What Is Premature Ejaculation?
Premature ejaculation is a type of sexual dysfunction in which ejaculation happens before a man or his partner is ready. It results in the penis becoming flaccid (limp), making it more difficult to penetrate the partner. Also referred to as rapid or early ejaculation and premature climax, premature ejaculation is defined according to three essential criteria:
- Brief ejaculatory latency
- Loss of control
- Psychological distress in the patient and/or partner
Premature ejaculation is a common problem, affecting about 1 in 3 men 18 to 59 years old in the U.S. While premature ejaculation can be frustrating for a man and his partner, it is not necessarily a sign of a serious health problem.
What Are Symptoms of Premature Ejaculation?
The main symptom of premature ejaculation is an inability to delay ejaculation for more than a minute after penetration during intercourse.
This may also cause frustration and avoidance of sexual contact.
What Causes Premature Ejaculation?
The causes of premature ejaculation are unknown but neurotransmitters, physical factors, and psychological issues are believed to play a role.
The neurotransmitter serotonin may be a contributing factor in premature ejaculation in some men. Low amounts of serotonin in the brain can shorten the time to ejaculation and lead to premature ejaculation.
Physical factors that may contribute to premature ejaculation include:
- Being too excited or stimulated
- Having an overly sensitive penis
Psychological issues that may contribute to the development of premature ejaculation include:
- Performance anxiety
- History of sexual repression or abuse
- Low confidence
- Relationship problems
- Nervousness with a new partner
How Is Premature Ejaculation Diagnosed?
Premature ejaculation is diagnosed with a history and physical exam. In order to be diagnosed with premature ejaculation, there are three components that are considered:
- Ejaculatory latency time (ELT), which is the time it takes a man to ejaculate after penetration
- An ELT of about one minute or less may be considered premature ejaculation
- Consistent inability to delay or control ejaculation
- Marked distress about the condition
Lab tests are only needed if a doctor finds something of concern during a physical exam.
What Is the Treatment for Premature Ejaculation?
Treatment for premature ejaculation includes medications and/or therapy.
Medications used to treat premature ejaculation include:
- Selective serotonin reuptake inhibitors (SSRIs), such as sertraline (Zoloft), paroxetine (Paxil and Seroxat), citalopram (Celexa), or escitalopram (Lexapro)
- Tricyclic antidepressants such as clomipramine (Anafranil)
- Phosphodiesterase (PDE) inhibitors
- Used mainly in men with coexisting erectile dysfunction (impotence)
- A narcotic pain reliever used off-label (not approved by the FDA for this use) may be tried if SSRIs and clomipramine are ineffective or not tolerated
- Topical medications
- Anesthetics: lidocaine-prilocaine spray
- Alprostadil cream (Edex, Vitaros)
Wearing a condom may also help dull sensation and delay ejaculation.
Therapies used to treat premature ejaculation include:
- Psychological counseling to work through the feelings and emotions that may lead to problems with sexual relationships
- Can help couples learn to grow closer
- Can help men become less nervous about sexual performance
- Behavioral therapy
- Uses exercises to help build tolerance to delay ejaculation.
- Behavioral methods help more than 95% of men who have premature ejaculation
- The squeeze method:
- The man or his partner stimulates the penis until close to ejaculation and then the man or his partner firmly squeezes the penis so the erection partly goes away
- The goal is for the man to become aware of the sensations leading to climax so he can better control and delay climax
- The stop-start method:
- The man or his partner stimulates the penis until just before ejaculation and then stops until the urge to climax goes away
- Then stimulation starts again and the process is repeated 3 times, with the man ejaculating on the fourth attempt
- This method is repeated 3 times a week until the man gains more control
How Do You Prevent Premature Ejaculation?
In some cases, premature ejaculation can be prevented, depending on the cause. Behavioral methods including the squeeze method and the stop-start method can successfully help men delay ejaculation.
Distracting thoughts that are non-sexual in nature such as those about sports may also help a man delay ejaculation while he is being sexually stimulated.
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