Premature Ejaculation

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.

Impotence starts when a man is incapable of providing the blood flow necessary to generate an erection. And premature ejaculation is caused when a man is incapable of lasting and ejaculating earlier than intended.

What causes premature ejaculation ?

Most cases of premature ejaculation do not have a clear cause. With sexual experience and age, men often learn to delay orgasm. Premature ejaculation may occur with a new partner, only in certain sexual situations, or if it has been a long time since the last ejaculation. Psychological factors such as anxiety, guilt, or depression can cause premature ejaculation. In some cases, premature ejaculation may be related to an underlying medical cause such as hormonal problems, injury, or a side effect of certain medicines.

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 health professional will discuss your medical and sexual history with you and conduct a thorough physical examination. Your doctor may want to talk to your partner as well. Because premature ejaculation can have many causes, your health professional may order laboratory tests to rule out any underlying medical problem.

Treatments and Drugs

Treatment options for premature ejaculation include sexual therapy, medications and psychotherapy. For many men, a combination of these treatments works best.

Sexual therapy

In some cases, sexual therapy may involve simple steps such as masturbating an hour or two before intercourse so that you're able to delay ejaculation during sex. Your doctor may also recommend avoiding intercourse for a period of time and focusing on other types of sexual play so that pressure is removed from your sexual encounters.

The squeeze technique

Your doctor may instruct you and your partner in the use of a method called the squeeze technique. This method works as follows : Step 1. Begin sexual activity as usual, including stimulation of the penis, until you feel almost ready to ejaculate. Step 2. Have your partner squeeze the end of your penis, at the point where the head (glans) joins the shaft, and maintain the squeeze for several seconds, until the urge to ejaculate passes. Step 3. After the squeeze is released, wait for about 30 seconds, then go back to foreplay. You may notice that squeezing the penis causes it to become less erect, but when sexual stimulation is resumed, it soon regains full erection. Step 4. If you again feel you're about to ejaculate, have your partner repeat the squeeze process. By repeating this as many times as necessary, you can reach the point of entering your partner without ejaculating. After a few practice sessions, the feeling of knowing how to delay ejaculation may become a habit that no longer requires the squeeze technique.

Medications

Certain antidepressants and topical anesthetic creams are used to treat premature ejaculation. Although none of these drugs are specifically approved by the Food and Drug Administration to treat premature ejaculation, some treatment guidelines recommend their use for this purpose. You may need to try different medications or doses before you and your doctor find a treatment that works for you.

Antidepressants

A side effect of certain antidepressants is delayed orgasm. Doctors suggest men who have premature ejaculation can take antidepressants to benefit from this specific side effect. Your doctor may prescribe one of several selective serotonin reuptake inhibitors (SSRIs) such as sertraline (Zoloft), paroxetine (Paxil) or fluoxetine (Prozac) to help delay ejaculation. If the timing of your ejaculation doesn't improve, your doctor may prescribe the tricyclic antidepressant clomipramine (Anafranil), which also has been shown to benefit men with this disorder. You may not need to take these medications every day to prevent premature ejaculation. Taking a low dose several hours before you plan to have sexual intercourse may be enough to improve your symptoms. Other side effects of these antidepressants can include nausea, dry mouth, drowsiness and decreased libido.

Topical anesthetic creams
Topical anesthetic creams containing lidocaine or prilocaine dull the sensation on the penis to help delay ejaculation. Applied a short time before intercourse, these creams are wiped off when your penis has lost enough sensation to help you delay ejaculation.
Some men using topical anesthetic creams report reduced sexual pleasure because of lessened sensitivity. Although the cream is wiped off before intercourse, in some studies female partners reported that it also reduced their genital sensitivity and sexual pleasure. In rare cases lidocaine or prilocaine can cause an allergic reaction.

Psychotherapy
This approach, also known as counseling or talk therapy, involves talking about your relationships and experiences with a mental health professional. These talk sessions can help you reduce performance anxiety or find effective ways of coping with stress and solving problems. For many couples affected by premature ejaculation, talking with a therapist together may produce the best results.

Prevention

In some cases, premature ejaculation may be caused by poor communication between partners or a lack of understanding of the differences between male and female sexual functioning. Women typically require more prolonged stimulation than men do to reach orgasm, and this difference can cause sexual resentment between partners and add pressure to sexual encounters. For many men, feeling pressure during sexual intercourse increases the risk of premature ejaculation.

Open communication between sexual partners, as well as a willingness to try a variety of approaches to help both partners achieve satisfaction, can help reduce conflict and performance anxiety. If you're not satisfied with your sexual relationship, talk with your partner about your concerns. Try to approach the topic in a loving way and to avoid blaming your partner for your dissatisfaction.

If you're not able to resolve sexual problems on your own, talk with your doctor. He or she may recommend seeing a therapist who can help you and your partner achieve a fulfilling sexual relationship.