PREMATURE EJACULATION

Premature ejaculation (PE) is a common sexual dysfunction affecting men of all ages but often more prevalent in younger males. It can significantly impact a person’s self-esteem and intimate relationships.

Premature ejaculation (PE) occurs when you climax either before or shortly after starting intercourse, leaving you feeling unsatisfied. While it can be frustrating and awkward, it’s quite common among individuals with penises, affecting about 30%-40% of those assigned male at birth at some point in their lives. Remember, occasional occurrences aren’t typically a cause for concern.

Timing matters in sex, but there’s no strict rule about when you should ejaculate. However, if you consistently climax within 1-3 minutes of penetration or struggle to delay ejaculation even during solo activities like masturbation, it may be time to seek assistance. Chatting with your doctor can open up options for treatment and improve your sexual experiences.

Causes of Premature Ejaculation

The exact cause of premature ejaculation (PE) remains somewhat elusive, but it’s believed that brain chemistry plays a significant role. Individuals with lower levels of serotonin, a chemical in the brain, often experience quicker ejaculation times.

Psychological factors can also contribute to PE, such as:

Stress
Depression
Anxiety
Feelings of guilt
Relationship issues
Low confidence or negative body image
Worries about sexual performance
Negative attitudes towards sex (sexual repression)
Early sexual encounters
History of sexual abuse
Medical Conditions: Certain medical conditions such as diabetes, prostate problems, and thyroid disorders can contribute to premature ejaculation.

These psychological aspects can intertwine with biological factors, influencing the timing of ejaculation during sexual activity.

Prevalence and Symptoms

Premature ejaculation is a prevalent condition, affecting approximately 20-30% of men globally. The primary symptom is the inability to control ejaculation, leading to climaxing sooner than desired during sexual activity. This can cause distress and frustration for both partners.

Risk Factors

Age: PE is more common in younger men, but it can affect males of any age.
Stressful Lifestyle: High-stress levels and unhealthy lifestyle choices such as smoking and excessive alcohol consumption can increase the risk.
Relationship Issues: Poor communication and unresolved conflicts with a partner can contribute to premature ejaculation.
Health Conditions: Certain medical conditions like erectile dysfunction and prostate problems may increase the risk.

Several physical conditions may contribute to premature ejaculation (PE). You might be more susceptible to PE if you have any of the following:

Abnormal hormone levels
Disrupted neurotransmitter levels (an imbalance in brain chemicals that transmit messages to the body)
Inflammation or infection in the prostate or urethra (the tube from the bladder for urine elimination)
Genetic predisposition inherited from your parents

Additionally, individuals experiencing erectile dysfunction (ED) may also encounter PE. ED occurs when the penis struggles to maintain sufficient firmness for sexual activity. Concerns about losing an erection can lead to a pattern of hurried ejaculation. Addressing ED through various medication options could potentially alleviate PE as well. It’s essential to discuss any concerns or questions about treatment with your doctor to find the most suitable solution.

Diagnosis

Diagnosing the causes of premature ejaculation typically involves a consultation with a urologist. Here’s how the process usually unfolds:

Initial Assessment:
- The urologist will start by discussing your sexual experiences and history. They may inquire about:
  - Duration of the issue
  - Circumstances surrounding premature ejaculation
  - Frequency of occurrences
  - Consistency across sexual encounters and partners
  - Occurrence during masturbation
  - Presence of erectile difficulties
Open Communication:
- While some questions may feel personal, it’s crucial to answer them honestly to facilitate an accurate diagnosis.
Medical History and Medication Review:
- Your urologist will ask about any existing medical conditions, medications (prescription, over-the-counter, supplements, and herbal products), as well as alcohol and illicit drug use. This comprehensive review helps identify potential contributing factors.
Laboratory Tests:
- Lab tests are generally unnecessary unless there’s suspicion of an underlying health issue exacerbating premature ejaculation. In such cases, specific tests may be ordered to investigate further.

Treatments

Treatment options for premature ejaculation (PE) encompass various approaches aimed at addressing underlying psychological or physical factors contributing to the condition. Here are some common methods:

