By Dr Joel Enejeta
Premature ejaculation occurs when a man ejaculates sooner during sexual intercourse than he or his partner would like. Premature ejaculation is a common sexual complaint. Estimates vary, but as many as 1 out of 3 men say they experience this problem at some time. As long as it happens infrequently, it’s not cause for concern.
However, you may meet the diagnostic criteria for premature ejaculation if you:
- -Always or nearly always ejaculate within one minute of penetration
- -Are unable to delay ejaculation during intercourse all or nearly all of the time
- -Feel distressed and frustrated, and tend to avoid sexual intimacy as a result
Both psychological and biological factors can play a role in premature ejaculation. Although many men feel embarrassed to talk about it, premature ejaculation is a common and treatable condition. Medications, counseling and sexual techniques that delay ejaculation — or a combination of these — can help improve sex for you and your partner.
Talk with your doctor if you ejaculate sooner than you wish during most sexual encounters. It’s common for men to feel embarrassed about discussing sexual health concerns, but don’t let that keep you from talking to your doctor. Premature ejaculation is a common and treatable problem.
For some men, a conversation with their doctor may help alleviate concerns about premature ejaculation. For example, it may be reassuring to hear that occasional premature ejaculation is normal and that the average time from the beginning of intercourse to ejaculation is about five minutes.
POSSIBLE CAUSES OF PREMATURE EJACULATION
The exact cause of premature ejaculation isn’t known. While it was once thought to be only psychological, doctors now know premature ejaculation is more complicated and involves a complex interaction of 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 an 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 related to other issues.
Relationship problems. If you have had satisfying sexual relationships with other partners in which premature ejaculation happened infrequently or not at all, it’s possible that interpersonal issues between you and your current partner are contributing to the problem.
Biological causes
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
- -Nerve damage from surgery or trauma (rare)
RISK FACTORS THAT CAN LEAD TO DEVELOPMENT OF PREMATURE EJACULATION
Various factors can increase your risk of premature ejaculation, including:
Erectile dysfunction. 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 consciously or unconsciously hurry through sexual encounters.
Health problems. If you have a serious or chronic medical condition, such as heart disease, you may feel anxious during sex and may unknowingly rush 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.
COMPLICATIONS THAT MAY ARISE AS A RESULT OF PREMATURE EJACULATION
While premature ejaculation alone doesn’t increase your risk of health problems, it can cause significant problems in your personal life, including:
Stress and relationship problems. A common complication of premature ejaculation is relationship stress.
Fertility problems. Premature ejaculation can occasionally make fertilization difficult or impossible for couples who are trying to have a baby.
TREATMENTS AND DRUGS THAT CAN BE USED IN MANAGEMENT OF PREMATURE EJACULATION
Common treatment options for premature ejaculation include behavioral techniques, topical anesthetics, oral medications and counseling. Keep in mind that it may take a little time to find the treatment or combination of treatments that will work for you.
Behavioural techniques
In some cases, therapy for premature ejaculation may involve taking simple steps, such as masturbating an hour or two before intercourse so that you’re able to delay ejaculation during sex. Your doctor also may 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 pause-squeeze technique
Your doctor may instruct you and your partner in the use of a method called the pause-squeeze technique. This method works as follows:
Begin sexual activity as usual, including stimulation of the penis, until you feel almost ready to ejaculate.
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.
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.
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 pause-squeeze technique.
Topical anaesthetics
Anaesthetic creams and sprays that contain a numbing agent, such as lidocaine or prilocaine, are sometimes used to treat premature ejaculation. These products are applied to the penis a short time before sex to reduce sensation and thus help delay ejaculation. A lidocaine spray for premature ejaculation (Promescent) is available over-the-counter.
Although topical anaesthetic agents are effective and well-tolerated, they have potential side effects. For example, some men report temporary loss of sensitivity and decreased sexual pleasure. In some cases, female partners also have reported these effects. In rare cases, lidocaine or prilocaine can cause an allergic reaction.
Oral medications
Many medications may delay orgasm. Although none of these drugs is specifically approved by the Food and Drug Administration to treat premature ejaculation, some are used for this purpose, including antidepressants, analgesics and phosphodiesterase-5 inhibitors. These medications may be prescribed for either on-demand or daily use, and may be prescribed alone or in combination with other treatments.
Counselling
This approach, also known as talk therapy, involves talking with a mental health provider about your relationships and experiences. These sessions can help you reduce performance anxiety and find better ways of coping with stress. Counselling is most likely to help when it’s used in combination with drug therapy.