Premature ejaculation (PE) is one of the most widespread issues in male sexual dysfunction and an estimated 1 in 3 men will experience PE at some time in their life, despite being common, it is probably the least understood and most stigmatized. In this article we will discuss what premature ejaculation is, what causes premature ejaculation, and when it is appropriate to seek help and treatments, to help both individuals and couples manage this situation confidently.
Overview
What is Premature Ejaculation?
Premature ejaculation is most frequently distinguished as ejaculation that occurs more rapidly than either the man or partner wishes, during sexual activity. And while this generally can be defined as occurring sooner then would be preferred, it is not strictly a definition that is solely temporal – as in climaxing in 30 seconds, or 2 minutes, or even 5 minutes. Rather it would be best defined with respect to evaluation of satisfaction and control.
For example, if a man climaxes 30 seconds into intercourse and both partners would have rated their satisfaction with the experience equally high, neither partner might consider this premature ejaculation (PE). Conversely, if intercourse lasts for 30 minutes and either the individual or partner evaluated their satisfaction independently as still remote from optimal, this might be considered an example of PE. Therefore, the important consideration is the extent to which the timing of the ejaculation creates distress or dissatisfaction.
In cases where the distressing experience of early ejaculation happens infrequently, or only a couple times, the event may be more accurately defined as rapid ejaculation; however, when it happens more than occasionally and is beginning to cause impairment to sexual relationships and enjoyment, it would be likely to be diagnosed as PE.
Is Premature Ejaculation a Type of Sexual Dysfunction?
Yes, premature ejaculation is considered a form of male sexual dysfunction. It may occur by itself or along with other problems like erectile dysfunction (ED). In fact, when both ED and premature ejaculation occur at the same time, healthcare providers sometimes tend to treat the ED first. Generally speaking, treating the ED results in better erectile function and some degree of improvement, or complete resolution, of the premature ejaculation issues.
Causes and Impact
What Causes Premature Ejaculation?
Regardless of the fact that researchers do not fully know all the mechanisms surrounding PE, the range of neurotransmitter serotonin appears to be a primary driver. Serotonin controls mood and sexual function. Elevated levels may delay ejaculation, while low levels may contribute to premature climax.
Potential other causes of premature ejaculation consist of:
- Psychological factors: stress, anxiety, depression, guilt, or unreasonable expectations surrounding sex.
- Relationship issues: Poor communication, pressure to perform or unresolved issues.
- Low self-esteem: Lack of confidence in sexual performance can create a psychological feedback loop that exacerbates the issue.
- Repressed sexual identity or the effect of past trauma may also be factors.
Note: Identifying the underlying cause is critical in order to devise effective treatment
When to Get Help
While an occasional premature ejaculation is not abnormal or concerning, when these events start to repeatedly create stress, lessen sexual satisfaction, or create issues with your relationship, it’s time to speak to a medical professional.
If you aren’t sure whether to seek help, you can ask yourself:
Will this often happen?
Is it really affecting your self-confidence or your relationship?
Note: If you answered yes to any of these questions, getting advice proactively is a valuable next step.
Treatment
How to Treat Premature Ejaculation?
The good news is that there are a variety of treatment options available, and many men find that their condition improves considerably when a suitable combination of treatment options are tailored for them, including:
1. Behavioral Techniques
The squeeze method and start-stop technique are two of the techniques used in behavioral therapy that have been shown to be effective in treating premature ejaculation (PE):
- The Squeeze Method: This technique includes stimulating the penis until the point of nearly ejaculating, and just before ejaculation, the pressure – typically to the head of the penis – is applied until the urge to ejaculate passes. This method can be repeated several times throughout the sexual encounter to learn to develop control.
- The “Start-Stop” Method: In this method of treatment, pressure or stimulation is stopped just as you are about to ejeculate. Once the sensation has subsided or decreased, stimulation can start again. Doing this repeatedly will help improve your awareness and ability to control ejaculation.
Note: Both methods can be used alone or with a partner and will work best if both partners are involved in the process and communicating freely.
2. Therapy and Counseling
Individual Therapy: Talking about the anxiety, or guilt, or other emotional blocks that are related to developing PE, can provide helpful awareness and help manage these concerns.
Couples Therapy: When PE is negatively impacting a relationship, a couple’s counselor may be able to help both partners gain insight into the dynamics around the PE and how their relationship can use planning and problem-solving to assist in rebuilding intimacy.
Sex Therapy: A more specialized form of counseling, sex therapy will typically focus on the sexual concerns, and will almost always result in evidence-based exercises or strategies for communication.
3. Medication Options
There are a few medications that have been proven to help treat the condition of quick ejaculation.
- Topical Anesthetics: Numbing creams and sprays work by decreasing sensations. There are some condoms that are numbed or numbing agents. Numbing creams or sprays are generally applied 15-30 minutes prior to sex and washed off before intercourse so that the partner can’t become numbed as well.
- Selective serotonin reuptake inhibitors (SSRIs): SSRIs were developed as antidepressant medications, but slow ejaculation by increasing serotonin levels. You can either take SSRIs daily or use them as needed (2-6 hours prior to sex). If the first medication doesn’t work, a different SSRI might work better.
Note: It is important to work with a medical provider before starting any medication so you find the medication option that best meets your needs and is safe.
Communication is Important
If you experience premature ejaculation, it may affect not just your physical health, but your emotional connection with your partner. The most important aspect of tackling your treatment is communicating with your partner. As you work through your treatment and recovery, openness and understanding can provide critical support and reduce anxiety. Patience, compassion, and teamwork are paramount.
Couples with open lines of communication about their experiences and problems will generally have more effective results with all of the behavioral techniques and therapy. Avoid placing blame on yourself or your partner and consider focusing on solutions instead. Open communication and support help to build your relationship, and minimize performance anxiety.
In conclusion
Premature ejaculation occurs more frequently than most people realize, and is not something to be ashamed of. With the right course of treatment, either through behavioral techniques, therapy, pharmacotherapy, or a combination of the both, the vast majority of men will experience significant benefits. The first step is recognizing the issue and seeking help or guidance if premature ejaculation becomes egregious or causes distress.
You are not alone, and there is very effective support available for you. You and your partner can work together, communicate openly about your treatment and emotions, seek professional input as guided, and choose the treatment approach that feels the best to you expressed as a couple.
