Premature Ejaculation

Premature Ejaculation

Premature ejaculation is uncontrolled ejaculation either before or shortly after sexual penetration. It happens with minimal sexual stimulation and before the person wishes. It may result in unsatisfactory sex for both partners. This can increase the anxiety that may add to the problem. It is one of the most common forms of male sexual dysfunction. It has probably affected every man at some point in his life.

Psychological causes

Some doctors believe that early sexual experiences may establish a pattern that can be difficult to change later in life, such as:

Situations in which you may have hurried to reach climax in order to avoid being discovered

Guilty feelings that increase your tendency to rush through sexual encounters

Other factors that can play a role in causing premature ejaculation include:

Erectile dysfunction. Men who are anxious about obtaining or maintaining an erection during sexual intercourse may form a pattern of rushing to ejaculate.

Anxiety. Many men with premature ejaculation also have problems with anxiety—either specifically about sexual performance or related to other issues.

Relationship problems. If you have had satisfying sexual relationships with other partners in which premature ejaculation happened infrequently or not at all, it’s possible that interpersonal issues between you and your current partner could be contributing to the problem.

Diagnosis

The manual used by psychiatrists and psychologists for making a clinical diagnosis (known as the DSM-V) defines PE as a sexual disorder only when the following description is true:

“Ejaculation with minimal sexual stimulation before or shortly after penetration and before the person wishes it. The condition is persistent or occurs frequently and causes significant distress.”

However, a more loosely defined form of PE is one of the most common kinds of sexual dysfunction.

A doctor will ask certain questions that are intended to help them assess symptoms, such as how long it takes before ejaculation occurs. This is known as latency.

Questions might include:

  • How often do you experience PE?
  • How long have you had this problem?
  • Does it happen in every sexual encounter, or only at certain times?
  • How much stimulation brings on an ejaculation?
  • How has PE affected your sexual activity?
  • Can you delay your ejaculation until after penetration?
  • Do you or your partner feel annoyed or frustrated?
  • How does PE affect your quality of life?

Results from surveys suggest that PE affects between 15 percent and 30 percent of men. However, there are far fewer medically diagnosed and diagnosable cases. This statistical disparity does not in any way diminish the discomfort experienced by men who do not meet the strict criteria for diagnosis.

Treatment

Premature ejaculation, in some cases, can lead to depression.

In most cases, there is a psychological cause, and the prognosis is good.

If the problem occurs at the beginning of a new sexual partnership, the difficulties often resolve as the relationship goes on.

If, however, the problem is more persistent, doctors may recommend counseling from a therapist specializing in sexual relationships, or “couples therapy.”

No medications are officially licensed in the United States for treating PE, but some antidepressants have been found to help some men delay ejaculation.

A doctor will not prescribe any medicines before taking a detailed sexual history to reach a clear diagnosis of PE. Drug treatments can have adverse effects, and patients should always discuss with a doctor before using any medication.

Dapoxetine (brand name Priligy) is used in many countries to treat some types of primary and secondary PE. This is a rapid-acting SSRI that is also licensed to treat PE. However, certain criteria must be met.

It can be used if:

  • vaginal sex lasts for less than 2 minutes before ejaculation occurs
  • ejaculation persistently or recurrently happens after very little sexual stimulation and before, during, or shortly after initial penetration, and before he wishes to climax
  • there is marked personal distress or interpersonal difficulty because of the PE
  • there is poor control over ejaculation
  • most attempts at sexual intercourse in the past 6 months have involved premature ejaculation

Side-effects from dapoxetine include nausea, diarrhea, dizziness, and headache.

Symptoms

The main symptom of premature ejaculation is the inability to delay ejaculation for more than one minute after penetration. However, the problem might occur in all sexual situations, even during masturbation.

Premature ejaculation can be classified as:

  • Lifelong (primary). Lifelong premature ejaculation occurs all or nearly all of the time beginning with your first sexual encounters.
  • Acquired (secondary). Acquired premature ejaculation develops after you’ve had previous sexual experiences without ejaculatory problems.

Many men feel that they have symptoms of premature ejaculation, but the symptoms don’t meet the diagnostic criteria for premature ejaculation. Instead these men might have natural variable premature ejaculation, which includes periods of rapid ejaculation as well as periods of normal ejaculation.

When to see a doctor

  • Talk with your doctor if you ejaculate sooner than you wish during most sexual encounters. It’s common for men to feel embarrassed about discussing sexual health concerns, but don’t let that keep you from talking to your doctor. Premature ejaculation is a common and treatable problem.
  • For some men, a conversation with a doctor might help lessen concerns about premature ejaculation. For example, it might be reassuring to hear that occasional premature ejaculation is normal and that the average time from the beginning of intercourse to ejaculation is about five minutes.

