Lucas
Premature ejaculation (PE) is a common sexual disorder that affects many men worldwide. It can cause distress and impact both physical and emotional well-being. Fortunately, there are effective treatments and strategies available to address this issue. In this blog post, we will delve into the causes of PE, explore its impact, and provide evidence-based solutions for overcoming it.
Premature ejaculation
Premature ejaculation, one of the most common male sexual dysfunctions in today’s society, affects approximately 30% of adult men aged 18 to 59, with some reports estimating the prevalence as high as 75%. It is worth noting that 30% of men with premature ejaculation also experience erectile dysfunction, where premature ejaculation occurs without a full erection. While premature ejaculation can occur at any age during adulthood, it is most commonly reported among men aged 18 to 30, while erectile dysfunction is more prevalent in the 45 to 65 age group.
However, despite its prevalence, the definition of premature ejaculation remains controversial, lacking a unified standard definition. To address this, the International Society of Sexual Medicine has provided the following criteria for diagnosing premature ejaculation:
- Primary Premature Ejaculation: Occurring from the first sexual encounter, consistently or nearly always before sexual contact, or within 1 minute after sexual contact.
- Secondary Premature Ejaculation: Less than 3 minutes of sexual contact.
- Inability to delay ejaculation despite full or near full penetration.
- Negative impact on mental health, leading to frustration, distress, and worry.
Classification of premature ejaculation
Classification of premature ejaculation further divides the condition into major or minor and global or situational categories:
Primary and Secondary:
– Primary Premature Ejaculation: Present since the first sexual experience, usually caused by conditioning, upbringing, or an early traumatic sexual event.
– Secondary Premature Ejaculation: Develops after a period of relatively normal sexual function.
Specific and Intermittent:
– Specific Premature Ejaculation: Occurs constantly, not limited to a specific type of stimulus, partner, or situation.
– Intermittent Premature Ejaculation: Varies according to partner, stimulus, situation, masturbation, location, or other factors.
Degree:
– Mild Premature Ejaculation: Occurs within about 30 seconds to 1 minute after vaginal penetration.
– Moderate Premature Ejaculation: Occurs within 15 to 30 seconds of vaginal penetration.
– Severe Premature Ejaculation: Occurs before or during foreplay, at the beginning of sexual activity, or within about 15 seconds of vaginal penetration.
Causes of Premature Ejaculation
Premature ejaculation (PE) is a condition that affects countless individuals, impacting both their sexual satisfaction and overall well-being. While the causes of PE can vary from person to person, let’s shed some light on the most common contributing factors:
Psychological Factors
Our thoughts and emotions are significant in our sexual experiences, and PE is often intertwined with psychological factors. Consider the following scenarios:
- Fear of Discovery: When there’s no suitable or private setting for intimate encounters, the constant worry of being caught in the act can lead to heightened anxiety, potentially triggering premature ejaculation.
- Performance Anxiety: Inexperienced individuals or those attempting sexual activities for the first time may feel nervous, and overwhelmed by the pressure to perform, leading to early ejaculation.
- Relationship Disharmony: Troubled relationships can create emotional distress, affecting sexual encounters and potentially contributing to PE.
- Unexpected Interruptions: Imagine being interrupted by an unwanted doorbell or phone call in the middle of the action. Such sudden disruptions can disrupt the sexual flow and inadvertently trigger premature ejaculation.
Medical Conditions
- Inflammatory Diseases: Inflammation in the seminal vesicles (seminal vesiculitis), urethra (urethritis), or prostate gland (prostatitis) can increase sensitivity to inflammatory stimuli, potentially leading to premature ejaculation.
- Hormonal Imbalances: Conditions like hyperthyroidism or diabetes can interfere with the body’s nerve conduction system, impacting ejaculatory control and potentially contributing to PE.
Serotonin and Penile Sensitivity
Getting down to the science of it, serotonin, a vital neurotransmitter in the brain, helps regulate our ejaculatory reflex. Here’s how it comes into play:
- Serotonin and Delayed Ejaculation: Studies have shown that increasing the concentration of serotonin – often referred to as 5-HT – can effectively delay ejaculation, providing more control during sexual activity.
- Excessive Penile Sensitivity: In some cases, hyper-sensitivity of the penis can lower the ejaculation threshold, leading to premature ejaculation.
Diagnosing Premature Ejaculation
Addressing any sexual dysfunction requires a delicate, understanding approach from healthcare professionals. When evaluating patients for premature ejaculation (PE), obtaining a thorough medical history is crucial. However, we understand that discussing intimate details can be uncomfortable. To alleviate this barrier, physicians can ensure a professional and empathetic environment by including open-ended questions about sexual function and satisfaction during routine intake discussions.
To facilitate the diagnostic process, healthcare providers may ask tailored questions to individuals suspected of experiencing premature ejaculation. Some key inquiries may include the following:
Timing of Ejaculation:
- On average, how long does it take to ejaculate after vaginal penetration?
- How often do you experience premature ejaculation: occasionally or almost every time?
Duration and Onset:
- How long have you been experiencing this problem?
- Did it develop gradually over time or start suddenly?
- Did a negative sexual experience precede the onset of premature ejaculation?
Partner Specificity:
- Does premature ejaculation occur with every sexual partner, or is it specific to certain partners?
- Do you experience premature ejaculation during every sexual encounter or only in specific situations?
Sexual Activity and Frequency:
- What sexual activities do you engage in (e.g., masturbation, foreplay, visual cues), and how frequently?
- How has premature ejaculation affected your sexual activity and overall satisfaction?
