Premature Ejaculation

What is premature ejaculation?

Premature ejaculation (PE) is a common sexual dysfunction in which ejaculation occurs too quickly. Specifically, PE is diagnosed if ejaculation occurs within 1 minute of penetration at least 75% of the time. This can leave both partners unsatisfied and can damage relationships and sexual fulfillment.

Premature ejaculation is not unusual. Approximately 30-70% of males in the US are affected in their lifetime. PE was once considered a psychological disorder, but recent research suggests physical, neurological and biochemical causes may also be involved.

Premature ejaculation can be related to a range of different organs, including the following:

• Male reproductive organs: penis, prostate, testicles and seminal vesicles (tubes that carry sperm from the testicles).
• Nerves: spinal nerves and nerves that carry information to and from the male reproductive organs.
• Female reproductive organs: The female reproductive organs may not have been stimulated enough to achieve orgasm.

What causes premature ejaculation in men?

The causes of premature ejaculation can be different in different people. Generally the causes can be categorized as psychological, neurological or hormonal. However, there is also a theory that PE may have a genetic basis. From an evolutionary perspective, males who ejaculate quickly are more likely to fertilize females and pass their genes onto future generations. Therefore, today’s males may have evolved to ejaculate more quickly than before.

Psychological

Some causes of early ejaculation are thought to be psychological. These often relate to anxieties and habits picked up from previous sexual encounters.

• Habits from masturbation
  It is thought that habits acquired from masturbation, in some people, may have an effect upon premature ejaculation - especially if they have experienced PE since puberty. It is thought that during masturbation, some young men may feel pressured to reach climax quickly to avoid being discovered while masturbating and that this may have conditioned them to ejaculate too quickly during other sexual encounters. It is also thought that use of porn during masturbation may allow men to climax more quickly which can then have a similar effect during sex.

• Trauma
  Tramatic experiences such as sexual assault can, understandably, have a lasting psychological impact upon survivors. This can influence their sexual experience and it is important that they seek out psychological help for this.

• Performance anxiety
  Performance anxiety can be related to concerns about body image and self-confidence, but is more commonly related to worries about sexual prowess. Performance anxiety can be a self-perpetuating cycle: you are worried about satisfying your partner > you experience PE > next time, you are more worried about your ability to satisfy your partner. Performance anxiety can also lead to other sexual problems such as erectile dysfunction (ED).

Neurological

Research suggests that there may be neurological reasons for premature ejaculation. Premature ejaculation can be caused by a problem in how signals travel along nerves in the body. The speeds at which these signals travel are called nerve conduction times. Researchers have found that men who experience premature ejaculation often have faster nerve conduction times compared to men who do not experience PE.

Hormonal

Research has shown that there may be hormones such as testosterone and prolactin may be premature ejaculation causes.

• Testosterone
  Testosterone is believed to be important to ejaculation. Men who experience premature ejaculation have been found to have higher testosterone levels than men without PE.

• Prolactin
  In men, prolactin is involved in regulating testosterone and producing sperm cells. Low prolactin levels have been associated with premature ejaculation in one study, but both erectile dysfunction and anxiety were commonly diagnosed in the group who had the lowest prolactin levels. Therefore, it is not yet understood whether prolactin causes PE, or is related to PE via other conditions.

How to know if you have premature ejaculation

There are various ways to diagnose premature ejaculation, but the best way is to see if you have many of the signs of premature ejaculation. If you experience any of the following signs at least 75% of the time when you have sex, you probably have PE:

• Ejaculating within one minute of penetration
• Ejaculating before penetration
• Ejaculating before your partner has had an orgasm
• Anxiety or fear associated with sexual activity

Premature ejaculation may also lead you to experience behavioral changes such as:

• Anxiety and fear associated with sexual activity
• Avoiding sex
• Blaming your partner for being too arousing.

