Premature Ejaculation

Overview

Premature ejaculation (PE) is one of the most common forms of male sexual dysfunction, affecting up to 30% of men at some point. It's characterized by ejaculation that occurs sooner than desired, either before or shortly after penetration, causing distress to one or both partners. PE can be lifelong (primary) or acquired (secondary).

Types of Premature Ejaculation

  • Lifelong (Primary) PE: Present from first sexual experiences
  • Acquired (Secondary) PE: Develops after period of normal function
  • Natural Variable PE: Occasional early ejaculation
  • Subjective PE: Normal ejaculation time but perceived as premature

Common Causes

Psychological Factors

  • Performance anxiety: Fear of sexual inadequacy
  • Stress: Work, financial, or relationship stress
  • Depression: Can affect sexual function
  • Guilt or shame: About sexual activity
  • Relationship problems: Poor communication or conflicts
  • Early sexual experiences: Rushed or anxiety-provoking
  • Sexual abuse: Past traumatic experiences

Biological Factors

  • Abnormal hormone levels: Testosterone, prolactin
  • Neurotransmitter imbalance: Serotonin levels
  • Thyroid problems: Hyper- or hypothyroidism
  • Prostatitis: Prostate inflammation
  • Genetic factors: May run in families
  • Hypersensitivity: Of glans penis
  • Erectile dysfunction: Rushing due to fear of losing erection

Diagnosis Criteria

Medical definition typically includes:

  • Ejaculation within 1 minute of penetration
  • Inability to delay ejaculation during intercourse
  • Negative personal consequences (distress, frustration)
  • Occurs in majority of sexual encounters

Evaluation

  • Detailed sexual history
  • Medical history and medications
  • Physical examination
  • Laboratory tests if underlying condition suspected
  • Assessment of relationship factors

Treatment Options

Behavioral Techniques

  • Stop-start technique: Pause stimulation before ejaculation
  • Squeeze technique: Apply pressure to reduce arousal
  • Pelvic floor exercises: Strengthen ejaculatory muscles
  • Masturbation before intercourse: Reduce sensitivity
  • Distraction techniques: Think of non-sexual topics

Medical Treatments

  • Topical anesthetics: Numbing creams or sprays
  • SSRIs: Antidepressants that delay ejaculation
  • Tramadol: Pain medication with PE benefits
  • PDE5 inhibitors: If concurrent ED present
  • Dapoxetine: Specifically approved for PE (where available)

Psychological Approaches

  • Sex therapy: Individual or couples counseling
  • Cognitive behavioral therapy: Address negative thoughts
  • Mindfulness techniques: Reduce anxiety
  • Relationship counseling: Improve communication

Self-Help Strategies

  • Open communication with partner
  • Reduce performance pressure
  • Use thicker condoms to reduce sensitivity
  • Try different sexual positions
  • Focus on partner's pleasure
  • Practice relaxation techniques
  • Maintain overall health
  • Limit alcohol consumption

When to Seek Help

Consult a healthcare provider if:

  • PE causes significant distress
  • Affects relationship satisfaction
  • Occurs with most sexual encounters
  • Self-help techniques aren't effective
  • Sudden onset of PE
  • Associated with other sexual problems
  • Accompanied by pain or other symptoms

Remember: PE is a common, treatable condition. Many men find relief through various treatment approaches, often combining techniques for best results.