- Does premature ejaculation also occur during masturbation?
Erectile Function:
- Are you experiencing issues with maintaining an erection—sometimes or all the time?
- Do you typically lose your erection before ejaculating?
- Are orgasms generally normal for you?
Impact on Relationships:
- How are your relationships affected by premature ejaculation?
- How does your partner perceive and feel about this issue?
- Are you and your partner avoiding sexual intimacy due to premature ejaculation?
Previous Remedies and Considerations:
- Have you tried any remedies or treatments for premature ejaculation? If so, what were the outcomes?
- How bothered are you by this issue?
- Would you be open to exploring therapies or treatments to address and improve this problem?
- Are there any specific treatments you’ve heard or read about that you may consider trying?
Triggers and Influencing Factors:
- Have you noticed any factors that worsen or improve your premature ejaculation (e.g., drug or alcohol use)?
By asking these pertinent questions, healthcare providers can gain valuable insights into the individual’s experiences and develop a comprehensive understanding of their premature ejaculation. This understanding paves the way for appropriate treatment strategies tailored to their needs and goals, ultimately leading to improved sexual health.
Effective Treatment for Premature Ejaculation
Premature ejaculation (PE) is a common sexual concern that can significantly impact individuals and their relationships. Fortunately, various treatment options are available, including behavioral techniques, medication, counseling, and other interventions. A combination of treatments is often found to be most effective. Let’s explore these treatment approaches in detail:
Behavioral Therapy
Behavioral techniques aim to increase tolerance and delay ejaculation through training and habituation. Two commonly recommended methods are:
– Stop and Start Technique: Engage in sexual activity until the sensation of ejaculation is imminent, then pause and divert attention to something non-sexual until arousal subsides. Resume sexual activity once the urge subsides. Consistent practice helps train the body to delay ejaculation naturally.
– Squeeze Technique: Similar to the stop and start technique, but just before ejaculation, the glans is gently squeezed to reduce an erection. After a pause to allow arousal to subside, sexual activity can be resumed. Consistent practice can lead to improved control over ejaculation.
Additional behavioral techniques include cognitive distraction, varying sexual positions, adjusting spacing between encounters, increasing frequency, and prolonging foreplay. However, it’s important to note that behavioral therapy alone may not address underlying psychological causes or relationship issues associated with PE. Concurrent treatment of related conditions, such as erectile dysfunction (ED) or hyperthyroidism, is crucial.
Medication
– Antidepressants: Selective serotonin reuptake inhibitors (SSRIs), such as fluoxetine (Prozac), paroxetine (Paxil), and sertraline (Zoloft), can help delay premature ejaculation.
– Topical Anesthetics: Applying numbing creams or sprays containing local anesthetics, like lidocaine, to the penis can help delay ejaculation by reducing sensitivity.
– Erectile Dysfunction Medications: Drugs like sildenafil (Viagra), tadalafil (Cialis), vardenafil (Levitra), and avanafil (Stendra), primarily used for treating ED, have also shown benefits in managing premature ejaculation, especially in individuals with underlying erectile dysfunction.
Psychotherapy
Psychotherapy can be beneficial for addressing underlying psychological factors that contribute to PE, reducing performance anxiety, and improving sexual confidence. It is particularly valuable in cases where subjective premature ejaculation or psychological issues are present. Psychotherapy integrates various approaches, including behavioral, cognitive, systems, and psychodynamic techniques, to help patients regain control over ejaculation and address negative psychological effects and feelings associated with PE.
Exercise and Physical Therapy
Regular exercise, including pelvic muscle exercises and physical therapy, can aid in preventing and managing premature ejaculation. Kegel exercises, specifically designed to strengthen the pelvic floor muscles, have shown promise in improving ejaculatory control.
A tailored treatment plan for premature ejaculation may involve a combination of behavioral therapy, medication, psychotherapy, and exercise. It’s essential to consult with qualified healthcare professionals specialized in sexual medicine or sexual therapy to determine the most suitable treatment options based on individual circumstances and goals. With the right approach, individuals with premature ejaculation can regain control over their sexual experiences, improving satisfaction.
Sources：
[1]Rowland, D. L., & Antonio, J. (2016). Psychological Perspectives on Premature Ejaculation: A Critical Review. Sexual medicine reviews, 4(4), 497-515.
[2]Patrick, D. L., Althof, S. E., Pryor, J. L., Rosen, R. C., Rowland, D. L., Ho, K. F., … & Jamieson, C. (2005). Premature ejaculation: an observational study of men and their partners. The Journal of sexual medicine, 2(3), 358-367.
[3]Waldinger, M. D., & Schweitzer, D. H. (2008). Changing paradigms from a historical DSM-III and DSM-IV view toward an evidence-based definition of premature ejaculation: part I—the validity of DSM-IV-TR. The Journal of sexual medicine, 5(10), 2191-2197.
[4]McMahon, C. G. (2016). Premature ejaculation. Indian Journal of Urology: IJU: journal of the Urological Society of India, 32(2), 103–112.
[5]Althof, S. E., McMahon, C. G., Waldinger, M. D., Serefoglu, E. C., Shindel, A. W., Adaikan, P. G., … & Porst, H. (2014). An update of the International Society of Sexual Medicine’s guidelines for diagnosing and treating premature ejaculation (PE). The Journal of sexual medicine, 11(6), 1392-1422.
[6]Oudiz, A., & Teloken, C. (2017). Erectile Dysfunction and Premature Ejaculation: Interrelationships and Psychosexual Approaches. Sexual medicine reviews, 5(4), 503-509.