Counseling: Seeking guidance from a psychologist or psychiatrist can assist in addressing underlying issues such as depression, anxiety, or stress that may exacerbate PE.
Medication: Various medications can be considered for managing premature ejaculation (PE). Here are the options:
- Antidepressants:
  - Selective serotonin reuptake inhibitors (SSRIs) like citalopram (Celexa), escitalopram (Lexapro), fluoxetine (Prozac), paroxetine (Paxil), and sertraline (Zoloft), as well as the tricyclic antidepressant clomipramine (Anafranil), are commonly prescribed to delay ejaculation.
  - It’s essential to note that this usage is considered “off-label,” meaning these drugs are not FDA-approved specifically for PE treatment. Discuss potential side effects with your urologist to determine suitability.
- Anesthetic Creams and Sprays:
  - Numbing agents applied to the penis’s head and shaft can decrease sensitivity, thus prolonging ejaculation time.
  - These creams or sprays are absorbed for 10 to 30 minutes before intercourse, ensuring reduced sensitivity. However, it’s vital to wash the penis before intercourse to prevent numbness in your partner’s genital area or loss of erection.
- Erectile Dysfunction Medications:
  - Drugs like sildenafil (Viagra), tadalafil (Cialis), vardenafil (Levitra), and avanafil (Stendra), primarily used to treat erectile dysfunction, have also shown efficacy in managing premature ejaculation, especially in men with concurrent ED.
- Tramadol: A pain reliever that can also delay ejaculation, although it carries the risk of addiction and may not be suitable for everyone.
Anesthetic creams or sprays: These products are applied to the penis’s head to reduce sensitivity, thus prolonging the time to ejaculation. It’s important to follow usage instructions carefully, including washing off the product before intercourse to avoid numbing sensations for your partner. Local anesthetics, such as lidocaine or prilocaine creams, can be applied to the penis to reduce sensitivity and delay ejaculation.

Each treatment option has its considerations and potential side effects, so discussing them thoroughly with your healthcare provider is crucial to determine the most suitable approach for your individual needs.

Home Care Tips

Premature ejaculation (PE) can often be managed effectively with a combination of psychological, medical, and behavioral therapies. Here are some home remedies and techniques you can try:

Start-stop Technique: Stimulate your penis until you feel close to orgasm, then pause for about 30 seconds until the sensation subsides. Resume stimulation and repeat this cycle several times before allowing ejaculation.
The Squeeze Method: Similar to the start-stop technique, but when you feel nearing orgasm, apply pressure to the head of the penis to reduce arousal and delay ejaculation. Repeat as needed.
Distraction: Some individuals find that thinking about something non-sexual during intercourse can help prolong ejaculation.
Pelvic Floor Exercises (Kegels): Strengthening your pelvic floor muscles can improve ejaculatory control. Identify these muscles by stopping urination midstream, then contract and hold them for 3 seconds before releasing. Aim for 10 repetitions, three times daily.
Condom Use: Wearing a condom may reduce sensitivity and help delay ejaculation.
Pre-sex Masturbation: Some find that masturbating a few hours before intercourse can help them last longer during sex.
Communication: Open communication with your partner about sexual needs and preferences can help alleviate performance anxiety.

Ayurvedic treatments:

Ayurvedic Medicine: While there’s limited scientific evidence, Ayurveda offers potential remedies such as yoga, herbal supplements, and dietary changes. However, it’s essential to consult a qualified practitioner for personalized guidance and to ensure safety and efficacy.

Remember, individual responses vary, so it may take some trial and error to find the most effective strategy for managing PE. If home remedies don’t provide sufficient relief, consider consulting a healthcare professional for further evaluation and treatment options.

Prevention and When to See a Doctor

Preventing premature ejaculation involves maintaining a healthy lifestyle, managing stress effectively, and addressing any underlying medical or psychological issues. It’s essential to seek medical help if premature ejaculation is causing significant distress or affecting your relationship.

FAQs:

What is the main cause of premature ejaculation?
- PE can stem from a variety of psychological and physical factors, including stress, depression, anxiety, relationship issues, hormonal imbalances, inflammation or infection in the prostate or urethra, genetic predisposition, and erectile dysfunction.
How can I fix premature ejaculation?
- Seeking help from your doctor is recommended. They may suggest counseling, medications, or behavioral techniques tailored to your needs.
What is the average time of premature ejaculation?
- PE typically occurs within 1-3 minutes of penetration during sexual intercourse.
Why do I only last 30 seconds in bed?
- Ejaculating sooner than desired may have multiple causes, including psychological, emotional, or physical factors. Consult your doctor to identify the underlying reasons and explore suitable solutions.

Key Points:

Premature ejaculation (PE) can affect anyone with a penis, but it’s treatable with various approaches.
Consult your doctor to explore counseling, medication, or behavioral techniques for managing PE and improving sexual satisfaction.
Support from healthcare professionals is available for addressing concerns about starting a family or enhancing sexual experiences.

Outlook/Prognosis

With proper diagnosis and treatment, the outlook for premature ejaculation is generally favorable. Many men experience significant improvement in ejaculatory control and sexual satisfaction with therapy and medication.

Sources

Mayo Clinic – Premature Ejaculation
American Urological Association – Premature Ejaculation
International Society for Sexual Medicine – Premature Ejaculation
National Institute of Diabetes and Digestive and Kidney Diseases – Premature Ejaculation
European Urology – Premature Ejaculation
Merck Manual Consumer Version: Ayurveda.
Sexual Medicine Society of North America: Conditions: Premature Ejaculation.
Urology Care Foundation: How Is ED Treated? What is Premature Ejaculation? Premature Ejaculation: What You Should Know.
Cleveland Clinic: Premature Ejaculation, Urethral Stricture In Men.
Fertilitypedia: Premature Ejaculation.