Diagnostic criteria

In the US, premature ejaculation is diagnosed following criteria in the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, Fifth ed.):

1. In almost all (75-100%) sexual activity, the pattern of ejaculation occurs within 1 minute of penetration and before the individual wishes to ejaculate.
2. The symptoms persist for at least 6 months
3. The symptoms cause significant emotional distress to the individual
4. The dysfunction cannot be better explained by a nonsexual mental disorder, a medical condition, the side effects of a drug or medication, or be the result of relationship problems or other significant stressors.

Measuring severity

The severity of premature ejaculation can also be classified:

• Mild: (PE occurs within approximately 30 seconds to 1 minute of penetration)
• Moderate (PE occurs within approximately 15-30 seconds of vaginal penetration)
• Severe (PE occurs before sexual activity, at the start of sexual activity, or within approximately 15 seconds of vaginal penetration)

Other investigations

According to the above DSM-5 criteria, only 1-3% of men would be classified as having premature ejaculation. However, many men will experience similar symptoms, which would not officially come under the diagnosis of premature ejaculation. For example, a man who continuously climaxes between 1 and 2 minutes after penetration and who feels unable to sexually satisfy his partner, or someone who experiences early ejaculation as a consequence of performance anxiety. Even if an individual does not meet the diagnostic criteria, they may still benefit from some premature ejaculation solutions. Therefore, to find the best treatment, a doctor may ask for more information about the following:

• In patients with a lifelong ejaculation problem, other inquiries include:

  • History of prior psychological difficulties
  • Early sexual experiences
  • Family relationships
  • Friend and peer relationships
  • Overall attitude toward sex
  • Social context such as married or not
  • Attitudes towards sexuality and response of the female partner
  • Other nonsexual aspects of the relationship

• Men with acquired premature ejaculation should be evaluated for:

  • Erectile dysfunction
  • Performance anxiety
  • Psychotropic drug use
  • Sexual activities in previous and current relationships
  • Nonsexual event or activities of the current relationship
  • Physical capacity for the sex act
  • Surrounding environment of the sex act
  • Partner’s sexual response

How to stop premature ejaculation?

There are several medical treatments for premature ejaculation. These include prescription creams and pills to stop premature ejaculation and non-medical treatment for premature ejaculation. There are currently no surgical interventions for PE.

It is a good idea to involve your partner in your premature ejaculation treatments. This will help you to communicate about your PE and any related aspects of your relationship.

How to treat premature ejaculation without drugs:

• Relieve performance anxiety. Performance anxiety can create a negative cycle in which you are anxious about satisfying your partner, which contributes to your PE, which contributes to your future anxieties about satisfying your partner. It is important to try to take steps to break the cycle. The roots of performance anxiety can also be related to self-confidence and concerns about body-image. A doctor, sex therapist, counsellor or even just talking to your partner can help you overcome performance anxiety, whatever the cause.

• Stop-start or squeeze-pause technique. These techniques, developed by Masters’ and Johnson can help you to improve control over your ejaculation. If using the squeeze-pause technique, you begin sexual activity as normal, but just before you feel you might ejaculate, you should squeeze the head of the penis, where the head joins the shaft, and pause sexual activity until the urge to ejaculate passes. Similarly, the stop-start technique involves beginning sexual activity as normal, but then stopping as soon as you feel you are about to ejaculate. After you stop, the urge to ejaculate will fade. This can be a great way to improve your control and to build your confidence. You can practice both of these techniques during masturbation too.

• Attempt sex after masturbating or after premature ejaculation. If you have recently orgasmed, you can wait a few minutes and attempt to have sex again. This can improve control of ejaculation and makes it more likely that you will last longer before ejaculating.

Treating premature ejaculation with medication:

• Topical creams: Creams such as EMLA cream contain lidocaine or prilocaine, which are numbing agents that help to desensitize the penis. Reducing sensation can help you to last longer before ejaculation.

• SSRIs: SSRIs (selective serotonin reuptake inhibitors), such as Priligy (Dapoxetine) are more commonly used as antidepressants, however they have also been found useful in the treatment of premature ejaculation. They work by increasing the activity of serotonin - a chemical involved in transmitting signals between nerves, including those related to ejaculation.