Premature Ejaculation

Premature ejaculation is a very common sexual disorder that affects about 30% of the men. It is not a well understood condition and therefore results in considerable misconceptions. Due to the vast cultural and socioeconomic differences amongst men, what exactly constitutes a premature ejaculation versus what constitutes a normal ejaculation time remains unclear. However, recent advances in scientific research over the last few decades has helped to properly define and classify the disorder

What Is Premature Ejaculation?

DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, Fifth edition) defines premature ejaculation as a persistent or recurrent pattern of ejaculation during partnered sexual activity occurring within approximately one minute following vaginal penetration and before the person wishes it. The symptoms are required to be present for at least 6 months and must have been experienced by the person on almost all or more than 75% of the occasions of sexual activity. The symptoms cause clinically significant distress in the person. The problem is generally not attributable to the effects of substance abuse or specific medication or any other medical condition.

The International Society of Sexual Medicine (ISSM) defines premature ejaculation as ejaculation that always or nearly always occurs prior to or within one minute of vaginal penetration from the first sexual experience (primary or lifelong PE) or a clinically significant and bothersome reduction in latency time, often to about three minutes or less (secondary or acquired PE).

The man is unable to control his orgasm and climaxes in under a minute of vaginal penetration and releases semen. This is not a sufficient period of time for women to reach orgasm and results in dissatisfaction for both or either one of the partners. Though premature ejaculation can occur during any kind of sexual activity, it is classified as a problem only if it occurs during vaginal intercourse.

Premature ejaculation can be classified into four different types depending on when the condition develops and the situations it tends to occur in. These are:

• Lifelong-premature ejaculation
  The condition is known as lifelong premature ejaculation if a person has been having symptoms since the very first intercourse. The person ejaculates even before penetration or within a minute of vaginal penetration. It leaves him feeling embarrassed and unsatisfied and he and his partner do not achieve sexual satisfaction.
• Acquired-premature ejaculation
  Acquired premature ejaculation is a condition when a person has had intercourse without problems of premature ejaculation earlier and developed the problems later. The condition may develop suddenly or gradually.
• Generalised Premature Ejaculation  
  ​Generalised premature ejaculation is when the condition occurs in a variety of situations.
• Situational Premature Ejaculation
  Situational premature ejaculation is when the condition occurs only during a specific situation or with specific partners.

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According to DSM-5, a person is said to have premature ejaculation if he experiences the following:

• Ejaculation within one minute of penetration into the vagina.
• A persistent condition of early ejaculation for six months or more.
• Early ejaculation at least 75% to 100% of the time.
• Sexual dissatisfaction, frustration, tension and stress amongst the partners
• The presence of a mental disorder or a medical condition that can lead to such a condition.
• Indulgence in substance abuse in the past or taking certain medicines that may result in premature ejaculation.

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Causes

There are no definite reasons for premature ejaculation and they often tend to vary. Some of the factors that may be responsible are mentioned below.

• Dopamine - It is a neurotransmitter that may be involved in controlling ejaculation.
• Genetics - According to a study, premature ejaculation may be a genetic disorder.
• Serotonin - Low levels of the chemical serotonin in the brain may also be associated with premature ejaculation.
• Depression
• Stress
• Performance anxiety
• Guilt

Risk Factors

The presence of certain medical conditions and psychological factors may increase the risk of developing premature ejaculation. These include:

• A thyroid disorder, more particularly hyperthyroidism, is known to cause premature ejaculation. Monitoring the thyroid levels may resolve the problem.
• Prostatic inflammation and erectile dysfunction also increase the probability of developing premature ejaculation.
• Often, high levels of stress and anxiety make it difficult for a person to relax, concentrate and enjoy the experience. This can greatly speed up the onset of premature ejaculation.
• Sometimes, sexual abuse may also lead to the development of a negative body image resulting in such a condition.

All men tend to suffer from premature erection at some time or the other and an occasional incident does not require any medical intervention. Premature ejaculation can occur due to an interplay of complex psychological and biological factors. There is no single factor that has been identified as the cause, the elimination of which could prevent the disorder from occurring. However, seeking medical help is one of the best methods to solve the problem and a combination of various treatment options can greatly help men to cope with the disorder.

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Your doctor will ask you a series of questions about your sex life such as whether you always had the problem or whether it has developed recently. He or she may also conduct a physical examination and note the details about your overall health in order to assess your condition. Your doctor may perform blood tests to check the levels of the male hormone testosterone in addition to several other tests like those for thyroid and pituitary gland functioning, lipid profile, blood sugar and HbA1c levels to rule out diabetes.

