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Premature Ejaculation

Overview

Premature ejaculation affects about one in five men ages 18 to 59. Although the problem is often assumed to be psychological, biology also may play a role. Premature ejaculation is characterized by a lack of voluntary control over ejaculation. Many men occasionally ejaculate sooner than they or their partner would like during sexual activities. Premature ejaculation is a frustrating problem that can reduce the enjoyment of sex, harm relationships and negatively affect quality of life. Occasional instances might not be cause for concern but, when the problem occurs frequently and causes distress to the man or his partner, treatment may be necessary.

Education/General Information

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. 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 temporary depression, anxiety, guilt, stress, unrealistic expectations about performance, a history of sexual repression or an overall lack of confidence can cause premature ejaculation. Interpersonal dynamics may contribute to sexual function. Premature ejaculation can be caused by a lack of communication between partners, hurt feelings or unresolved conflicts that interfere with the ability to achieve emotional intimacy. Premature ejaculation can also be related to underlying medical causes such as hormonal problems, injury or a side effect of certain medicines.

Research also suggests that serotonin, a natural substance produced by nerves, is important in the ejaculation process. A breakdown of the actions of serotonin in the brain may be a cause of premature ejaculation. Studies have found that high amounts of serotonin in the brain slow the time to ejaculation, while low amounts of serotonin can produce a condition like premature ejaculation.

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

Diagnosis

When premature ejaculation happens so often that it interferes with your sexual pleasure, it is time to see the doctor. Your urologist will ask you questions about your sexual history, such as:

  • How often does the premature ejaculation occur?
  • How long have you had this problem?
  • Is the problem specific to one partner? Or does it happen with every partner?
  • Does it occur with all or just some attempts at sexual relations?
  • How much stimulation results in premature ejaculation?
  • What type of sexual activity do you engage in and how often?
  • How has premature ejaculation affected sexual activity?
  • What is the quality of your personal relationships?
  • How does it affect your quality of life?
  • Are there any factors that make premature ejaculation worse or better, such as drugs or alcohol?

Your doctor may also want to speak with your sexual partner, if you are in a monogamous relationship. Typically, further testing is not performed unless the doctor suspects that a more complicated issue is involved or finds something during a physical exam.

Treatment

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

Psychological therapy, behavioral therapy and medications are treatment options for recurring premature ejaculation.

  • Psychological therapy addresses anxiety and other feelings a man may have about sexuality and sexual relationships.
  • Behavioral therapy makes use of exercises to help a man develop tolerance to stimulation and, as a result, delay ejaculation.
  • Medical therapy includes medications that are commonly used to treat depression, such as selective serotonin reuptake inhibitors (SSRIs). A side effect of SSRIs is inhibited orgasm, which helps delay ejaculation. The use of SSRIs for the treatment of premature ejaculation is not related to depression and is considered an “off-label” use. In addition, topical anesthetic creams may be used to lessen sensitivity.
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