Premature ejaculation is one of the most common male sexual dysfunctions in men, yet it is one of the most underreported conditions. In this interview by SADE OGUNTOLA, a consultant urologist at the University College Hospital, Ibadan, Dr Augustus Takure speaks on stigmatisation and the wrong assumptions about premature ejaculation.
Is premature ejaculation the same as erectile dysfunction in men?
Premature ejaculation and erectile dysfunction are different. Premature ejaculation means the early release of the semen within the first two minutes before the man gets to orgasm or the partner gets orgasm. It is very fast; it comes before the expected time. In other words, the man has difficulty controlling or delaying ejaculation. That is why it is said to be premature although erection is normal.
Now, erectile dysfunction is a conglomerate of diseases. It means the inability of the man to achieve or maintain an erection for satisfactory sexual intercourse. Even when he has sexual intercourse, he does not get through the process of enjoying the sexual intercourse. That is erectile dysfunction.
For premature ejaculation, it has to do with the synapses, the nerve endings that release some substances to activate the emission of semen. The substance released in the brain called serotonin ensures the release from the seminal vesicle and testis to form the semen that is released into the posterior urethra from where it moves straight out. The posterior urethra in men is surrounded by the prostate and above that prostate is the bladder neck. Erectile dysfunction doesn’t follow that pathway; it is totally different.
Of course, while erectile dysfunction generally increases with age, premature ejaculation is not age-related.
Men tend to overlook premature ejaculation because they attribute premature ejaculation to stress; is there a link between the two?
Premature ejaculation in men shouldn’t be attributed to stress. No study to confirm that this is the case. Now, in Africa, there is always a reason for whatever is happening to us. Stress can cause everything, including abnormalities within the body system. It does not have to be premature ejaculation. So men use stress as an excuse for all problems.
Do men come to complain about premature ejaculation at the hospital?
No, men wouldn’t complain of premature ejaculation. A man in Africa is a man; he is a lion; he is a king. He is not supposed to discuss his problem in the public. The man will not come because he wouldn’t want such a piece of information to filter out. We work in a society where people do not keep sealed lips. A man that will likely come and tell you that he has premature ejaculation is likely to be an old man who doesn’t have anything to lose. You cannot stigmatise him. A young man will feel disappointed and worry about telling the doctor that he has difficulty in controlling or delaying ejaculation. It looks shameful. It is that fear or the misconception that his complaint may be misinterpreted as him being less of a man that actually prevents him from saying it.
Of course, men are also not talking to their doctors about it because they lack understanding about premature ejaculation. They do not have enough information. But, the condition itself is not their fault and the condition can be treated easily.
So, if a man has premature ejaculation, more often than not, it is his wife that usually says it. And then the wife, who knows how to help the husband, then convinces him to come to the hospital to seek help because it is treatable. Premature ejaculation can be treated easily with medication; it does not require surgical treatment.
Premature ejaculation is not really the man’s problem; it is the woman’s problem. It is the woman that is bordered. Once the man ejaculates, he cannot continue, he has to rest. The man has attained orgasm even before the ejaculation. So it is the woman that does not enjoy sexual intercourse and that is why it is women who bring them to us.
Of course, weak penile erection can also be treated with medications most of the time. In very rare cases, surgery is done to correct weak penile erection in men.
Does it reduce the quality of a man’s life?
It makes a man feel less of himself; if a man ejaculates fast, he will not want to go near any woman because the woman will say that he is not allowing her to have that satisfaction that comes with sexual intercourse. In fact, she could give information to other women, thereby making him less accepted in the community.
Will this impact his ability to father a child?
No, it will not disturb him from having as many children as he so desires. It has nothing to do with fertility. On the contrary, he will father more children because he is able to release early. It also does not affect the quality of his semen.
Remember the story of a young man, who went swimming in a pool and several girls that got pregnant were traced to him? That must have been due to premature ejaculation. The young man must have ejaculated in the pool. And of course, probably the girls were not covered, and so the swimming spermatozoa will find its way in.
Is there data on men that experience premature ejaculation in Nigeria?
A leaflet by a pharmaceutical company quoted the Premature Ejaculation Prevalence Attitudes (PEPA) study in the United States, Germany, and Italy, the largest up-to-date prevalence study on premature ejaculation saying that one in 5 men experience premature ejaculation.
It also said that men with premature ejaculation were more likely to self-report other sexual dysfunctions (such as low libido and erectile dysfunction) and psychological disturbances (depression, anxiety and excessive stress) than men without premature ejaculation. But we don’t have any data on it in Nigeria. We don’t know how substantial the problem is in Nigeria. Nevertheless, if we are to go by how often we see men who have premature ejaculation, it is rare; on a clinic day, you may not see one. They are not coming.
Is true that stress is not responsible for premature ejaculation?
Stress is not necessarily responsible for premature ejaculation. I do not have data that says that stress can cause premature ejaculation because scientifically speaking, it doesn’t work that way, and so I cannot justify it.
But having said that, there is what we call epidemiological studies in which you can have associations between two issues by virtue of what is seen in the environment. In that context, premature ejaculation may be related to stress.
Will alcohol consumption and hard drug use contribute to this condition in men?
Of course, alcohol use should not cause premature ejaculation. It should actually delay ejaculation because when a man takes too much alcohol, his performance status is reduced. He might not have the energy to even ejaculate.
Hard drugs wouldn’t cause premature ejaculation but may cause erectile dysfunction. Its use may even affect fertility. Drugs generally have a multi-system effect on the body. Any system in the body can be affected by the use of hard drugs.
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