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Treatment options may include counselling, medication, behavioural techniques and even the application of topical anaesthetics.

• Counselling and sex therapy
  Counselling involves having an open and honest conversation with your counsellor about the problems in your sex life. Your doctor or counsellor will provide you with techniques and ways to cope with performance anxiety as well as stress. Sex therapy and relationship counselling help to bring back the connection between partners.
• Medication
  Various medicines may be prescribed that help in delaying ejaculation. These include certain antidepressants, analgesics and phosphodiesterase-5 inhibitors. These medicines have the side-effect of delaying ejaculation (although they are not approved by the FDA for this purpose). Your doctor may prescribe these medicines either alone or in combination with certain other drugs depending on your overall health. Self-medication can result in serious medical problems and one should avoid taking any medicines without the advice of a medical practitioner.
• Behavioural techniques
  In many people, premature ejaculation can be treated by simple changes in behaviour. Removing the pressure from your sexual performance by avoiding vaginal intercourse and focusing on other forms of sexual intimacy is known to greatly help the condition. Your doctor may suggest other ways to help you control your ejaculation.
• Topical Anaesthetics
  Your doctor may prescribe anaesthetic creams and sprays that numb the penis and prevent overstimulation, thereby controlling ejaculation. These products may be applied 10 to 15 minutes before intercourse. Some of these sprays are available over the counter while others require a prescription. Although most of these medicines help with premature ejaculation, there have been reports of a loss of sensitivity and decreased sexual pleasure in both men and women after using these products.
• Exercises
  Exercising the pelvic floor muscles can help to improve one's ability to delay ejaculation as weak pelvic floor muscles can result in premature ejaculation.
  • Identify the correct muscles
    To correctly identify the muscles involved, stop urination in midstream. This is the muscle that helps to control ejaculation. The muscles that help you to stop passing gas at an inappropriate time also helps to control the disorder.
  • Train the muscles
    ​Contract your pelvic muscles for 3 to 4 seconds and relax them. Repeat the exercise 4 to 5 times. As your muscles become stronger, increase the exercises to thrice daily with 10 repetitions each time.
• The pause-squeeze technique
  This is a technique that can be helpful in premature ejaculation. Begin foreplay as usual. When you feel that you cannot control the erection and will ejaculate, then get your partner to squeeze and hold the penis at the place where the head gland joints the shaft for a few seconds until the urge to ejaculate has passed. Repeat the process as many times as required until you can enter your partner without ejaculating. Eventually, you will learn to control your ejaculation and will not require the use of this technique to control ejaculation.
• Use of condoms
  Condoms made of a thick material are known to delay sensitivity of the penis and consequently control/delay ejaculation. 'Climax control' condoms are available over the counter in certain countries. These condoms contain numbing agents that decrease sensitivity.

Self Care:

Premature ejaculation can adversely impact the sex life and intimacy in a relationship causing the partners to feel distanced and stressed. Studies show that 1 out of 3 men experiences premature ejaculation at some time in their lives. Most of these incidents appear just a couple of times and get better on their own.

Performance anxiety and stress tends to worsen the problem. Relaxing your mind and body and trying to enjoy the sexual experience helps. It is advised to avoid stress even if you have a premature ejaculation. Remember, there are many ways to satisfy your partner and keep the flame alive and the intimacy intact. If you think that you need help, do not hesitate to seek a doctor’s help.

Lifestyle management

Premature erection is a result of many factors some of which are both physiological and psychological. Stress and performance anxiety play an important role in acquired premature ejaculation. Managing stress levels and having an open and honest communication with your partner is important for dealing with the condition. De-stressing your life can help in dealing with the condition to a great degree. Certain lifestyle diseases such as diabetes, high blood pressure, thyroid problems, and prostate disorders are known to contribute to the condition and taking care of these diseases helps in preventing and treating the disorder.

Prognosis

Timely diagnosis and proper treatment can effectively treat premature ejaculation. The condition tends to cause problems when individuals facing it do not seek treatment. The reluctance could be due to various reasons such as embarrassment and lack of knowledge that it is a common disorder which can be treated easily. The condition can seriously affect a person's self-esteem, and may even result in depression. A strained and unsatisfied sexual relationship leads to dissatisfaction and the quality of life is lowered.

Complications

Men suffering from the condition tend to live a highly unsatisfied and sexually frustrated life if they do not seek treatment. Men continue to live in shame and embarrassment either because they are unaware that the condition can be treated or because they are too hesitant to seek medical help.