Premature Ejaculation

Premature EjaculationPremature Ejaculation: is a condition where a man ejaculates (spurting out of semen) earlier than he or his partner would like him to. Premature ejaculation is also known as rapid ejaculation, rapid climax, premature climax, or early ejaculation. In other words, premature ejaculation is persistent or recurrent ejaculation with minimal sexual stimulation before, on, or shortly after penetration and before the person wishes it.

The factors that need to be considered here are-

  • Age of the individual- Premature Ejaculation or Rapid Ejaculation is more common in younger age groups and as age advances the individual who is more experienced in sexual activity eventually learns to control the ejaculation
  • Novelty of the sexual activity or the situation- Having sex in an atmosphere with the fear of ‘getting caught’ will lead to incidence of premature ejaculation
  • Recent frequency of sexual activity- Abstinence from any sexual activity (including masturbation) for a long duration will lead to increased occurrence of Premature Ejaculation or Rapid Ejaculation during the immediate subsequent act.

Causes of Premature Ejaculation or Rapid Ejaculation:
There are two different categories of Premature Ejaculation or Rapid Ejaculation. These are outlined below.

  • Primary or Life Long Premature Ejaculation - where a man has always experienced premature ejaculation since becoming sexually active.
  • Secondary premature ejaculation or Rapid Ejaculation - where a man has experienced normal ejaculation in the past, and then suddenly experiences the condition of premature ejaculation.

Primary (Life long) Premature Ejaculation or Rapid Ejaculation is the result of psychological factors as described below.

Conditioning - many doctors believe that early sexual experiences can condition future sexual behavior. So, if a teenager conditions himself to ejaculate quickly, in order not to be caught masturbating, or having sex, then it can be difficult to break the habit.

Trauma - a traumatic experience at an early age, involving sex, can lead to a life-long sexual anxiety. Experiences can range from the relatively mild, such as being caught masturbating, to the more serious, such as sexual abuse.

Upbringing - some men, who have had a strict upbringing, where sexual activity is only considered appropriate in certain circumstances, such as after marriage, may find it difficult to relax during sex, or be unable to not regard it as wrong, or sinful.

No physical cause has been identified as leading to primary (life-long) Premature Ejaculation or Rapid Ejaculation. While there are physical things that may lead to temporary Premature Ejaculation or Rapid Ejaculation, in most cases, there is no reason why ejaculation cannot return to normal once the physical causes have been addressed.

Secondary premature ejaculation can be caused by both psychological and physical factors.

Common psychological factors include:

  • unresolved problems, conflicts, or issues within a sexual and emotional relationship,
  • anxiety about sexual performance (this is often the factor at the start of a new sexual relationship, or where a man has had previous problems with sexual performance),
  • depression, and
  • stress.

Physical causes of secondary premature ejaculation include:

  • diabetes,
  • multiple sclerosis,
  • prostate disease,
  • hypertension,
  • under-active thyroid gland (hypothyroidism) and
  • drinking more than the safe limits of alcohol (the recommended daily levels are 3 – 4 units of alcohol for men, 2 – 3 units for women. A unit of alcohol is equal to about half a pint of normal strength lager) and using recreational drugs.

Diagnosis of Premature Ejaculation or Rapid Ejaculation

  • If you have an ejaculation problem, you will usually become aware of it through your own sexual behavior or through discussion with your partner. The next step is to visit your Sexual Physician, who will discuss the problem with you, and examine you.
  • Depending on the nature of your problem, you may be asked questions about your family medical history, and conditions, such as diabetes, heart disease, and high blood pressure. You will also be asked about your sexual and emotional health. The Sexual Medicine Specialist, may ask if you have had an injury, or surgery, to your pelvic area, check what medications you are taking, and ask about aspects of your lifestyle, such as alcohol consumption.
  • A rectal examination may be carried out to check for an enlarged prostate gland, and to check the nerves of your penis for any damage. Blood and urine samples may also be taken to check your hormone and cholesterol levels. The Sexual Medicine specialist, may also carry out a visual examination of the pelvic area to check for injury or infection.

Treatment of Premature Ejaculation or Rapid Ejaculation

If your Premature Ejaculation or Rapid Ejaculation is caused by physical conditions, your Sexual Physician should be able to suggest possible treatment options.

Treating Premature Ejaculation or Rapid Ejaculation that is caused by psychological factors can be more challenging, but most men who persevere with treatment have successful outcomes.

There are a number of techniques and tips you that the Sexual Physician will advise you apart from medication. These include:

  • masturbating an hour, or two, before you have sex,
  • using a thick condom to help decrease sensation,
  • taking a deep breath in order to briefly shut down the ejaculatory reflex (an automatic reflex of the body during which ejaculation occurs),
  • having sex with your partner on top (men are less aroused in this position), and
  • taking breaks during sex.

Couples therapy

If you are in a long term relationship, (married) you may benefit from couples therapy. The purpose of couples therapy is two-fold. First, couples are encouraged to explore any issues that may be affecting their relationship, and given advice on how to resolve them.

Secondly, couples are shown techniques that can help the man ‘unlearn’ the habit of Premature Ejaculation or Rapid Ejaculation. The two most popular techniques are the ‘squeeze technique’ and the ‘stop and start technique’.

In the squeeze technique, the woman begins masturbating the man. When he feels that he is almost at the point of ejaculation, he signals to the woman. She stops masturbating him, and squeezes the head of his penis for between 10-20 seconds. She then lets go, and waits for another 30 seconds, before resuming masturbating the man. This is done several times before ejaculation is allowed to happen.

The stop-start technique is similar, except that the woman does not squeeze the penis. Once the man feels more confident about delaying his ejaculation, the couple can then begin to have sexual intercourse, stopping and starting as required.

Though the techniques sound simple, they require a lot of instruction, guidance and practice.

Medication

Another treatment is a local anaesthetic spray that can be bought over-the-counter (OTC) at your pharmacist without prescription. You spray it on the head of your penis 10 minutes before having sex. Many men have found it particularly useful when used in combination with the squeeze, or stop and start techniques. However, when you penetrate your penis with local anesthetic, you wife’s vagina also absorbs the medicine and she will feel loss of sensation, which may be counterproductive

Some men have been treated with selective serotonin reuptake inhibitors (SSRIs). Though not licensed for the treatment of Premature Ejaculation or Rapid Ejaculation, they do have the useful side-effect of delaying ejaculation. However, SSRIs carry other side effects, including nausea, headaches, problems sleeping and, in some rarer cases, suicidal thoughts. Therefore, you should not take SSRIs without medical supervision.

Depoxitine is the latest drug which is released in Europe, after successful clinical trials and subsequent approval. This is an ultra short acting SSRI and can be used ‘on demand medication for premature ejaculation’. Sexual Physicians are hopeful that this new molecule would revolutionize the treatment of Premature Ejaculation.