Condition Header Background

Premature Ejaculation

Few life events affect us as powerfully as a sexual encounter. Feelings of desire, anticipation and excitement create potent chemistry within us and between us, moving partners from attraction to union, and tension to release. For men suffering from Premature Ejaculation, however, what should be a close encounter of the best kind can become a debilitating source of distress, frustration, and embarrassment.

Many men experience Premature Ejaculation during their first ever sexual encounters, but as they gain experience, most develop sufficient control. The issue becomes significant when it lasts for longer than six months, despite their best efforts. For other men, it begins later in life, around age 30 or 40, and is often related to medical conditions or medications.

Men with Premature Ejaculation often develop performance anxiety and frequently worry that the problem will negatively effect their relationships with their partners. They suffer with low self esteem and a sense of loss of control. It may even lead men to avoid sexual intimacy because of their embarrassment. Patients often compare themselves to false concepts of how long sex should last. In reality, sex isn’t a marathon, and the average duration of penetrative intercourse is around 5 to 10 minutes. Partners may blame themselves and often have lower levels of sexual satisfaction. Severe Premature Ejaculation that happens before intercourse begins can even interfere with efforts to have children.

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Causes and Risk Factors

Age and rates

The percentage of men who deal with Premature Ejaculation depends on how narrowly it is defined. Whether it’s their first time with a new partner, or the first time ever, one third of men will experience at least a few episodes of premature ejaculation at some point during their lifetimes. A much smaller number, about 1-3% of men, will be diagnosed with Premature Ejaculation during their lives. Age also affects Premature Ejaculation as length of intercourse before ejaculation naturally decreases with increased age.

Medical causes

Although Premature Ejaculation can be a disorder in its own right (primary), it also frequently appears as a symptom of another medical issue (termed “secondary” Premature Ejaculation). Hormone imbalances, prostate infections, and medication side effects are all potential sources of trouble.

Erectile dysfunction

Although it may seem counterintutive, erectile issues can occur alongside Premature Ejaculation and contribute to the problem. Men who have trouble maintaining erections can get into the habit of hurrying during sex because they are nervous about being able to perform.

Relationship factors

The status of a relationship is a crucial piece of the puzzle when investigating the possible causes of Premature Ejaculation. This includes differences in libido and lack of communication about each others’ sexual wants and needs. Sometimes Premature Ejaculation is more likely to occur when a relationship is new or the man is sexually inexperienced.

Psychological side

Anxiety is very common in men dealing with Premature Ejaculation and usually centers around performance. The blow to confidence the men face in these situations can exacerbate underlying issues of body image and unresolved emotional or sexual trauma. Religious, familial, or cultural attitudes around sex, especially those that have a negative outlook on it, can also make the situation worse.

Diagnosing Premature Ejaculation

The criteria

Ejaculation is defined as premature if it happens after less than one minute of penetrative sexual intercourse and before the patient wants. This goes on for at least 6 months and usually happens in all or almost all sexual encounters. However, sometimes it is confined to sexual encounters in specific situations or with only certain partners. Severity is based on how long intercourse lasts before ejaculation, with shorter periods indicating a more severe condition. For some people, the issue has existed since the beginning of sexual activity, while for others, it is a new occurrence.

Other possible complications

Taking a comprehensive medical history to parse out possible medical causes is a crucial part of making the diagnosis. These may include physical factors, such as thyroid or other endocrine and hormone abnormalities, prostate issues, and the patient’s stage of life. Premature Ejaculation and Erectile Dysfunction that occur together may be the sign of an underlying hormonal imbalance and warrants deeper medical investigation. Medications, such as some antidepressants and blood pressure medications, over-the-counter medications, and homeopathic remedies, can also affect ejaculation. Mental disorders, including depression, anxiety, and substance abuse play a role as well.

Treating Premature Ejaculation

Oral medications

Although no medication currently has FDA approval to treat Premature Ejaculation, selective serotonin reuptake inhibitors (SSRIs) are frequently prescribed as “off-label” treatments. Drugs like Celexa (citalopram), Lexapro (escitalopram), Paxil (paroxetine), Prozac (fluoxetine), and Zoloft (sertraline) may be used either daily or as needed (about 4–6 hours before intercourse). The side effects of these drugs are usually minimal, and taking antidepressants is generally safe. A prescription for an SSRI may help more than PE in men who are also depressed or anxious. Additionally, Ultram (tramadol) is a moderate-strength pain medication that can be taken as needed 2 hours before intercourse and can help delay ejaculation.

Patients who are dealing with both Premature Ejaculation and Erectile Dysfunction can benefit in both areas from treatment with medications like Viagra (sildenafil), Levitra (vardenafil), and Cialis (tadalafil).

Topical anesthetics

The topical numbing agents prilocaine and lidocaine come as both a cream, Emla, and a spray, Tempe. These treatments temporarily dull penis sensitivity and allow a man to last longer. Some couples find that stopping sex to apply a topical anesthetic can be disruptive, but still others find that the interruption is worth the effort. Condoms like Trojan Extended and Durex Performax Intense come coated on the inside with similar anesthetics to simplify the application process. Additionally, for some people, just a regular condom, without anesthetics, can reduce sensation enough to delay ejaculation.

Behavioral interventions

One of the easiest behavioral interventions for a man to employ is to masturbate an hour or so before intercourse, which can help him last longer. Building more control over the muscles of the pelvic floor (the same muscles that one would use to stop urination) through Kegel exercises will also help delay ejaculation. Kegel exercises involve contracting the muscles for about three seconds at a time, then relaxing for three more seconds. Start by doing three sets of ten repetitions each per day. Other time-tested recommendations include the Semans pause maneuver and the Masters and Johnson squeeze technique. These are variations on the same technique that involves pausing intercourse when the man feels they are close to orgasm, waiting for the sensation to subside a bit, and then continuing. By repeating this several times, the couple can extend the duration of intercourse.

Therapy

Experiencing physical intimacy without actually having intercourse can also help a man gain better control over the sensation of ejaculation. A specially trained sex therapist can help couples learn and practice these techniques to attain positive, long-lasting results.

Psychotherapy for the man and ideally, the affected couple, can address any underlying psychological issues that may cause a sexual problem. Anxiety, misplaced feelings of shame and anger, and a sense of loss of intimacy are common. Because Premature Ejaculation is a self-reported diagnosis, a partner’s perspective can contribute much to the clinical conversation. The therapist will very likely encourage a meeting with both partners.

Managing Premature Ejaculation

Let comfort be your guide

Seek help from the medical practitioner with whom you can speak most candidly about your concerns. Where a family practitioner or urologist is well qualified to rule out any underlying physical or medical causes of PE, a psychiatric professional is ideally qualified to identify and treat the psychological and interpersonal roots of the disorder. A psychiatrist will also make sure you see a medical doctor if you haven’t yet done so before seeking his or her help.

Couple up

Patient and partner satisfaction are the twin goals of therapy. If the problem is at all related to relationship or intimacy issues, engaging in therapy together can speed discovery and aid recovery. Effective communication is key for dealing with the main problem and surrounding issues. Open and honest conversations between partners help address the embarrassment and anxiety that often arise.

Stay positive

Most men who encounter a problem with Premature Ejaculation are able to significantly improve their performance with behavioral treatments alone. For those who have a more persistent problem, numerous other treatments are available. When interventions are successful and the ejaculatory reflex responds to retraining, the results of therapy can have such an enduring effect that PE may never be a problem again. With behavioral treatments alone, most men are able to extend the time before ejaculation by at least a minute.

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References
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