PREMATURE EJACULATION DEFINITION
Premature ejaculation occurs when a man ejaculates sooner during sexual intercourse than he or his partner would like. Premature ejaculation is a common sexual complaint. Estimates vary, but as many as 1 out of 3 men say they experience this problem at some time. As long as it happens infrequently, it’s not cause for concern.
However, you may meet the diagnostic criteria for premature ejaculation if you:
- Always or nearly always ejaculate within one minute of penetration
- Are unable to delay ejaculation during intercourse all or nearly all of the time
- Feel distressed and frustrated, and tend to avoid sexual intimacy as a result
Both psychological and biological factors can play a role in premature ejaculation. Although many men feel embarrassed to talk about it, premature ejaculation is a common and treatable condition. Medications, counseling and sexual techniques that delay ejaculation — or a combination of these — can help improve sex for you and your partner.
PREMATURE EJACULATION CAUSES
Premature ejaculation is a common complaint. It is only rarely caused by a physical problem.
Premature ejaculation early in a relationship is most often caused by anxiety and too much stimulation. Guilt and other psychological factors may also be involved. The condition often improves without treatment.
PREMATURE EJACULATION PATHOPHYSIOLOGY
Premature ejaculation is believed to be a psychological problem and does not represent any known organic disease involving the male reproductive tract or any known lesions in the brain or nervous system. The organ systems directly affected by premature ejaculation include the following :
- Male reproductive tract (ie, penis, prostate, seminal vesicles, testicles, and their appendages)
- Portions of the central and peripheral nervous system controlling the male reproductive tract
- Reproductive organ systems of the sexual partner (if female) that may not be stimulated sufficiently to achieve orgasm
Perhaps the most pronounced effect of premature ejaculation, however, is psychological: Both partners are likely to be dissatisfied emotionally and physically by this problem. Attempted pregnancy is a particular concern. If the premature ejaculation is so severe that it happens before commencement of sexual intercourse, conception will not be possible unless artificial insemination is used.
Some have questioned whether premature ejaculation is purely psychological. A number of investigators have found differences in nerve conduction/latency times and hormonal differences in men who experience premature ejaculation compared with individuals who do not. The theory is that some men have hyperexcitability or oversensitivity of their genitalia, which prevents downregulation of their sympathetic pathways and delay of orgasm.
A group of nerves in the lumbar spinal cord has been identified as the possible generator of ejaculation. This nerve site is thought to be linked to excitatory and inhibitory dopamine pathways in the brain, which play significant roles in sexual behavior. While research continues, this knowledge is providing the foundation for possible development of medications specifically targeting delay of ejaculation.
PREMATURE EJACULATION SYMPTOMS
The primary symptom of premature ejaculation is the inability to delay ejaculation for more than one minute after penetration. However, the problem may occur in all sexual situations, even during masturbation.
Premature ejaculation can be classified as lifelong (primary) or acquired (secondary). Lifelong premature ejaculation occurs all or nearly all of the time beginning with your first sexual encounters. Acquired premature ejaculation has the same symptoms but develops after you’ve had previous sexual experiences without ejaculatory problems.
Many men feel that they have symptoms of premature ejaculation, but the symptoms do not meet the diagnostic criteria for premature ejaculation. Instead these may have natural variable premature ejaculation, which is characterized by periods of rapid ejaculation as well as periods of normal ejaculation.
PREMATURE EJACULATION DIAGNOSIS
In most cases, there are no abnormalities that can be detected. The health care provider can get more information by talking to the person or couple.
PREMATURE EJACULATION TREATMENT
Common treatment options for premature ejaculation include behavioral techniques, topical anesthetics, oral medications and counseling. Keep in mind that it may take a little time to find the treatment or combination of treatments that will work for you.
In some cases, therapy for premature ejaculation may involve taking simple steps, such as masturbating an hour or two before intercourse so that you’re able to delay ejaculation during sex. Your doctor also may recommend avoiding intercourse for a period of time and focusing on other types of sexual play so that pressure is removed from your sexual encounters.
The pause-squeeze technique
Your doctor may instruct you and your partner in the use of a method called the pause-squeeze technique. This method works as follows:
- Begin sexual activity as usual, including stimulation of the penis, until you feel almost ready to ejaculate.
- Have your partner squeeze the end of your penis, at the point where the head (glans) joins the shaft, and maintain the squeeze for several seconds, until the urge to ejaculate passes.
- After the squeeze is released, wait for about 30 seconds, then go back to foreplay. You may notice that squeezing the penis causes it to become less erect, but when sexual stimulation is resumed, it soon regains full erection.
- If you again feel you’re about to ejaculate, have your partner repeat the squeeze process.
By repeating this as many times as necessary, you can reach the point of entering your partner without ejaculating. After a few practice sessions, the feeling of knowing how to delay ejaculation may become a habit that no longer requires the pause-squeeze technique.
Anesthetic creams and sprays that contain a numbing agent, such as lidocaine or prilocaine, are sometimes used to treat premature ejaculation. These products are applied to the penis a short time before sex to reduce sensation and thus help delay ejaculation. A lidocaine spray for premature ejaculation (Promescent) is available over-the-counter.
Although topical anesthetic agents are effective and well-tolerated, they have potential side effects. For example, some men report temporary loss of sensitivity and decreased sexual pleasure. In some cases, female partners also have reported these effects. In rare cases, lidocaine or prilocaine can cause an allergic reaction.
Many medications may delay orgasm. Although none of these drugs is specifically approved by the Food and Drug Administration to treat premature ejaculation, some are used for this purpose, including antidepressants, analgesics and phosphodiesterase-5 inhibitors. These medications may be prescribed for either on-demand or daily use, and may be prescribed alone or in combination with other treatments.
- Antidepressants. A side effect of certain antidepressants is delayed orgasm. For this reason, selective serotonin reuptake inhibitors (SSRIs), such as sertraline (Zoloft), paroxetine (Paxil) or fluoxetine (Prozac, Sarafem), are used to help delay ejaculation. If SSRIs don’t improve the timing of your ejaculation, your doctor may prescribe the tricyclic antidepressant clomipramine (Anafranil). Unwanted side effects of antidepressants may include nausea, dry mouth, drowsiness and decreased libido.
- Analgesics. Tramadol (Ultram) is a medication commonly used to treat pain. It also has side effects that delay ejaculation. It may be prescribed when SSRIs haven’t been effective. Unwanted side effects may include nausea, headache and dizziness.
- Phosphodiesterase-5 inhibitors. Some medications used to treat erectile dysfunction, such as sildenafil (Viagra, Revatio), tadalafil (Cialis, Adcirca) or vardenafil (Levitra, Staxyn), also may help premature ejaculation. Unwanted side effects may include headache, facial flushing, temporary visual changes and nasal congestion.
This approach, also known as talk therapy, involves talking with a mental health provider about your relationships and experiences. These sessions can help you reduce performance anxiety and find better ways of coping with stress. Counseling is most likely to help when it’s used in combination with drug therapy.