The Ejaculation Distribution Theory of Premature Ejaculation

Waldinger (5,49) formulated a new theory on the etiology and genesis of lifelong premature ejaculation. He postulated that lifelong premature ejaculation is not an

Figure 9.2 The IELT (29) measured by stopwatch in a sample of 110 Dutch males with lifelong premature ejaculation. Ninety percent ejaculates within 1 min and 80% ejaculates within 30 s (48).

acquired disorder due to habituation of initial hurried intercourses, as has been suggested by Masters and Johnson. Instead, Waldinger argues that early ejaculation is part of a normal biological variability of the intravaginal ejaculation latency time (IELT) in men, with a possible familial genetic vulnerability (5,23,49). In 1994, Waldinger et al., introduced and defined the IELT as a measure for pharmacological research (29). The IELT is the time between vaginal penetration and intravaginal ejaculation (29,31). According to Waldinger, early ejaculation is primarily a neurobiological phenomenon, which may or may not secondarily lead to psychological or psychosocial distress. Dependent on intra- and interpersonal and probably also cultural factors, early ejaculation may become perceived as premature ejaculation. Both animal and large-scale human epidemiological stopwatch studies are needed to demonstrate the existence of a biological continuum of the IELT.

On the basis of animal and human psychopharmacological studies, Waldinger and co-workers further postulated that lifelong premature ejaculation is related to decreased central serotonergic neurotransmission, and 5-HT2C receptor hyposensitivity and/or 5-HT1A receptor hypersensitivity (1,5,49,50a). Treatment should therefore consist of 5-HT2C receptor stimulation and/or 5-HT1A receptor inhibition.

Evidence for the role of the 5-HT2C receptor has been found in four stopwatch studies in men with premature ejaculation (31,42-44). It was demonstrated that the 5-HT2C receptor stimulating and the 5-HT2C blocking antidepressants exerted an ejaculation delay and absence of ejaculation delay, respectively. In a double-blind placebo-controlled study with the 5-HT2C/ 5-HT2A receptor antagonist and 5-HT/noradrenaline reuptake inhibitor nefazo-done, 400 mg nefazodone daily did not exert any ejaculation delay in contrast to a significant delay after 20 mg paroxetine daily and 50 mg sertraline daily (42). In a similar study, the 5-HT2C/5-HT3 receptor antagonist, and noradrenergic and specific serotonergic antidepressant mirtazapine did not induce ejaculation delay compared with the significant delay resulting from 20 mg paroxetine daily (43). In both studies, nefazodone and mirtazapine did not delay ejaculation. Recent research suggests that 5-HT1A receptors are likely to play a more important role than 5-HT2C receptors in premature ejaculation and its treatment (50b). Further studies with selective 5-HT2C and 5-HT1A agonist and antagonists are encouraged to elucidate still undiscovered pharmacological mechanisms underlying the ejaculatory process.

5 Secrets to Lasting Longer In The Bedroom

5 Secrets to Lasting Longer In The Bedroom

How to increase your staying power to extend your pleasure-and hers. There are many techniques, exercises and even devices, aids, and drugs to help you last longer in the bedroom. However, in most cases, the main reason most guys don't last long is due to what's going on in their minds, not their bodies.

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