Premature Ejaculation

What is Premature Ejaculation?

Ejaculation is when semen is released from the male reproductive system. Premature ejaculation is when this release happens earlier than a man or his partner wants it to during sexual activity. About 30% of men experience this, although some studies suggest it could be as high as 75%. It is considered the most common sexual disorder in men.

There are different ways to define premature ejaculation. It can be understood as a lack of control over the timing of ejaculation, or when a man reaches orgasm and ejaculates earlier than he wants to. For instance, sex researchers Masters and Johnson describe it as a situation where a man cannot control his ejaculation to satisfy his female partner during more than half of their sexual encounters. Another definition suggests it’s when a man has limited control over his ejaculation and it happens within two minutes of sexual penetration in at least half instances.

The World Health Organization views premature ejaculation as not being able to delay ejaculation long enough to enjoy sex. This can occur if ejaculation happens before or very soon after starting intercourse, or if it happens without an adequate erection. Some suggest that if ejaculation happens within one minute of vaginal penetration, it can be considered “premature”, while others believe that normal penetration time should typically last at least 4 minutes, with anything less being considered a problem.

The International Society for Sexual Medicine defines premature ejaculation in multiple ways. These include ejaculation occurring within about one minute of penetration, from the first sexual experience or a considerable decrease in the time it takes to ejaculate, often to less than three minutes. Other indications involve an inability to delay ejaculation during most or all sexual encounters and distressing consequences such as frustration, annoyance, and avoiding sexual intimacy.

The American Psychiatric Association’s Manual of Mental Disorders also has a definition for premature ejaculation. According to them, it occurs when ejaculation takes place within approximately 1 minute of vaginal penetration, before the man wants it to, in most or all sexual activities. These symptoms should last for at least six months and cause significant distress. The issue should not be caused by nonsexual mental health issues, medical conditions, side effects of drugs, relationship distress, or other significant stress factors.

However, it’s important to note that many women may take a long time to climax with vaginal intercourse. This is known as delayed female orgasm rather than premature ejaculation.

Experiencing premature ejaculation occasionally is not worrisome. However, if it happens frequently and matches the diagnostic criteria, it can cause considerable stress, depression, emotional pain, and relationship issues as sexual activity becomes less enjoyable.

If premature ejaculation has been present for a year or more, it can have a significant effect on the couple, leading to clinical depression, relationship issues, and other problems.

Approximately 30% of men between the ages of 18 to 59 experience premature ejaculation. However, due to feelings of shame and embarrassment, many do not discuss this issue with their doctors.

What Causes Premature Ejaculation?

Premature ejaculation mostly happens for psychological reasons. However, we don’t exactly know what causes it. There are several potential contributors that could play a role, including some physical factors and some mental factors.

Physically, some possible factors could be:

• Unusual amounts of a brain chemical called serotonin. If you have less serotonin, you might ejaculate quicker.
• Different levels of hormones like LH, prolactin, and TSH.
• When your body doesn’t produce enough testosterone (a condition called hypogonadism).
• Inflammation or infection in your prostate or urethra, which are parts of the male reproductive and urinary systems.
• Erectile dysfunction, or trouble getting an erection.
• Being extra sensitive to sexual stimulation (ejaculatory hyperreflexia).
• Genetics: If someone in your family has premature ejaculation, you might be more likely to have it too.
• A condition called hyperthyroidism, where your thyroid gland is overactive.
• Nerve damage, for example from a condition like multiple sclerosis.
• Alcoholism, diabetes, drug use, or not getting enough sleep (which also lowers your serotonin levels).

On the mental side, potential factors include:

• Depression, anxiety, stress, or guilt.
• Seeing yourself as extremely special (narcissism).
• Believing unrealistic things or having unrealistic expectations about how you should perform sexually.
• Feeling anxious about sexual performance.
• Bottling up sexual feelings (sexual repression).
• Feeling insecure or negative about how your body looks.
• A past experience of sexual abuse or a sexual experience that went wrong.
• Problems in your relationship.
• Conflict with your partner about who’s in control.
• Feeling bad about yourself.
• Irrationally fearing vaginal penetration.
• Feeling angry or hostile towards women.
• Any other mental health problems.

Risk Factors and Frequency for Premature Ejaculation

Premature ejaculation is a common sexual issue worldwide, affecting roughly 30% of men between the ages of 18 and 59. However, some studies suggest that the number could be as high as 75%. This problem is not isolated, as around 30% of men with premature ejaculation also struggle with erectile dysfunction, which means ejaculating without a full erection.

Premature ejaculation can happen at any adult age, but is most often reported in the 18 to 30 age group and, together with erectile dysfunction, in the 45 to 65 age group. There seems to be some variations among different ethnic groups: premature ejaculation is found in 34% of African Americans, 27% of Hispanics, and 29% of Whites.

