Premature Ejaculation

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What is premature ejaculation?

Premature ejaculation is uncontrolled ejaculation either before or shortly after sexual penetration, with minimal sexual stimulation and before the person wishes. It may result in an unsatisfactory sexual experience for both partners. This can increase the anxiety that may contribute to the problem. Premature ejaculation is one of the most common forms of male sexual dysfunction and has probably affected every man at some point in his life.

What causes premature ejaculation?

The exact cause of premature ejaculation isn’t known. While it was once thought to be only psychological, doctors now know premature ejaculation is more complicated and involves a complex interaction of psychological and biological factors.

Psychological causes

Some doctors believe that early sexual experiences may establish a pattern that can be difficult to change later in life, such as:

  • Situations in which you may have hurried to reach climax in order to avoid being discovered
  • Guilty feelings that increase your tendency to rush through sexual encounters

Other factors that can play a role in causing premature ejaculation include:

  • Erectile dysfunction. Men who are anxious about obtaining or maintaining an erection during sexual intercourse may form a pattern of rushing to ejaculate, which can be difficult to change.
  • Anxiety. Many men with premature ejaculation also have problems with anxiety — either specifically about sexual performance or related to other issues.
  • Relationship problems. If you have had satisfying sexual relationships with other partners in which premature ejaculation happened infrequently or not at all, it’s possible that interpersonal issues between you and your current partner are contributing to the problem.

Biological causes

A number of biological factors may contribute to premature ejaculation, including:

  • Abnormal hormone levels
  • Abnormal levels of brain chemicals called neurotransmitters
  • Abnormal reflex activity of the ejaculatory system
  • Certain thyroid problems
  • Inflammation and infection of the prostate or urethra
  • Inherited traits
  • Nerve damage from surgery or trauma (rare)

What are the symptoms?

The main symptom of premature ejaculation is an uncontrolled ejaculation either before or shortly after intercourse begins. Ejaculation occurs before the person wishes it, with minimal sexual stimulation.

How is premature ejaculation diagnosed?

Your doctor will discuss your medical and sexual history with you and conduct a thorough physical exam. Your doctor may want to talk to your partner also. Premature ejaculation can have many causes. So your doctor may order laboratory tests to rule out any other medical problem.

Risk factors

Various factors can increase your risk of premature ejaculation, including:

  • Erectile dysfunction. You may be at increased risk of premature ejaculation if you occasionally or consistently have trouble getting or maintaining an erection. Fear of losing your erection may cause you to consciously or unconsciously hurry through sexual encounters.
  • Health problems. If you have a serious or chronic medical condition, such as heart disease, you may feel anxious during sex and may unknowingly rush to ejaculate.
  • Stress. Emotional or mental strain in any area of your life can play a role in premature ejaculation, often limiting your ability to relax and focus during sexual encounters.

How is it treated?

In many cases premature ejaculation resolves on its own over time without the need for medical treatment. Practicing relaxation techniques or using distraction methods may help you delay ejaculation. For some men, stopping or cutting down on the use of alcohol, tobacco, or illegal drugs may improve their ability to control ejaculation.

Your doctor may recommend that you and your partner practice specific techniques to help delay ejaculation. These techniques may involve identifying and controlling the sensations that lead up to ejaculation and communicating to slow or stop stimulation. Other options include using a condom to reduce sensation to the penis or trying a different position (such as lying on your back) during intercourse. Counseling or behavioral therapy may help reduce anxiety related to premature ejaculation.

Antidepressant medicines such as clomipramine (Anafranil) and dapoxetine (Priligy) are sometimes used to treat premature ejaculation. These medicines are used because one of their side effects is inhibited orgasm, which helps delay ejaculation. Tramadol (Ultram), which has been used for many years to control pain, is another medicine that can delay ejaculation.

There are also creams, gels, and a spray that may be used to treat premature ejaculation by reducing sensation. These medicines, such as lidocaine or lidocaine-prilocaine, are applied to the penis before sexual intercourse. But some of these medicines can also affect a man’s sexual partner by reducing sensation for the partner.