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PREMATURE EJACUALTION

Premature ejaculation is one of the most frequent sexual problems in men and couples, accounting for 40% of the complaints found in sexual therapists’ offices.

Premature ejaculation happens to be commonplace in youth, in meetings with new partners or after a period of abstinence. When it is extended into mature age and becomes present in more than half of sexual meetings, it becomes thus a chronic condition and a sexual disorder.

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:

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

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

  • 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 

1. Some doctors believe that early sexual experiences may establish a pattern that can be difficult to change later in life such as:

2. Situations in which you may have hurried to reach climax in order to avoid being discovered

3. Guilty feelings that increase your tendency to rush through sexual encounters

  • Other factors that can play a role in causing premature ejaculation include:

  • 1. 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.

  • 1. Anxiety. Many men with premature ejaculation also have problems with anxiety — either specifically about sexual performance, or caused by other issues.

  • Biological causes

1. Experts believe a number of biological factors may contribute to premature ejaculation, including:

2. Abnormal hormone levels

3. Abnormal levels of brain chemicals called neurotransmitters

4. Abnormal reflex activity of the ejaculatory system

5 Certain thyroid problems

6. Inflammation and infection of the prostate or urethra

7. Inherited traits

Rarely, premature ejaculation is caused by:

1. Nervous system damage resulting from surgery or trauma

2. 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.
  • Complications

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

  • 1. 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.
  • 2. 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.  
  • 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:

    • 1. How often you have premature ejaculation
    • 2. Whether you have premature ejaculation only with a specific partner or partners
    • 3. Whether you have premature ejaculation every time you have sex
    • 4. How often you have sex
    • 5. How you feel premature ejaculation affects your enjoyment of sex and your quality of life
    • 6. Whether you also have trouble getting and maintaining an erection (erectile dysfunction)
    • 7. 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:

    • 1. Your religious upbringing
    • 2. Your early sexual experiences
    • 3. Your sexual relationships, past and present
    • 4. 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.

    What’s a normal ejaculation?
  • From the perspective of physical functioning , ejaculation takes place in two stages. In the first stage occurs the expulsion of the seminal fluid (semen) from accessory reproductive organs - prostate, seminal bladder, and ejaculatory canal – into the urethra. At the second stage, there’s a progression of this fluid throughout the extension of the urethra to the urethral meatus, which is the orifice in the glans through which also the urine exits. This physiological process is accompanied by a subjective sensation of deep pleasure known as orgasm.

    How do I know if I suffer from premature ejaculation?

    There’s no specific time prior to ejaculation for defining it as a sexual problem. The problem is defined by your and your partner’s perception that the ejaculation was faster than expected and that it wasn’t controlled. Sometimes the penis doesn’t even get around becoming erected, and the movement of approaching and the touch of the sheets are enough to put an end to what could be a pleasant moment. At times, the man maintains the erection for a few minutes, begins the penetration, but ejaculates shortly after, becoming frustrated and letting his partner down. Feelings of guilt and anxiety become constant. Greater difficulties may arise subsequently, such as erection dysfunction (impotence) and loss of intimacy for the couple.

    Why does premature ejaculation occur?
  • Darwin followers (English evolutionist that proposed the natural selection theory – 1859) explain that premature ejaculation was an old defense method against predators.

    Imagine the early days of mankind, where hundreds of dangers existed, the human animal being too fragile and small in face of the risks from their environment.

    Those individuals that took too long to ejaculate into their partners would be more vulnerable to aggressions from enemies and wild beasts.

    The premature ejaculator had more advantages in being done with insemination quickly and running away immediately, also allowing the female to escape, in order to inseminate the largest number of females within a shorter time. Thereby the probability of spreading his genes around would be elevated.

    Other reasons assumed as causes of premature ejaculation are:

    • 1. Abnormal increase in the sensitivity of the glens,
    • 2. Sexual inexperience,
    • 3. First experience with partner that stimulates a fast intercourse, 4. Guilt or negative feelings towards the partner.

    Seldom is there a medical condition accounting for premature ejaculation, such as acute prostatitis or multiple sclerosis. As a matter of fact, there isn’t only one scientifically proven cause for premature ejaculation.

    Does it have a cure?

 

Treatment exists, both with drugs and psychotherapy. The first line of treatment is reorientation and reeducation of the man or couple for a normal sexual function. Situations in which the shorter or unsatisfactory ejaculation time is considered to be normal are elucidated (common in the young, sex with new partners, or following a long abstinence). When premature ejaculation becomes steady, that is, occurs in more than half of sexual meetings, a more specific treatment is made necessary.

The second line of therapy is the so-called cognitive behavioral treatment. A set of exercises and tasks should be performed at home for control of the ejaculation time. Below are some merely illustrative examples:

Distraction Technique

During the sexual relation, the man is told to set his mind on some situation that deviates him from sex, as somebody’s death, a partner that isn’t of his liking, or bills to pay. As soon as he perceives that he’s losing the erection, he focuses on the partner again. He should use this distraction method a few times so that he can extend the penetration time prior to ejaculation.

Squeeze technique

 

The man must compress the glans base for 4-5 seconds immediately after the first sensation of arousal. With this procedure he’s going to make it harder for the blood to enter the penis, delaying ejaculation a little.

Stop-start technique

It consists of instructing the man to stay in a position above his partner in order to have control over the sexual motion. He must start the penetration and stop the movements altogether near the moment of greatest arousal. He can use the diversion technique concomitantly.

The goal of these tasks is to get the man to be aware of the moment preceding the first stage of ejaculation, becoming able to voluntarily control his ejaculation and avoiding frustration for his partner and himself.

A third line of treatment can be combined with these exercises: drugs. There’s a wide range of medications that have as side effect a delay in ejaculation time. Such drugs must be administered only with judicious medical prescription, as they present many other effects on the organism.

Some of them (e.g. tricyclic antidepressants) are contraindicated for people with heart rhythm problems. Some topical medications (ointments) based on herbs or anesthetics haven’t been proven to be effective for premature ejaculation treatment.

Anyway, this sexual dysfunction has a good prognosis, that is, shows good cure rates for most individuals that seek specialized advice. Usually, 6 to 10 sessions suffice to improve a man’s and couple’s sex life.

Treatment

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