Premature ejaculation (PE) is a form of sexual dysfunction that can adversely affect the quality of a man’s sex life. PE (male sexual dysfunction) might occasionally complicate reproduction, but it can also adversely affect sexual satisfaction, both for men and their partners.
What is a premature ejaculation?
Premature ejaculation is a form of male sexual dysfunction and means having an orgasm or “climaxing” sooner than wanted.
Medically, the most persistent form of Premature ejaculation (primary or lifelong PE) is defined by the presence of the following three problems:
- Ejaculation always, or nearly always, happening before sexual penetration has been achieved, or within about a minute of penetration.
- The man finding an inability to delay his ejaculation every time, or nearly every time, he does achieve penetration.
- Negative personal consequences, such as distress and frustration, or avoidance of sexual intimacy.
Premature ejaculation can cause a lot of embarrassment in boys and men, with a significant degree of stigma often attached to male sexual performance.
How many men experience premature ejaculation?
Information obtained through surveys puts the “self-reported” prevalence of PE in men as somewhere between 15 percent and 30 percent. However, the prevalence of medically diagnosed and diagnosable PE is much lower. This statistical disparity does not in any way diminish the suffering experienced by men who do not meet the strict criteria for diagnosis.
In one analysis of nearly 5,000 men in nine Asia-Pacific countries, 16 percent of men met the criteria for a diagnosis of PE on the five-question Premature Ejaculation Diagnostic Tool (PEDT). Probable PE was found in 15 percent of respondents, while 13 percent of men self-reported PE.
Primary or lifelong PE is the most persistent problem in men and describes a condition where men have rarely experienced sex without prematurely ejaculating. This is the least common form of the condition and is thought to affect around 2 percent of men.
However, more loosely defined, PE remains the most common form of male sexual dysfunction.
Symptoms of premature ejaculation
Put simply; premature ejaculation involves a man ejaculating sooner than he and his partner desire.
Psychological symptoms are secondary to the physical ejaculatory events and can be experienced by the man, his partner, or both.
Secondary symptoms caused by premature ejaculation include:
- decreased confidence in the relationship
- interpersonal difficulty
- mental distress
Causes of premature ejaculation
Most cases of PE(male sexual dysfunction) are not related to any disease and are instead due to psychological factors, including:
- sexual inexperience
- issues with body image
- the novelty of a relationship
- overexcitement or too much stimulation
- relationship stress
- feelings of guilt or inadequacy
- issues related to control and intimacy
These common psychological factors can affect men who have previously had normal ejaculation; such cases are often referred to as secondary, or acquired, PE.
Most cases of the rarer, more persistent form – primary or lifelong PE – are also believed to be caused by psychological problems.
The causes of primary or lifelong PE can often be traced back to early trauma, such as:
- strict sexual teaching and upbringing
- traumatic experiences of sex
- conditioning – for example, a teenager learning to ejaculate quickly to avoid being found masturbating
Medical causes of premature ejaculation
Biological causes of PE are much less common than psychological ones. In rare cases, the cause can be more serious. The following are possible medical causes of PE:
- multiple sclerosis
- prostate disease
- thyroid problems
- illicit drug use
- excessive alcohol consumption
Diagnosis of premature ejaculation
The manual used by psychiatrists and psychologists for making a clinical diagnosis (known as the DSM-V) defines PE as a sexual disorder only when the following description is true:
“Ejaculation with minimal sexual stimulation before or shortly after penetration and before the person wishes it. The condition is persistent or occurs frequently and causes significant distress.”
A doctor will ask certain questions that are intended to help them assess symptoms, such as asking for an estimate of the time taken before ejaculation occurs (known as latency). Questions might include:
- How often do you experience PE?
- How long have you had this problem?
- Does it happen in every sexual encounter, or only at certain times?
- How much stimulation brings on an ejaculation?
- How has PE affected your sexual activity?
- Can you delay your ejaculation until after penetration?
- Do you or your partner feel annoyed or frustrated?
- How does PE affect your quality of life?
Treatments for premature ejaculation
The majority of cases have a psychological cause and a good prognosis. If the problem occurs at the beginning of a new sexual partnership, the difficulties often resolve as the relationship goes on.
If, however, the problem is more persistent, doctors may recommend treatment in the form of counseling from a therapist specializing in sexual relationships, or “couples therapy.”
Pills to treat premature ejaculation (male sexual dysfunction)
Doctors will not prescribe any medicines before taking a detailed sexual history to reach a clear diagnosis of PE.
Drug treatments can have unwanted side effects and these should be discussed prior to patients taking any medications.
While some doctors recommend dapoxetine, in some acquired (psychological) cases of PE as well as “lifelong” ones, the official license restricts its use to a man who meets all of these criteria:
- Has vaginal sex for less than two minutes before ejaculating.
- Persistently or recurrently ejaculates after very little sexual stimulation and before, during, or shortly after initial penetration, and before he wishes to climax.
- Has marked personal distress or interpersonal difficulty because of the PE.
- Has poor control over ejaculation.
- Describes a sexual history of prematurely ejaculating during most attempts at sexual intercourse in the past 6 months.
Side-effects from dapoxetine can include nausea, diarrhea, dizziness, and headache.
Topical drugs applied to the penis to treat premature ejaculation
Another option for men with PE is a topical therapy – applied to the penis before sex, with or without a condom. These local anesthetic creams reduce stimulation.
Notable examples include lidocaine or prilocaine, which can improve the amount of time before ejaculation. However, longer use of anesthetics can result in numbness and loss of erection. The reduced sensation created by the creams may not be acceptable to the man, and the numbness can affect the woman, too.
Home remedies to improve ejaculation timing
Here are three methods that could be helpful for men:
The start-and-stop method
aims to improve a man’s control over ejaculation. This is by far the most simple technique and can be done alone or with a partner. The technique involves stimulating the penis and stopping just before you feel you are about to ejaculate. Stop the stimulation for 30-60 seconds and start again once you feel that you have regained control.
The squeeze method for male sexual dysfunction
similar to above but the man gently squeezes the end of his penis – or his partner does this for him – for the duration of the 30-second pause before restarting stimulation.
Stimulation then resumes after this feeling has subsided. A man tries to achieve this three or four times, and up to several times, before allowing himself to ejaculate. It is essential to practice, and if there is a persistent problem with PE, it may be worth talking to a doctor.
Kegel exercises for men
Kegel exercises for men can help improve bladder control and possibly improve sexual performance. Here’s a guide to doing Kegel exercises correctly.
How to do Kegel exercises for men
To get started:
- Find the right muscles.To identify your pelvic floor muscles, stop urination in midstream or tighten the muscles that keep you from passing gas. These maneuvers use your pelvic floor muscles. Once you’ve identified your pelvic floor muscles, you can do the exercises in any position, although you might find it easiest to do them lying down at first.
- Perfect your technique.Tighten your pelvic floor muscles, hold the contraction for three seconds, and then relax for three seconds. Try it a few times in a row. When your muscles get stronger, try doing Kegel exercises while sitting, standing or walking.
- Maintain your focus.For best results, focus on tightening only your pelvic floor muscles. Be careful not to flex the muscles in your abdomen, thighs or buttocks. Avoid holding your breath. Instead, breathe freely during the exercises.
- Repeat 3 times a day.Aim for at least three sets of 10 repetitions a day.
Don’t make a habit of using Kegel exercises to start and stop your urine stream. Some doctors think this could cause a bladder infection.