Dear Dr G,I face a rather curious problem in the bedroom and really hope you can help.My ex-wife and I were married for 20 years and we had a normal sex life.Being a divorcee for a while, I finally built up the courage and started seeing someone again for companionship.At the age of 50, I feel lucky I can start a relationship with a younger woman in her late 30s.While the relationship is going well, I feel somewhat concerned because I’ve started having difficulty controlling my ejaculation.I am rather curious why this is happening to me at this age.Since premature ejaculation was never a problem for me, I wish to put Dr G on the spot for some clarification.What exactly is premature ejaculation and what causes it?Are there any other reasons behind my premature ejaculation at this age?Am I getting this problem because I am too active or inactive in my sex life in the past few years?The early ejaculation is really bothering my partner and I hope there is some treatment available. Are there risks involved?Regards,Flash Freddie Premature ejaculation (PE) is a sexual dysfunction when a man has an orgasm with minimal penile stimulation. Such sexual dysfunction termed ejaculatio praecox was documented in the historical literature more than one hundred years ago. PE is also known as early ejaculation, rapid climax or premature climax. According to the International Society of Sexual Medicine (ISSM), premature ejaculation (PE) is a medical condition characterised by a man having the inability to control his ejaculation, resulting in short latency time of intercourse (around one minute) and causing significant bothersome or impairment of the quality of life both for the sufferers and his partners. Many clinicians and sexual health physicians believe premature ejaculation (PE) is the commonest form of sexual dysfunction compared to erectile dysfunction (ED). The prevalence studies conducted in many countries, namely Premature Ejaculation Prevalence and Attitude (PEPA) revealed PE affects up to one in three men. The study revealed that PE can affect men, starting from their first sexual encounter and persists throughout their lives. PE is believed to stem from deficiency in the neurotransmitters in the brain, such as serotonin. Hence, this may explain why men get lifelong PE or primary premature ejaculation. In recent years, clinicians and scientists have started investigating another group of individuals who experience early ejaculation problems as they age, typically after their fifties. Researchers believe the etiology of acquired PE, or secondary PE, is very different from lifelong PE, as data showed association of acquired PE with the possibility of prostate diseases and hormonal changes. The exact causes of PE are unknown, and many theories have been proposed. Some psychologists suggest PE being the result of masturbating quickly during adolescence to avoid being caught. Others highlighted the link of PE with performance anxiety or passive aggression of having too little sex. However, there is very little evidence to support any of these theories, and the sufferers of PE continue to feel frustrated with a tremendous degree of guilt and self-doubt. Although the etiology and causative factors of the acquired PE remains a subject of scientific scrutiny, the treatment of both primary and secondary premature remains essentially the same. Pause-squeeze technique is an old manoeuvre to delay the ejaculation. On the other hand, numbing creams are also well known to take the pleasure out of sex. Pharmaceutical intervention that enhances the serotonin levels in the brain now plays a vital role in the treatment of men with PE. Patients who are treated with Selective Serotonin Re-uptake inhibitors (SSRI) medications such as Depoxetine can benefit from better control and prolonged ejaculatory latency interval up to four fold. Although the medication is effective, the potential side effects of SSRI may be nausea and vomiting.
