffering from PE.

Although this is a mere 20-second increase in interval, the finding is statistically significant. On the other hand, another study by Waldinger found the mean intervals of sex in men with no PE are 6.7min and 6.0min in circumcised and uncircumcised men respectively and the author concluded thatthere is no real significance in improvement of sexual performance after circumcision.

Anne Frank once said: “People are just people, and all people have faults and shortcomings, but all of us are born with basic goodness.” The argument for and against the practice of elective circumcision has already gone on for many centuries and the added dimension of circumcision as a treatment of PE can even pose more of a dilemma for sufferers.

Despite weighing out the risks and benefits of life without foreskins, the decision is still difficult as it impinges on culture, personal experience, religions and preconceived ideas about its sexual impacts. Men with shortcomings between the sheets often put Dr. G on the spot, contemplating the shortcut overcoming the shortcomings. His advice is that “All of us are born with basic goodness, even if it is the mere foreskin. Cutting short the basic goodness without much consideration may just be just the beginning of more faults and shortcomings in future days!”

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