Ejakulasi dini: Perbedaan antara revisi

Meskipun pria yang mengalami ejakulasi dini menganggap dirinya tidak memiliki tenaga setelah ejakulasi, ternyata menurut penelitian banyak dari pria yang berharap bisa bertahan lebih lama.<!-- Secara umum, pria Men's typical ejaculatory latency is approximately 4–8 minutes.--><ref name = Oxford2009 />

[[ImageBerkas:Mechanism of Ejaculation.jpg|thumb|Mechanism of Ejaculation]]

The emission is the first phase. It involves deposition fluid from the [[ampulla of ductus deferens|ampullary]] [[vas deferens]], [[seminal vesicle]]s, and [[prostate gland]] into the [[Posterior (anatomy)|posterior]] [[urethra]].<ref>{{cite journal |author=Böhlen D, Hugonnet CL, Mills RD, Weise ES, Schmid HP |title=Five meters of H(2)O: the pressure at the urinary bladder neck during human ejaculation |journal=Prostate |volume=44 |issue=4 |pages=339–41 |year=2000 |pmid=10951500|doi=10.1002/1097-0045(20000901)44:4<339::AID-PROS12>3.0.CO;2-Z}}</ref> The second phase is the expulsion phase. It involves closure of bladder neck, followed by the rhythmic contractions of the [[urethra]] by pelvic-perineal and [[bulbospongiosus muscle]], and intermittent relaxation of [[external sphincter muscle of male urethra|external urethral sphinctersphincters]]s.<ref>{{cite journal |author=Master VA, Turek PJ |title=Ejaculatory physiology and dysfunction |journal=Urol. Clin. North Am. |volume=28 |issue=2 |pages=363–75, x |year=2001 |pmid=11402588|doi=10.1016/S0094-0143(05)70145-2}}</ref>

=== Intromission time ===

== Diagnosis ==

When deciding the appropriate treatment, it is important for physician to distinguish PE as a "complaint" versus PE as a "syndrome".<ref name="ReferenceA">{{cite web|last=Waldinger|first=MD|title=Changing paradigms from a historical DSM-III and DSM-IV view toward an evidence based definition of premature ejaculation. Part II: Proposals for DSM-V and ICD-11|work=Proposals for DSM-V and ICD-11|publisher=J Sex Med}}</ref> About 20 years ago, PE was classified into "lifelong PE" and "acquired PE".<ref>{{cite journal|last=Godpodinoff|first=ML|title=Premature ejaculation: clinical subgroups and etiology|journal=J Sex Marital Ther. |volume=15|page=130|year=1989|pmid=2769774|doi=10.1080/00926238908403817}}</ref> Recently, a new classification of PE was proposed based on controlled clinical and epidemiological stopwatch studies,<ref name="ReferenceA" /> and it included 2 other PE syndromes: "natural variable PE" and "premature-like ejaculatory dysfunction". Only individuals with lifelong PE with IELT shorter than 1–1.5 minutes should require medication as a first option, along with or without therapy. For those who fall into one of the other categories, treatment should consist of patient reassurance, behavior therapy, and/or psychoeducation<!-- better term for 'psychoeducation' needed to explain that irregular early ejaculation is a normal variation.<ref>{{cite web|last=Waldinger|first=Marcel D.|title=New Insights in Premature Ejaculation|url=http://www.psychiatrictimes.com/dsm-5/content/article/10168/54676|work=Psychiatric Times Vol. 24 No. 9|publisher=Psychiatric Times|accessdate=1 August 2007}}</ref><ref>{{cite journal|last=Serefoglu|first=EC|coauthors=Yaman O, Cayan S, et al.|title=Prevalence of the complaint of ejaculating prematurely and the four premature ejaculation syndromes|journal=J Sex Med|year=2011|issue=8|pages=540–8|pmid=21054799}}</ref>

Banyak pria mencoba untuk mengobati dirinya dari ejakulasi dini dengan mengalihkan pikiran, seperti mencoba untuk menjauhi segala sesuatu yang dapat menstimulasi aktivitas seksualnya. Cara yang lain adalah melakukan hubungan seksual dengan perlahan, menolak melakukan masturbasi, ejakulasi sebelum melakukan aktivitas seksual, dan menggunakan lebih dari satu [[kondom]]. Menggunakan lebih dari satu kondom sangat tidak dianjurkan, karena akan terjadi gesekan antara kondom dengan penis dan akan menyebabkan iritasi hingga kerusakan. Banyak pria yang berpendapat bahwa cara tersebut berhasil.<ref name = Oxford2009 />

