Premature Ejaculation

Premature ejaculation is characterized by a lack of voluntary control over ejaculation. Many men occasionally ejaculate sooner than they or their partner would like during sexual activities. PE is a frustrating problem that can reduce the enjoyment of sex, harm relationships and affect quality of life. Occasional instances of PE might not be cause for concern. However, when the problem occurs frequently and causes distress to the man or his partner, treatment may be of benefit.

  Although the exact cause of premature ejaculation (PE) is not known, new studies suggest that serotonin, a natural substance produced by nerves, is important. A breakdown of the actions of serotonin in the brain may be a cause. Studies have found that high amounts of serotonin in the brain slow the time to ejaculation while low amounts of serotonin can produce a condition like PE.

Psychological factors also commonly contribute to PE. Temporary depression, stress, unrealistic expectations about performance, a history of sexual repression, or an overall lack of confidence can cause PE. Interpersonal dynamics may contribute to sexual function. PE can be caused by a lack of communication between partners, hurt feelings, or unresolved conflicts that interfere with the ability to achieve emotional intimacy.

Can premature ejaculation develop later in life?

Premature ejaculation (PE) can occur at any age. Surprisingly, aging appears not to be a cause of PE. However, the aging process typically causes changes in erectile function and ejaculation. Erections may not be as firm or as large. Erections may be maintained for a shorter period before ejaculating. The feeling that an ejaculation is about to happen may be shorter. These factors can result in an older man having an ejaculation earlier than when he was younger.

Can both premature ejaculation and erectile dysfunction affect a man at the same time?

Sometimes premature ejaculation (PE) may be a problem in men who have erectile dysfunction (ED)—the inability to achieve and/or maintain an erection sufficient for satisfactory sexual performance. Some men do not understand that the loss of erection normally occurs after ejaculation and may wrongly complain to their doctor that they have ED when the actual problem is PE. It is recommended that the ED be treated first if you experience both ED and PE, since the PE may resolve on its own once the ED has been adequately treated.

When should a doctor be seen?

When premature ejaculation (PE) happens so frequently that it interferes with your sexual pleasure, it becomes a medical problem requiring the care of a doctor.
   
Premature ejaculation (PE) affects not only you but also your partner and your sexual relationship. In an episode of PE, the intimacy shared with a partner suddenly comes to a quick end. You might feel angry, ashamed, and frustrated, and turn away from your partner. At the same time, your partner may be upset with the rapid emotional change, or the outcome of the sexual encounter.
Communication is not only important to successful diagnosis and treatment, but can also help a partner understand the feelings of the individual. Sometimes couple counseling or sex therapy may be useful. Together a couple might develop techniques (for example, the squeeze technique) that may prolong an erection. Most importantly, the couple should try to relax. Anxiety (especially performance anxiety) only makes this condition worse.
 But there is a way to control premature ejaculation :

 therapy can be used as the only treatment or can be used together with medical therapy or behavioral therapy. The focus of psychological therapy is to help you to identify and solve any difficulties in your relationships that may have added to the cause of premature ejaculation (PE). This therapy can also help couples to talk about problems with intimacy that occurred after PE began. Psychological therapy can also help a man learn to be less anxious about his sexual performance and have greater sexual confidence. Typically, a man will receive specific advice on how to enhance his and his partner’s sexual satisfaction.

Behavioral therapies

Behavioral therapy can play a key part in the usual treatment of premature ejaculation. Exercises are effective; however, they may not always provide a lasting solution to the problem. Also, they rely heavily on the cooperation of the partner, which in some cases, may be a problem.

With the squeeze method , an exercise developed by Masters and Johnson, the partner stimulates the man’s penis until he is close to ejaculation. At the point when he is about to ejaculate, the partner squeezes the penis hard enough to make him partially lose his erection. The goal of this technique is to teach the man to become aware of the sensations leading up to orgasm, and then begin to control and delay his orgasm on his own.

With the stop-start method , the partner stimulates the man’s penis until just before ejaculation. The partner should then stop all stimulation until the urge to ejaculate subsides. As the man regains control, he instructs the partner to begin stimulating his penis again. This procedure is repeated three times before allowing the man to ejaculate on the fourth time. The couple repeats this exercise three times a week, until the man has gained good control.

Medical therapies

Although not approved by the U.S. Food and Drug Administration (FDA) for this purpose, drugs used for depression and anesthetic creams have been shown to delay ejaculation in men with premature ejaculation (PE).

Medications are a relatively new form of treatment for PE. Doctors first noticed that men and women who were taking drugs for the treatment of depression (antidepressants) also had delayed orgasms. Doctors then began to use these drugs “off-label” (this implies using a medication for a different illness than what it was originally manufactured for) to treat PE. These medications include antidepressants that affect serotonin such as fluoxetine, paroxetine, sertraline and clomipramine.

If one medication fails to work, a second one is usually recommended. If the second one fails, trying a third medication will not likely be beneficial. An alternative is to combine medication with behavioral therapy and/or creams.

For use in PE, the doses of antidepressants are usually lower than those recommended for the treatment of depression. Common side effects of antidepressants can include nausea, dry mouth, drowsiness and reduced desire for sexual activity.

These drugs can be taken either every day or only taken before sexual activity. Your doctor will decide how you should take the medication based on the frequency of intercourse. The best time for taking the antidepressant medications before sexual activity has not been established, but most doctors will recommend from two to six hours depending on the medication. Because PE can recur when the medication is not taken, you most likely will need to take it on a continuing basis.