Premature ejaculation occurs when a man ejaculates faster than he or his partner would like during intercourse. Premature ejaculation is a common sexual problem. Estimates vary, but as many as 1 in 3 men have this problem at some time.
As long as this happens rarely, it is no reason to be afraid. However, you may be diagnosed with premature ejaculation if:
Almost always ejaculate within one minute of penetration
Inability to delay premature ejaculation during intercourse all or most of the time
Feeling distressed and frustrated, and as a result tend to avoid sexual intimacy
Both psychological and biological factors can play a role in premature ejaculation. Although many men may feel embarrassed to talk about it, premature ejaculation is a common and treatable condition. Medications, counseling and sexual techniques for premature ejaculation — or a combination of these — can help improve sex for you and your partner.
Symptoms
The main symptom of premature ejaculation is the inability to delay ejaculation for more than one minute after penetration. However, the problem may occur in all sexual situations, even during masturbation.
Premature ejaculation can be classified as:
For life (initial). Lifelong premature ejaculation occurs nearly all of the time or so, beginning with the first sexual intercourse.
acquired (secondary). Acquired premature ejaculation develops after you've had previous sexual experiences without problems with ejaculation.
Many men feel that they have symptoms of premature ejaculation, but the symptoms do not meet the diagnostic criteria for premature ejaculation. Alternatively, these men may have normal variable premature ejaculation, which includes periods of premature ejaculation as well as periods of normal ejaculation.
When do you visit the doctor?
See your doctor if you ejaculate faster than you'd like during most sexual intercourses. It's common for men to feel embarrassed discussing sexual health concerns, but don't let that stop you from talking to your doctor. Premature ejaculation is a common and treatable problem.
For some men, a conversation with a doctor may help reduce anxiety about premature ejaculation. For example, it may be reassuring to hear that premature ejaculation is normal and that the average time from the start of intercourse to ejaculation is about five minutes
Causes
The exact cause of premature ejaculation is unknown. Whereas in the past it was believed that it was merely a psychological cause, doctors now know that the causes of premature ejaculation involve a complex interaction of psychological and biological factors.
psychological reasons
Psychological factors that may play a role include the following:
Try early sex
Sexual abuse
Image of a weak body
Depression
Concern about premature ejaculation
Guilt situations that increase your tendency to rush during sexual encounters
Other factors that could play a role include the following:
Erectile dysfunction (erectile dysfunction). Men who worry about getting or maintaining an erection during sexual intercourse may form a pattern of premature ejaculation, which can be difficult to change.
Anxiety. Many men with premature ejaculation also have anxiety issues — either about sexual performance specifically or about other problems.
Relationship problems If you have satisfactory sexual relations with other spouses in which premature ejaculation occurs infrequently or not at all, it is possible that personal problems between you and your current spouse are part of the problem.
Vital reasons
Many biological factors contribute to premature ejaculation, including:
Hormonal imbalance
Disruption of the rate of brain chemicals called neurotransmitters
Infection and inflammation of the prostate and urinary tract
inherited traits
Risk factors
There are many factors that may increase the risk of premature ejaculation, including:
Erectile dysfunction (erectile dysfunction). You may be at increased risk of premature ejaculation if you occasionally or always have trouble getting or maintaining an erection. The fear of losing an erection may consciously or unconsciously speed up during intercourse.
Stress. Emotional or psychological stress in any area of life may play a role in premature ejaculation and limiting your ability to relax and focus during intercourse.
Complications
Premature ejaculation can cause problems in your personal life, including:
Stress and relationship problems. Stress in a relationship is a common complication of premature ejaculation.
Fertility problems. Premature ejaculation can sometimes make fertilization difficult for couples trying to have a baby if ejaculation does not occur inside the vagina.
Diagnosis
In addition to asking about your sex life, your doctor will ask about your health history and possibly perform a physical exam. If you have premature ejaculation and trouble getting or maintaining an erection, your doctor may order blood tests to check your levels of the male hormone (testosterone) or other tests.
In some cases, your doctor may suggest that you see a urologist or mental health professional who specializes in ED.
Treatment
Common treatment options for premature ejaculation include behavioral techniques, local anesthesia, medication, and counseling. Keep in mind that it may take time to find a treatment or combination of treatments that will work for you. Behavioral therapy in addition to drug therapy can be the most effective treatment.
Behavioral techniques
In some cases, premature ejaculation treatment may include simple steps, such as masturbating an hour or more before intercourse, so the patient can delay ejaculation during sex. The doctor may also recommend that you avoid penetration for a period of time and focus on other sexual foreplay so that the stress of sexual encounters is removed.