[[Freudian]] theory postulated that rapid ejaculation was a symptom of underlying [[neurosis]]. It stated that the man suffers unconscious hostility toward women, so he ejaculates rapidly, which satisfies him but frustrates his lover, who is unlikely to experience [[orgasm]] that quickly.<ref name=Kaplan /> Freudians claimed that premature ejaculation could be cured using psychoanalysis. But even years of psychoanalysis accomplished little, if anything, in curing premature ejaculation.<ref name=Kaplan>{{citation|author= Kaplan, Helen S. |title= PE: How to Overcome Premature Ejaculation |page=28 |year=1989 |publisher=Brunner Mazel/New York Times}}</ref>

=== Sex therapy ===

Several techniques have been developed and applied by sex therapists, including [[Kegel exercise]]s (to strengthen the muscles of the pelvic floor) and Masters and Johnson's "stop-start technique" (to desensitize the man's responses) and "squeeze technique" (to reduce excessive arousal).<ref name = LeVay />

To treat premature ejaculation, Masters and Johnson developed the "squeeze technique". Men were instructed to pay close attention to their arousal pattern and learn to recognize how they felt shortly before their "point of no return", the moment ejaculation felt imminent and inevitable. Sensing it, they were to signal their partner, who squeezed the head of the penis between thumb and index finger, suppressing the ejaculatory reflex and allowing the man to last longer.<ref>{{citation|author=Castleman, M. |title=Great Sex|year=2004|pages=137–138 |publisher=[[Rodale, Inc.]] }}</ref><ref>{{citation|author= Masters, W. and V. Johnson |title= Human Sexual Inadequacy |year=1970|publisher=[[Little Brown & Company]] }}</ref><ref>{{citation|author= Belliveau, F. and L. Richter |title= Understanding Human Sexual Inadequacy |year=1970|publisher=[[Hodder and Stoughton]] }}</ref>

The squeeze technique worked, but many couples found it cumbersome. From the 1970s to the 1990s, sex therapists refined the Masters and Johnson approach, largely abandoning the squeeze technique and focused on a simpler and more effective technique called the "stop-start" technique. During intercourse, as the man senses he is approaching climax, both partners stop moving and remain still until the man's feelings of ejaculatory inevitability subside, at which point, they are free to resume active intercourse.<ref>{{citation|author=Castleman, M. |title=Great Sex|year=2004|pages=136–137 |publisher=[[Rodale, Inc.]] }}</ref><ref>{{citation|author= Kaplan, Helen S. |title= PE: How to Overcome Premature Ejaculation |pages=48–58 |year=1989 |publisher=Brunner Mazel/New York Times}}</ref><ref>{{citation|author= Metz, M. and B. McCarthy |title= Coping With Premature Ejaculation |pages=123–128|year=2003 |publisher= New Harbinger Publications }}</ref><ref>{{citation|author= Silverberg, S. |title= Lasting Longer: The Treatment Program for Premature Ejaculation |pages=44–57|year=1978, 2010 |publisher= Physicians Medical Press }}</ref><ref>{{citation|author= Birch. R.W.|title= A Short Book About Lasting Longer|pages=27–38|year=2007 |publisher= PEC Publishing }}</ref> To help the man increase awareness of his sexual experience, he is encouraged to create an excitement scale of 1-100. Successful completion of this scale will include paying attention to his heart rate, when (and if) he squeezes his inner thighs, and sensations in all parts of his body. By creating this scale, he will be more able to pace himself as he uses the "stop-start" technique.

=== Medications ===

Drugs that increase serotonin signalling in the brain slow ejaculation and have been used successfully to treat PE. These include [[selective serotonin reuptake inhibitor]]s (SSRIs), such as [[paroxetine]], as well as [[clomipramine]]. Ejaculatory delay typically begins within a week of beginning medication. The treatments increase the ejaculatory delay to 6–20 times greater than before medication. Men often report satisfaction with treatment by medication, many discontinue it within a year.<ref name=Althof2007 /> SSRIs can cause various types of sexual dysfunction such as [[anorgasmia]], erectile dysfunction, and diminished libido. It can last for months, years, or sometimes permanently after the discontinuation of SSRIs.