The problem is not just confined to the United States. The estimated rate in Europe and India is similar to that in the US. Unfortunately, information about the incidence of premature ejaculation in Asia, Australia, Africa, and other parts of the world is not available.

Signs and Symptoms of Premature Ejaculation

When it comes to evaluating a male patient for sexual issues, it’s critical for the health professional to take a thorough patient history. This includes asking about the patient’s sexual history, their sex drive, and whether they’re experiencing any issues with erections.

A key part of this process involves a complete medical history and physical examination. However, discussing private details about sexual health can often make patients feel uncomfortable. To ease this discomfort, the health professional should approach the subject in a professional manner. For instance, they could ask open-ended questions about sexual satisfaction as part of their usual discussion with the patient. A good time to introduce these questions could be towards the end of the visit – that way, there’s time to build an understanding relationship beforehand.

For those with erectile dysfunction (ED), the health professional should investigate the time the dysfunction began, assess whether performance anxiety may be contributing to the problem, and seek out any other potential risk factors.

For instance, the health professional could ask, “How is your sex life? Is everything working okay for you and your partner?”. If the patient’s response is anything less than a direct and clear “everything’s fine”, this could suggest there may be a sexual issue at play. Any issues raised can then be followed up with more detailed questions. Importantly, the patient should be reassured that these are common problems that can be treated.

• On average, how long does it take after vaginal penetration before ejaculation?
• How often do you experience premature ejaculation?
• Is it sporadic or constant?
• How long has this problem been affecting you?
• Did it develop gradually or appear suddenly?
• Did a negative sexual experience precede the emergence of premature ejaculation?
• Does it happen with just one partner or with all partners?
• Does premature ejaculation occur every time you are sexually active?
• What kind of sexual activity do you engage in, and how frequently?
• How has this changed your sex life?
• Does it happen during masturbation?
• Do your erections work? Sometimes, or consistently?
• Do you lose your erection before ejaculation?
• Does orgasm feel normal to you?
• Are your personal relationships affected by this problem?
• Is this issue impacting your relationship?
• Do you or your partner avoid sexual intimacy due to this problem?
• Is your partner supportive of your efforts to address this problem?
• Have you tried any treatments, and what were the results?
• How much does this issue bother you? Are you open to considering potential treatments?
• Have you heard or read about a specific treatment that you’re interested in trying?
• Does anything make the issue worse or better? For example, drugs or alcohol.

Testing for Premature Ejaculation

In diagnosing premature ejaculation, a detailed medical and sexual history of the patient is gathered. This includes any past or current medical problems and a full account of the person’s sexual experiences.

Most of the time, no specific lab tests or scans are needed to check for premature ejaculation. However, certain blood tests may be performed if additional problems such as difficulty in achieving an erection or a decrease in sexual desire are reported. This helps to identify conditions like low testosterone levels or hormonal imbalances.

While low levels of testosterone have been seen in patients with premature ejaculation, treating this condition doesn’t usually fix the early ejaculation issue. On the other hand, a condition where the thyroid gland is overactive (hyperthyroidism) can cause premature ejaculation. So, in some cases, a doctor may check your thyroid hormone levels. Treating an overactive thyroid can improve symptoms of premature ejaculation.

Several advanced tests like evaluating the sensitivity to touch on the skin of the penis, nerve conduction studies, and testing levels of various hormones are sometimes carried out by specialists. However, these tests are not usually recommended for routine practice and are more for research purposes.

Because premature ejaculation mainly involves psychological aspects, a mental health check-up is a key part of the evaluation. Experts such as psychiatrists, psychologists, or certified sex therapists who have experience dealing with male sexual issues are involved in this assessment.

It may be challenging for some patients to agree to a mental health evaluation. It’s important to understand that this is a normal part of the assessment process for premature ejaculation. This evaluation is conducted by experienced professionals and isn’t a judgement of the individual. The objective of this assessment is to offer the best treatment options.

Premature ejaculation isn’t a physical problem; it’s more about not being able to control the ejaculation due to factors such as stress, anxiety, and nervousness. Identifying and treating any underlying emotional issues is the best approach to managing the problem effectively. Emotional health issues related to premature ejaculation often include stress, anxiety, depression, feelings of insufficiency, and lowered self-esteem. Addressing these problems requires an experienced mental health professional.

There are many potential psychological and emotional issues linked with premature ejaculation. These might include feelings of worthlessness, difficulty in controlling sexual arousal, early negative experiences, exaggerated self-love or narcissism, fear of vaginal penetration, lack of awareness of bodily sensations, and having hidden negative emotions towards women.

Mental health professionals who are experienced in dealing with male sexual disorders can help individuals understand these and other potential psychological factors contributing to the condition.

Treatment Options for Premature Ejaculation

Premature ejaculation is a common issue that can often require a combination of different treatments. These can include behavioral practices, psychological therapies, and medications. Even though it’s not a disease and doesn’t actually damage any physical function, it can still greatly affect a male’s sexual and emotional wellbeing.