Treatments for Premature Ejaculation Include: 

  • Trying to build control over your ejaculatory reflex. Begin by self-stimulating (masturbating) regularly (three to five times per week) to become accustomed to the level of sensitivity and stimulation. Try masturbating with both a wet hand and a dry hand to get use to varying sensations. Try building control by masturbating right up until you feel yourself about to release, then stop masturbating, let your erection die down a little bit, maybe five minutes or so, and then start masturbating again. Do this exercise three or four times before you finally allow yourself to “finish” and masturbate to orgasm.

Practicing this idea will help you to know where your “point of no return” is so that during partner sex when you feel this sensation happening, you can back off either by “pulling out” to change sexual positions thus dulling your sensation for a moment or you can change your stroke (instead of thrusting in and out during sex you can leave your penis inside your partner and go in circles, which can be a bit less stimulating). Knowing what your “point of no return” feels like is crucial for gaining control over ejaculation.

  • Practice Kegels to attempt to delay orgasm. Kegels are useful when the ejaculation is near and can help to stave the ejaculation off. Just Google “Kegel Exercises” to see what they are. They help to build up the muscles in your pelvic floor to help you have better control.

In a controlled study in 2012 on premature ejaculation, men who couldn’t last for even one minute before ejaculating completed a 12 week course of pelvic floor exercises and were found to increase their ejaculation response time from 31.7 seconds to 146.2 seconds.

  • Using condoms also helps to delay ejaculation. They work by reducing sensitivity during intercourse so they can be helpful for a premature ejaculation problem. Use a thick brand condom: Trojan Enz will work if you can use latex.
  • Try making use of the “refractory period” after ejaculation. How soon can you achieve an erection after ejaculation? How long can you stimulate the second erection before ejaculation? Many men experience less sensitivity during the second erection and often a good treatment for premature ejaculation is to have the man ejaculate once (maybe during intercourse) then move on to please his partner until his erection returns, then use that second erection to have a longer intercourse session. Although some couples initially complain about this idea, it has worked very well for lots of couples.
  • Another tip to try is to use more lubricant. Reducing the friction may help you last longer.
  • If you haven’t orgasmed within 24 hours of being sexual with your partner, you will ejactulate quicker. Men who masterbate in the mornings and then have relations with their partners in the evening tend to be able to last longer because they have had an orgasm within the same day. You can also masterbate at night and have sex in the morning with the same effect.
  • How much foreplay are you engaging in? Try more or less, or different types of foreplay. Try more or less focus on the penis to control the level of stimulation. If you are achieving an 8.5 level of stimulation before attempting to penetrate, where a nine is the point of ejaculatory inevitability, penetrate when you are a six or seven. Never carry a lit match into a dynamite factory. Sometimes more foreplay helps with premature ejaculation because it allows the man to gain control over his anxiety and to be relaxed instead of hurrying through, which could “amp up” his anxiety and lead to premature ejaculation.
  • Many SSRI Medications works magically to help dull orgasmic sensation. This side effect can be very frustrating to men who don’t have a premature ejaculation problem but for a man who ejaculates prematurely, it can work amazingly. Talk to your doctor about the benefits of taking an SSRI Antidepressant for premature ejaculation.
  • Using the “Squeeze Technique.” This technique is where the man is having intercourse and then when he feels like he is close to release, pulls out and squeezes the head of his penis where it joins the shaft thus producing a “stop sensation,” helping him to be able to dull the sensation of wanting to orgasm. When he feels like that “point of no return sensation” has dulled he would then re-insert and begin again having intercourse. He could use the “squeeze technique” as many times as he wanted before finally allowing himself to orgasm.
  • Finally, examine the relationship to deal with the sexual dysfunction. Look at how we are communicating regarding sex and what our hopes and goals are for our sexual relationship. Talking to a qualified sex therapist can also work wonders.

Exercises

Researchers have found that Kegel exercises, which aim to strengthen the pelvic floor muscles, can help men with lifelong PE.

Forty men with the condition underwent physical therapy involving:

  • physio-kinesiotherapy to achieve muscle contraction
  • electrostimulation of the perineal floor
  • biofeedback, which helped them understand how to control the muscle contractions in the perineal floor

They also followed a set of individualized exercises.

After 12 weeks of treatment, over 80 percent of the participants gained a degree of control over their ejaculation reflex. They increased the time between penetration and ejaculation by at least 60 seconds.