== Epidemiology ==

Premature ejaculation is a prevalent [[sexual dysfunction]] in men;<ref name="premature ejaculation">{{cite web|url=http://www.mayoclinic.com/health/premature-ejaculation/DS00578|title=Premature ejaculation|publisher=[[Mayo Clinic]].com|accessdate=2007-03-02}}</ref> however, because of the variability in time required to ejaculate and in partners’ desired duration of sex, exact prevalence rates of PE are difficult to determine. In the “Sex in America” surveys (1999 and 2008), [[University of Chicago]] researchers found that between [[adolescence]] and age 59, approximately 30% of men reported having experienced PE at least once during the previous 12 months, whereas about 10 percent reported [[erectile dysfunction]] (ED).<ref name=Laumann>{{cite journal |author= Laumann, E.O., et al.|title= Sexual Dysfunction in the United States: Prevalence and Predictors |journal= Journal of the American Medical Association |volume=281 |page=537 |year=1999 |pmid= 10022110|doi=10.1001/jama.281.6.537}}</ref> Although ED is men's most prevalent sex problem after age 60, and may be more prevalent than PE overall according to some estimates,<ref name="erectile dysfunction">{{cite journal | pmid = 20497307 | doi=10.1111/j.1743-6109.2010.01849.x |volume=7 | issue=7 | title=Erectile dysfunction in the community: trends over time in incidence, prevalence, GP consultation and medication use—the Krimpen study: trends in ED|date=July 2010 | author=Schouten BW, Bohnen AM, Groeneveld FP, Dohle GR, Thomas S, Bosch JL |journal=J Sex Med | pages=2547–53}}</ref> premature ejaculation remains a significant issue that, according to the survey, affects 28 percent of men age 65–74, and 22 percent of men age 75–85.<ref name=Laumann /> Other studies report PE prevalence ranging from 3 percent to 41 percent of men over 18, but the great majority estimate a prevalence of 20 to 30 percent—making PE a very common sex problem.<ref name=Barnes /><ref name=Althof2010>{{cite journal |author= Althof, S.E. et al. |title= International Society for Sexual Medicine’s Guidelines for the Diagnosis and Treatment of Premature Ejaculation |journal= Journal of Sexual Medicine|volume=7|page=2947|year=2010|pmid=21050394 |doi=10.1111/j.1743-6109.2010.01975.x |issue=9}}</ref><ref name="premature ejaculation" /><ref>{{cite journal |author= Mathers, M.J. et al. |title= Premature Ejaculation in Urological Routine Practice |journal= Aktuelle Urology (German)|volume=44 |page=33 |year=2013|pmid= 23381878 |doi=10.1055/s-0032-1331727 |issue=1}}</ref><ref>{{cite journal |author= Serefoglu E.C. and T.R. Saitz |title= New Insights on Premature Ejaculation: A Review of Definition, Classification Prevalence, and Treatment |journal= Asian Journal of Andrology |volume=14|page=822 |year=2012|pmid=23064688 |doi=10.1038/aja.2012.108 |issue=6}}</ref><ref>{{cite journal |author= Tang, W.S. and E.M. Khoo |title= Prevalence and Correlates of Premature Ejaculation in a Primary Care Setting: A Preliminary Cross-Sectional Study |journal= Journal of Sexual Medicine |volume=8 |page=2071 |year=2011|pmid= 21492404 |doi=10.1111/j.1743-6109.2011.02280.x |issue=7}}</ref><ref>{{cite journal |author= Porst, H. et al. |title= The Premature Ejaculation Prevalence and Attitudes (PEPA) Survey: Prevalence, Co-morbidities, and Professional Help-Seeking |journal= European Urology |volume=51|page=816|year=2007|pmid=16934919|doi=10.1016/j.eururo.2006.07.004 |issue=3}}</ref><ref>{{cite journal |author= Rowland, D. et al. |title= Self-Reported Premature Ejaculation and Aspects of Sexual Functioning and Satisfaction |journal= Journal of Sexual Medicine |volume=1|page=225|year=204|pmid= 16429622|issue=2 |doi=10.1111/j.1743-6109.2004.04033.x}}</ref>

There is a common misconception that younger men are more likely to suffer premature ejaculation and that its frequency decreases with age. Prevalence studies have indicated, however, that rates of PE are constant across age groups.<ref name = Althof2007 />

== History ==

[[KategoriCategory:Andrologi]]

[[KategoriCategory:Seks]]