Pelvic floor exercises
Weak pelvic floor muscles can impair your ability to delay ejaculation. Pelvic floor exercises (Kegel exercises) can help strengthen these muscles.
To perform these exercises:
Find the right muscles. To identify the pelvic floor muscles, stop urinating in the middle of the urine output or tighten the muscles that prevent you from passing gas. These maneuvers use the pelvic floor muscles. Once you have identified your pelvic floor muscles, you can do the exercises in any position, although you may find it easier to do so at first.
Master your style. Tighten the pelvic floor muscles, hold the muscles for three seconds, then relax them for three seconds. Try a few times in a row. As your muscles get stronger, try doing Kegel exercises while sitting, standing or walking.
Keep your focus. For best results, focus on tightening your pelvic floor muscles only. Be careful not to flex the muscles in the abdomen, thighs, or buttocks. Avoid holding yourself back. Instead, breathe freely while you exercise.
Repeat 3 times a day. Do this exercise for at least three sets daily, repeating it 10 times for each set.
Pause and press method
The doctor can guide the patient and the spouse while using a method known as the pause and hold technique. This method is implemented as follows:
Begin sexual activity as usual, including arousal of the penis until the man feels he is about to ejaculate completely.
Letting the wife press on the tip of the penis, at the point where the head (the glans) meets the body of the penis, and remain in the pressure for several seconds, until the moments of urgency of ejaculation end.
The wife can repeat the pressing process as necessary.
By repeating this process as many times as necessary, it is possible to reach the stage of penetration in the wife's vagina without ejaculation. After a few practice sessions, the feelings of knowing how to delay ejaculation become a habit that doesn't require pause and pressure.
If the pause and pressure technique causes pain or discomfort, another technique can stop sexual arousal just before ejaculation, waiting until the level of excitement subsides and then starting again. This method is known as the stop and start method.
Condoms
Condoms may reduce penis sensitivity, which may help delay ejaculation. Condoms are available for "ejaculation control" over-the-counter. These condoms contain anesthetics such as benzocaine or lidocaine or are made of thick latex to delay ejaculation. Examples include: Trojan Extended, Durex Performax Intense, and Lifestyles Everlast Intense.
Pharmaceutical
Local anesthesia
Numbing creams and sprays that contain a numbing agent, such as benzocaine, lidocaine or prilocaine, are sometimes used to treat premature ejaculation. These products are applied to the penis 10 to 15 minutes before sex to reduce sensation and help delay ejaculation.
Lidocaine-prilocaine cream for premature ejaculation (Imla) is available by prescription. Sprays containing lidocaine are available over-the-counter to treat premature ejaculation.
Although local anesthetic agents are effective and well-tolerated, they have potential side effects. For example, some men report temporary loss of sensation and decreased sexual pleasure. Sometimes, female partners also report these effects.
Oral medications
Many medications may delay orgasm. Although none of these drugs are specifically approved by the Food and Drug Administration to treat premature ejaculation, some are used for this purpose, including antidepressants, sedatives, and phosphodiesterase-5 inhibitors. These medications may be prescribed for daily or as needed use, and may be prescribed alone or in combination with other treatments.
Antidepressants. A side effect of some antidepressants is a delay in orgasm. For this reason, selective serotonin reuptake inhibitors (SSRIs), such as escitalopram (Lexapro), sertraline (Zoloft), paroxetine (Paxil), or fluoxetine (Prozac, Sarafem) are used to help delay ejaculation.
Of the drugs approved for use in the United States, paroxetine appears to be the most effective. Typically, these drugs take five to 10 days to start working. But it may take two to three weeks of treatment before the full effect is achieved.
If SSRIs don't improve timing of ejaculation, your doctor may prescribe the tricyclic antidepressant clomipramine (Anafranil). Unwanted side effects of antidepressants may include nausea, excessive sweating, drowsiness, and decreased sexual desire.
pain killers. Tramadol (Ultram) is a medication often used to treat pain. But it also has the side effect of delaying ejaculation. Unwanted side effects may include nausea, headache, drowsiness, and dizziness.
Tramadol may be prescribed if the SSRIs do not work. Tramadol cannot be used with selective serotonin reuptake inhibitors.
Phosphodiesterase-5 inhibitors. Some medications used to treat erectile dysfunction may help treat premature ejaculation, such as sildenafil (Viagra), tadalafil (Cialis, Adcirca) or vardenafil (Levitra, Staxyn). Unwanted side effects may include headache, flushing and indigestion. These drugs may be more effective when used with selective serotonin reuptake inhibitors.
