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Premature Ejaculation; Cause, Symptom, Diagnosis, Treatment

Premature ejaculation (PE) occurs when a man experiences orgasm and expels semen soon after sexual activity and with minimal penile stimulation. It has also been called early ejaculation, rapid ejaculation, rapid climax, premature climax and (historically) ejaculatio praecox. There is no uniform cut-off defining “premature”, but a consensus of experts at the International Society for Sexual Medicine endorsed a definition of around one minute after penetration. The International Classification of Diseases (ICD-10) applies a cut-off of 15 seconds from the beginning of sexual intercourse.

Causes of Premature Ejaculation

Psychological factors

sexual inexperience
issues with body image
the novelty of a relationship
overexcitement or too much stimulation
relationship stress
anxiety
feelings of guilt or inadequacy
depression
issues related to control and intimacy
strict sexual teaching and upbringing
traumatic experiences of sex
conditioning, for example, when a teenager learns to ejaculate quickly to avoid being found masturbating

Medical Causes

Biological causes

Other factors that can play a role include:

Erectile dysfunction – Men who are anxious about obtaining or maintaining an erection during sexual intercourse might form a pattern of rushing to ejaculate, which can be difficult to change.
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 are contributing to the problem.
The nucleus para giganto cellulitis – of the brain has been identified as having involvement in ejaculatory control. Scientists have long suspected a genetic link to certain forms of premature ejaculation. However, studies have been inconclusive in isolated the gene responsible for Lifelong PE. Other researchers have noted that men who have premature ejaculation have a faster neurological response in the pelvic muscles

Symptoms of Premature Ejaculation

Primary

Ejaculation always, or nearly always, happens before sexual penetration has been achieved, or within about a minute of penetration.
There is an inability to delay ejaculation every time, or nearly every time, penetration occurs.
Negative personal consequences arise, such as distress and frustration, or avoidance of sexual intimacy.
Psychological symptoms are secondary to the physical ejaculatory events. The man, his partner, or both may experience them.

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Secondary

Decreased confidence in the relationship
Interpersonal difficulty
Mental distress
Anxiety
Embarrassment
Depression

Diagnosis of Premature Ejaculation

Premature ejaculation as a medical problem under evidence-based criteria generated by the International Society for Sexual Medicine in 2014 as being not the result of a nonsexual mental illness, a problem in a given relationship, or caused by medication, by the person ejaculating around a minute after penetration and before the person wants to ejaculate, occurring for a duration longer than 6 months and happening almost every time, and causing significant distress for person. These factors are identified by talking with the person, not through any diagnostic test.

The 2007 ICD-10 defined PE as ejaculating without control, and within around 15 seconds

Treatment of Premature Ejaculation

It can sometimes help to

masturbate an hour or two before having sex
use a thick condom to help decrease sensation
take a deep breath to briefly shut down the ejaculatory reflex (an automatic reflex of the body during which ejaculation occurs)
have sex with your partner on top (to allow them to pull away when you are close to ejaculating)
take breaks during sex and think about something boring

Couples therapy

If you’re in a long-term relationship, you may benefit from having couples therapy. During these sessions, the therapist will:

encourage couples to explore any relationship issues they have, and give them advice about resolving them
show the couple techniques that can help you “unlearn” the habit of premature ejaculation (the two most popular techniques are the “squeeze” and “stop-go” techniques)

In the squeeze technique, your partner masturbates you, but stops before the point of ejaculation and squeezes the head of your penis for between 10 to 20 seconds. They then let go and wait for another 30 seconds before resuming masturbation. This process is carried out several times before ejaculation is allowed to occur. The stop-go technique is similar, but your partner doesn’t squeeze your penis. Once you feel more confident about delaying ejaculation, you and your partner can begin to have sex, stopping and starting as required.

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These techniques may sound simple, but they require lots of practice.

Antidepressants (SSRIs)

Selective serotonin reuptake inhibitors (SSRIs) are designed to treat depression, but they also delay ejaculation. SSRIs used for this purpose include:

Dapoxetine

An SSRI specifically designed to treat premature ejaculation, known as dapoxetine (Priligy), has now been licensed in the UK.

It acts much faster than the SSRIs mentioned above and can be used “on demand”. You’ll usually be advised to take it between one and three hours before sex, but not more than once a day. Your response to the treatment will then be reviewed after four weeks (or after six doses), and again every six months.

‘Long love’ condoms

German scientists have come up with a slightly different approach that won’t cause vaginal irritation. It’s called the ‘long love condom’ and it contains a local anesthetic (benzocaine or lidocaine) inside it. Long love condoms are now being sold in many countries, under a variety of brand names.

Tramadol

This is a pain reliever that can delay ejaculation. It may be prescribed if antidepressants don’t help. This medicine is addictive, so it may not be an option for you.

Anesthetic creams or sprays

You put these on the head of your penis to make it less sensitive. Leave it on for about 30 minutes. It must be washed off before sex so you don’t lose your erection or cause loss of sensation for your partner.

Switching medication

There are a number of medications that can be used if it’s thought SSRIs are responsible for causing delayed ejaculation. These include:

amantadine – originally designed to treat viral infections
buproprion – usually prescribed to help people quit smoking
yohimbine – originally designed to treat erectile dysfunction

This help block some of the chemical effects of SSRIs that may contribute towards delayed ejaculation.

Alcohol and drugs

Alcohol misuse and drug use can be separate underlying causes of delayed ejaculation, so addressing these problems may help.

Pseudoephedrine

Pseudoephedrine tablets may be tried, but these will need to be prescribed “off-label”. This means the medicine shows promise in treating delayed ejaculation but it hasn’t been licensed for this particular use (pseudoephedrine is normally used as a decongestant).

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Cognitive behavior treatment (stop-start technique)

In 2006, we attended a conference on sexual medicine in Vienna. One of the speakers, Dr. Mehmet Sungur, claimed good results for the cognitive behavior (CBT) method of treatment for PE. The CBT method focuses on addressing the kind of thinking that has proved unhelpful.For example, a man may believe that ‘real men’ must thrust endlessly to give a woman pleasure. Such thinking is not only damaging to the man but wrong. Most women want penetration but also derive great pleasure from love play – often preferring fondling and oral sex to intercourse.

Counseling

There are sex therapists and other specialists to deal with ejaculation and other sexual problems. You may benefit from seeing one of these professionals.

Exercises

Electrostimulation – of the perineal floor muscle
Strengthen your muscles – Weak pelvic floor muscles sometimes contribute to PE. Kegel exercises may help strengthen them. Find the right muscles to tighten by stopping your urine in midstream. Hold them tight for 3 seconds and then release them for 3 seconds. Do this 10 times, at least 3 times a day.
Kegel exercises – which aim to strengthen the pelvic floor muscles, can help men with lifelong PE.
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

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.