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Premature Ejaculation

Important Facts

  • In premature ejaculation, a man ejaculates quickly after sexual arousal

  • Premature ejaculation, or rapid ejaculation, is a common type of sexual dysfunction

  • Causes for this condition usually are unknown, but it often is related to anxiety

  • Premature ejaculation that prevents sexual intercourse results in infertility

Premature ejaculation (PE) is a term used to describe a condition in which a man regularly ejects semen (i.e., ejaculates) very soon after the onset of sexual arousal, or sooner than he or his partner wishes. This condition, which is also called rapid ejaculation, is the most common type of sexual dysfunction in men under the age of 40.

Premature ejaculation can be primary (in men who have had the condition since puberty), or secondary (acquired; in men who previously had control of ejaculation). It may develop in men who have erectile dysfunction (impotence) and are anxious about maintaining an erection during sexual intercourse.

Premature ejaculation often causes distress for the man and for his partner. When the condition regularly occurs before penetration, it may prevent pregnancy.

Definition

Many men occasionally ejaculate sooner during sexual intercourse than they or their partner would like. As long as it happens infrequently, it's probably not cause for concern. However, if you regularly ejaculate sooner than you and your partner wish � such as before intercourse begins or shortly afterward � you may have a condition known as premature ejaculation.

Premature ejaculation is a common sexual disorder. Estimates vary, but some experts think it affects as many as one out of three men. Even though it's a common problem that can be treated, many men feel embarrassed to talk to their doctors about it or seek treatment.

Once thought to be purely psychological, experts now know that biological factors also play an important role in premature ejaculation. In some men, premature ejaculation is related to erectile dysfunction. 

You don't have to live with premature ejaculation � treatments including medications, psychological counseling and learning sexual techniques to delay ejaculation can improve sex for you and your partner. For many men, a combination of treatments works best.

Symptoms

There's no medical standard for how long it should take a man to ejaculate. The primary sign of premature ejaculation is ejaculation that occurs before both partners wish in the majority of sexual encounters, causing concern or distress. The problem may occur in all sexual situations, including during masturbation � or it may only occur during sexual encounters with another person.

Doctors often classify premature ejaculation as either primary or secondary:

  • You have primary premature ejaculation if you've had the problem for as long as you've been sexually active.

  • You have secondary premature ejaculation if you developed the condition after having had previous, satisfying sexual relationships without ejaculatory problems.

Incidence and Prevalence

Premature ejaculation affects males only and can occur at any age of adulthood. The condition is most common between the ages of 18 and 30. It is estimated that premature ejaculation affects from 30�70% of men during their lifetime.

The cause for premature ejaculation is unknown, although, in most cases, it is thought to be the result of psychological factors (e.g., anxiety, guilt). Rarely, the condition is caused by a physical problem, such as over sensitivity of the genitals or abnormal hormone (e.g., testosterone) levels. Certain medications (e.g., psychiatric drugs) may cause premature ejaculation.

Risk factors for the condition include erectile dysfunction (impotence), stress, and health conditions that cause anxiety during sex (e.g., angina, previous heart attack).

Causes

Experts are still trying to determine exactly what causes premature ejaculation. While it was once thought to be only psychological, we now know premature ejaculation is more complicated and involves a complex interaction of both 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 their 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 caused by other issues.

Biological Causes

Experts believe 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

Rarely, premature ejaculation is caused by:

  • Nervous system damage resulting from surgery or trauma

  • Withdrawal from narcotics or a drug called trifluoperazine (Stelazine), used to treat anxiety and other mental health problems

Although both biological and psychological factors likely play a role in most cases of premature ejaculation, experts think a primarily biological cause is more likely if it has been a lifelong problem (primary premature ejaculation).

Risk Factors

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

  • Impotence. 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 rush through sexual encounters. As many as one in three men with premature ejaculation also have trouble maintaining an erection.

  • Health problems. If you have a medical concern that causes you to feel anxious during sex, such as a heart problem, you may have an increased likelihood of hurrying 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.

  • Certain medications. Rarely, drugs that influence the action of chemical messengers in the brain (psychotropics) may cause premature ejaculation.

Tests and Diagnosis

Doctors diagnose premature ejaculation based on a detailed interview about your sexual history. Your doctor may ask a number of very personal questions and may want to include your partner in the interview. While it may be uncomfortable for both of you to talk frankly about sex, the details you provide will help your doctor determine the cause of your problem and the best course of treatment. A mental health professional may help make the diagnosis.

Your doctor will want to know about your health history, and may perform a general physical exam. You doctor may ask you questions about:

  • How often you have premature ejaculation

  • Whether you have premature ejaculation only with a specific partner or partners

  • Whether you have premature ejaculation every time you have sex

  • How often you have sex

  • How you feel premature ejaculation affects your enjoyment of sex and your quality of life

  • Whether you also have trouble getting and maintaining an erection (erectile dysfunction)

  • Your use of prescription medications and recreational drugs

To evaluate whether psychological factors may influence your premature ejaculation, your doctor or mental health professional may also want to know about:

  • Your religious upbringing

  • Your early sexual experiences

  • Your sexual relationships, past and present

  • Any conflicts or concerns within your current relationship

If you have both premature ejaculation and trouble getting or maintaining an erection, your doctor may order blood tests to check your male hormone (testosterone) levels or other tests.