Note that no operation can help with premature ejaculation. In the past, some men were given penile implants in an attempt to treat it, but the results were generally disastrous.

Various behavioral practices can help to delay ejaculation. One is the ‘stop-and-start’ technique, where you pause sexual activity as soon as you start to feel like you might ejaculate – then wait until that feeling subsides before starting again. Over time, you can train your body to delay ejaculation naturally. Another method is the ‘squeeze’ technique which includes squeezing the base of the penis when you’re about to ejaculate. Consistent practice of both methods can help delay ejaculation over time. Masturbation or having sex more than once in a session can also help to delay ejaculation by capitalizing on the natural refractory period — a period after orgasm when the body needs to recuperate before becoming aroused again.

Dealing with stress can also be helpful. One technique includes using a pre-arranged non-verbal signal to communicate interest in sexual activity, thereby avoiding any potential guilt or shame. Using specially designed condoms can also be beneficial for some people, as can regular exercise and especially exercises targeted at strengthening the pelvic muscles.

Various medications can also be used to help with premature ejaculation. Topical anesthetics, for example, can be applied to the penis to reduce sensation. Selective serotonin reuptake inhibitors (SSRIs), a type of antidepressant, can also be beneficial as they increase the amount of the serotonin in the body, which can delay ejaculation. However, these medications do need to be taken regularly and can have side effects such as reduced sexual desire and difficulty with ejaculation. So, it’s always important to discuss these factors with a healthcare provider.

Psychotherapy can be used to deal with the negative thoughts and emotions that can lead to sexual problems. Through therapy, you can learn to control ejaculation and resolve the psychological effects of premature ejaculation, such as low self-esteem and performance anxiety.

For some men, a combined approach using behavior techniques, psychosexual therapy, and medication may be the most effective. It should be noted, however, that regardless of the treatment used, the chances of premature ejaculation returning remain high. Thus, ongoing management may be necessary.

Lastly, while it may seem obvious, it’s important to remember that the cooperation and involvement of a sexual partner can greatly improve the success of treating premature ejaculation.

What else can Premature Ejaculation be?

Before diagnosing someone with premature ejaculation, several other factors need to be taken into account. One of these factors may include the female partner experiencing significant delay in reaching orgasm. Typically, women take around 12 to 25 minutes to climax. In severe cases where a woman’s orgasm is significantly delayed, practically any man might appear to be experiencing premature ejaculation. Therefore, it’s important to also assess the sexual response of the partner.

Another consideration before making a diagnosis is the potential side-effects of certain medications. Some drugs used to treat mental health disorders can influence sexual performance. Thus, any adverse effects of such drugs should be evaluated as a potential contributing factor.

What to expect with Premature Ejaculation

There’s currently no permanent solution for lifelong premature ejaculation. However, in most cases, the condition can be managed effectively through a combination of treatments.

When premature ejaculation is acquired, meaning it develops later in life, it is often possible to correct it by addressing the underlying cause. For example, if a man has difficulty maintaining an erection and ejaculates prematurely as a result, treating the erectile dysfunction may also solve the problem with premature ejaculation. At the very least, this can reduce stress around performance and lead to better outcomes.

In many situations, medication may need to be taken indefinitely, as stopping the treatment could bring back the premature ejaculation.

After treatment, success rates range from 30% to 70%. However, it’s important to note that it’s common to have the condition return, and some men may need to continue treatment throughout their lives.

Premature ejaculation can have a significant impact on a man’s self-esteem, frequently leading to serious relationship problems, divorce, and even depression.

Possible Complications When Diagnosed with Premature Ejaculation

Premature ejaculation can make it challenging for couples to conceive if the ejaculation doesn’t happen within the vagina. This issue can lead to an increase in stress, worry, and serious relationship problems.

Furthermore, premature ejaculation is often linked with performance anxiety and problems in maintaining an erection. Emotional and mental health difficulties can worsen the situation, and it’s worth noting that not all situations properly address these underlying psychological issues.

If the treatment doesn’t work, feelings of depression, defeatism, and poor self-esteem can become more intense.

Key points to remember:

• Premature ejaculation can make it difficult for a couple to have a baby
• Premature ejaculation can cause stress, anxiety, and relationship problems
• There is often a link between premature ejaculation, performance anxiety, and erectile dysfunction
• Premature ejaculation can also be influenced by underlying psychological issues that may not always be adequately addressed
• If treatment doesn’t work, it can lead to increased feelings of depression, defeatism, and low self-esteem

Preventing Premature Ejaculation

Doctors will advise patients that premature ejaculation is the most common sexual problem experienced by men. If left untreated, it can often lead to considerable emotional stress, low self-esteem, anxiety, problems with erections (erectile dysfunction), reduced sexual desire (decreased libido), and issues in relationships. It’s important for patients to know that there are successful, scientifically-validated treatments available for this condition.