Premature ejaculation: Treatments and causes
There may occasionally be complication with reproduction, but premature ejaculation (PE) can also adversely affect sexual satisfaction, both for men and their partners.
In recent years, the recognition and understanding of male sexual dysfunction has improved, and there is a better understanding of the problems that can result from it.
The information here aims to demystify the causes of PE and outline effective treatment options.
Here are some key points about premature ejaculation.
- In the majority of cases, an inability to control ejaculation is rarely due to a medical condition, although doctors will need to rule this out.
- PE can lead to secondary symptoms such as distress, embarrassment, anxiety, and depression.
- Treatment options range from reassurance from a doctor that the problem might improve in time, through to home methods of "training" the timing of ejaculation.
Premature ejaculation can cause significant distress.
In most cases, there is a psychological cause, and the prognosis is good.
If the problem occurs at the beginning of a new sexual partnership, the difficulties often resolve as the relationship goes on.
If, however, the problem is more persistent, doctors may recommend counseling from a therapist specializing in sexual relationships, or "couples therapy."
No medications are officially licensed in the United States for treating PE, but some antidepressants have been found to help some men delay ejaculation.
A doctor will not prescribe any medicines before taking a detailed sexual history to reach a clear diagnosis of PE. Drug treatments can have adverse effects, and patients should always discuss with a doctor before using any medication.
Dapoxetine (brand name Priligy) is used in many countries to treat some types of primary and secondary PE. This is a rapid-acting SSRI that is also licensed to treat PE. However, certain criteria must be met.
It can be used if:
- vaginal sex lasts for less than 2 minutes before ejaculation occurs
- ejaculation persistently or recurrently happens after very little sexual stimulation and before, during, or shortly after initial penetration, and before he wishes to climax
- there is marked personal distress or interpersonal difficulty because of the PE
- there is poor control over ejaculation
- most attempts at sexual intercourse in the past 6 months have involved premature ejaculation
Some topical therapies may be applied to the penis before sex, with or without a condom. These local anesthetic creams reduce stimulation.
Examples include lidocaine or prilocaine, which can improve the amount of time before ejaculation.
However, longer use of anesthetics can result in numbness and loss of erection. The reduced sensation created by the creams may not be acceptable to the man, and the numbness can affect the woman, too.
Two methods that can be helpful for men are:
- The start-and-stop method: This aims to improve a man's control over ejaculation. Either the man or his partner stops sexual stimulation at the point when he feels he is about to have an orgasm, and they resume once the sensation of impending orgasm has subsided.
- The squeeze method: This is similar, but the man gently squeezes the end of his penis, or his partner does this for him, for 30 seconds before restarting stimulation.
A man tries to achieve this upward of three or four times before allowing himself to ejaculate.
Practice is important, and if the problem continues, it may be worth talking to a doctor.
Researchers have found that Kegel exercises, which aim to strengthen the pelvic floor muscles, can help men with lifelong PE.
Forty men with the condition underwent physical therapy involving:
- 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
They also followed a set of individualized exercises.
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.
A number of factors may be involved.
Most cases of PE are not related to any disease and are instead due to psychological factors, including:
- sexual inexperience
- issues with body image
- novelty of a relationship
- overexcitement or too much stimulation
- relationship stress
- feelings of guilt or inadequacy
- issues related to control and intimacy
These common psychological factors can affect men who have previously had normal ejaculation. These cases are often called secondary, or acquired, PE.
Most cases of the rarer, more persistent form—primary or lifelong PE—are also believed to be caused by psychological problems.
The condition can often be traced back to early trauma, such as:
- strict sexual teaching and upbringing
- traumatic experiences of sex
- conditioning, for example, when a teenager learns to ejaculate quickly to avoid being found masturbating
More rarely, there may be a biological cause.
The following are possible medical causes of PE:
- multiple sclerosis
- prostate disease
- thyroid problems
- illicit drug use
- excessive alcohol consumption
PE can be a sign that an underlying condition needs treatment.
Medically, the more persistent form of PE, primary or lifelong PE, is defined by the presence of the following three features:
- 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.
Secondary symptoms include:
- decreased confidence in the relationship
- interpersonal difficulty
- mental distress
Men who ejaculate too soon can experience psychological distress, but results of a study of 152 men and their partners suggest that the partner tend to be less worried about PE than the man who has it.
The manual used by psychiatrists and psychologists for making a clinical diagnosis (known as the DSM-V) defines PE as a sexual disorder only when the following description is true:
"Ejaculation with minimal sexual stimulation before or shortly after penetration and before the person wishes it. The condition is persistent or occurs frequently and causes significant distress."
However, a more loosely defined form of PE is one of the most common kinds of sexual dysfunction.
A doctor will ask certain questions that are intended to help them assess symptoms, such as how long it takes before ejaculation occurs. This is known as latency.
Questions might include:
- How often do you experience PE?
- How long have you had this problem?
- Does it happen in every sexual encounter, or only at certain times?
- How much stimulation brings on an ejaculation?
- How has PE affected your sexual activity?
- Can you delay your ejaculation until after penetration?
- Do you or your partner feel annoyed or frustrated?
- How does PE affect your quality of life?
Results from surveys suggest that PE affects between 15 percent and 30 percent of men. However, there are far fewer medically diagnosed and diagnosable cases. This statistical disparity does not in any way diminish the discomfort experienced by men who do not meet the strict criteria for diagnosis.
Primary or lifelong PE is thought to affect around 2 percent of men.