Complications

While premature ejaculation doesn't increase your risk of serious health problems, it can cause distress in your personal life, including:

  • Relationship strains. The most common complication of premature ejaculation is relationship stress. If premature ejaculation is straining your relationship, ask your doctor about including couple's therapy in your treatment program.

  • Fertility problems. Premature ejaculation can occasionally make fertilization difficult or impossible for couples who are trying to become pregnant. If premature ejaculation isn't effectively treated, you and your partner may need to consider infertility treatment.

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

To Learn Ejaculatory Control

  • Don't use drugs or alcohol. They're distracting and they interfere with the self-awareness crucial to learning ejaculatory control.

  • Appreciate whole-body sensuality. Men often think sex happens only in the penis and only during intercourse. That view is a one-way ticket to premature ejaculation (not to mention erection problems, and women with those proverbial headaches). The best sex involves head-to-toe arousal. Men learning how to approach -- but not arrive at -- their point of no return, need to appreciate whole-body sensuality, the pleasure potential in every square inch of the body. Whole-body sensuality releases tension. Tense bodies that have no other outlet often find release through involuntary ejaculation. But as you learn to appreciate sensual pleasure from head to toe, whole-body arousal takes the pressure off your penis, and you last longer.

  • Whole-body sensuality means relaxation, but the "relaxation" involved in great sex is not the kind that includes an easy chair, a six pack, and Monday Night Football. It's the kind you feel after a hot bath or a good massage. In fact, bathing or showering together before lovemaking can help men relax and appreciate whole-body sensuality -- and last longer.

  • Breathe deeply. One very easy way to stay relaxed while making love is to breathe deeply. The body has a natural tendency to breathe deeply during sex. But many men fight it. They think they should stay in control by not breathing deeply and making the little love-moan sounds that go along with it. But when men work to control their breathing, they often sacrifice ejaculatory control. Try breathing deeply. Let your breath go. Many men are amazed how much this one little change improves their premature ejaculation.

  • Start with masturbation with a dry hand. By varying how you caress your penis, you can learn to stay highly aroused for quite a while without coming. When you feel yourself approaching your point of no return, simply back off a bit, stroke yourself more gently or not at all, and stay aroused without ejaculating. Then as you feel yourself getting a little distance from your point of no return, return to more vigorous self-stimulation. Repeat this several times over several sessions. Approach your point of no return, then back off. For most men, it doesn't take long to develop good ejaculatory control while alone.

  • Then move on to masturbation with a lubricated hand. Use saliva, vegetable oil, or a commercial sexual lubricant. For most people, lubricants increase the sensual intensity of erotic fondling. Follow the same program: Masturbate until you approach your point of no return, then back off. Repeat this several times over several sessions.

  • Once you have good control during masturbation, and appreciate whole-body sensuality, and feel comfortable breathing deeply during lovemaking, then you're ready for the couples program -- if you're in a couple. The couple approach is called the "Stop-Start Technique." First, arrange "stop" and "start" signals with your lover, for example, a light pinch or tap, or a tug on an ear.

  • Then, your lover strokes your penis by hand as you lie still. When you approach your point of no return, give the "stop" signal. Your lover immediately stops stroking you and simply holds your penis gently, as you continue to breathe deeply and pays close attention to the sensations you're feeling. When you no longer feels close to ejaculation, gives the "start" signal, and your lover begins stroking you again. How many stops and starts should you do? A half-dozen over a 15-minute period works well for most couples. Do what feels comfortable for you.

  • With stop-start, the focus is on the man. He's the one learning the new skill. But don't forget the woman's sensual needs. As part of each practice session, she might guide your hand over her to show you what she likes.

  • Once you've gained good ejaculatory control with your lover's hand, try the same stop-start procedure with oral caresses. Again, you begin by lying still.

  • Once you've gained good control orally, feel free to start moving. You're making love again -- but now you have ejaculatory control. Congratulations.

Here are some other suggestions for lasting longer:

  • The man-on-top (missionary) position can be fun, but it's harder for most men to control their ejaculatory timing, because they have to hold themselves up. Try making love with the woman on top. This position is more relaxing for men, and it often helps ejaculatory control.

  • Make some noise. Love moans help men (and women) relax, and they often help men last longer.

  • It's important to understand that learning ejaculatory control takes time and practice. You may feel a little awkward along the way. Try to maintain a sense of humor about any accidental spills.

  • Some penile skin creams advertise that they help a man last longer. These products contain topical anesthetics that dull sensation in the penis. If you like to play with penile sensation, there's no harm in using them. But they're not a good idea for learning to last longer. They dull sensation. But the key to lasting longer is for the man to become more familiar with what he feels so he can back off from his point of no return while still remaining highly aroused.

  • Finally, the program we recommend for learning ejaculatory control is very likely to provide your lover with greater sexual enjoyment -- but not just because you last longer. Women generally prefer leisurely, playful, whole-body, massage-oriented sensuality that includes the genitals but is not limited to them. Women's main complaints about men's sexual style are that it's too rushed, too mechanical, too eager for intercourse, and that it focuses only on the breasts and genitals. Women generally feel that the whole body is a sensual playground and can't understand why so many men explore only a few corners of it. Like women, penises generally prefer leisurely, playful, whole-body, massage-oriented lovemaking. The rushed, penis-centered, intercourse-fixated sex style puts a lot of pressure on the penis, and leads to premature ejaculation. But when men make love the way women prefer, whole-body arousal takes the pressure off your penis and you last longer. Basically, if men would make love the way women prefer, women would have fewer complaints, and men would have fewer sex problems.

Treatment

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