Premature Ejaculation: A Complete Guide

What is premature ejaculation?

Rapid ejaculation is a common sexual dysfunction that occurs when a man reaches orgasm and ejaculates too quickly during sexual activity, often before he or his partner is satisfied.

The duration of sexual intercourse before ejaculation varies widely, but on average, premature ejaculation is defined as ejaculation that occurs within one minute of penetration. However, the definition of premature ejaculation can vary depending on the individual and their partner's preferences and expectations.

How common is premature ejaculation?

Premature ejaculation (PE) is a common sexual dysfunction that affects many men worldwide. Studies suggest that approximately 1 in 3 men or 20-30% of men experience premature ejaculation at some point in their lives. However, the prevalence of PE varies widely among different populations and age groups.

It is also important to note that the definition of premature ejaculation can vary among individuals and healthcare professionals. Some definitions consider premature ejaculation as ejaculating within two minutes of penetration, while others consider it as ejaculating before the individual wishes to do so.

What is ejaculation?

Ejaculation is the process by which semen is released from the male reproductive system during sexual activity. It is a complex process that involves several organs and physiological mechanisms.

During sexual arousal, the brain sends signals to the reproductive organs, which stimulate the production of semen in the testicles. The semen then travels through the vas deferens, a tube that connects the testicles to the urethra, which is the tube that carries urine and semen out of the body. When a man reaches the point of orgasm, the muscles in the pelvic area contract, forcing the semen out of the urethra and out of the body. This process is typically accompanied by a pleasurable sensation known as ejaculation.

It's important to note that ejaculation and orgasm are not the same things, although they often occur together. Ejaculation refers specifically to the release of semen, while orgasm refers to the intense physical and emotional pleasure that typically accompanies ejaculation.

Postorgasmic illness syndrome (POIS) is a rare and poorly understood medical condition in which people experience a range of physical, cognitive, and emotional symptoms following sexual activity, particularly orgasm that can significantly affect the quality of life and can cause significant emotional distress. Most men have such extreme fatigue post-ejaculation that they start to avoid sexual activity completely.

Read the Detailed blog on How to treat symptoms of post-orgasmic illness syndrome [POIS].

What is the difference between lifelong and acquired premature ejaculation?

Acquired premature ejaculation refers to a condition where a person who previously had normal ejaculation control begins to experience a persistent and recurrent pattern of ejaculating too quickly, often with minimal sexual stimulation or before they desire to.

Lifelong premature ejaculation (LPE) is a type of PE that is present from the first sexual experience and continues throughout a man's life. It is also sometimes referred to as primary premature ejaculation.

What are some of the common causes of premature ejaculation?

The exact cause of premature ejaculation is not fully understood, but it is thought to be a combination of psychological and biological factors.

Psychological factors:

• Anxiety and Depression
• Stress
• Relationship issues
• Performance anxiety or fear of not satisfying one's partner.
• History of sexual abuse
• Inexperience: Men who are new to sexual experiences and have not yet learned how to control their arousal may experience premature ejaculation

Biological factors:

• Hormonal imbalances such as low or high testosterone.
• Abnormal levels of neurotransmitters in the brain such as serotonin.
• Genetics: There may be a genetic predisposition to premature ejaculation, as noted by impaired serotonin pathways in these individuals
• Certain medical conditions such as prostate problems, thyroid disorders, or neurological conditions can also increase the risk of premature ejaculation.

Medical Factors:

• Chronic inflammation of the prostate (Prostatitis). This is treated with 6 weeks of antibiotic therapy.
• Hyperthyroidism (overactive thyroid gland)

What is the difference between premature ejaculation and erectile dysfunction?

Although Erectile dysfunction and premature ejaculation can often co-exist, Premature ejaculation and erectile dysfunction are two different sexual health conditions that can affect men, and they involve different aspects of sexual function.

Premature ejaculation is a condition in which a man reaches orgasm and ejaculates too quickly during sexual activity, often before he or his partner has had the opportunity to achieve sexual satisfaction. Premature ejaculation is typically defined as ejaculation that occurs within one minute of penetration.

On the other hand, erectile dysfunction is a condition in which a man has difficulty achieving or maintaining an erection that is firm enough for sexual intercourse. Erectile dysfunction can be caused by a range of physical or psychological factors, and it can affect a man's ability to engage in sexual activity.

How is premature ejaculation diagnosed?

This is a clinical diagnosis based on history and a physical examination. There is no single diagnostic test. Healthcare providers at HEALOR will typically ask about sexual histories such as How long they have been experiencing PE, the frequency of PE episodes, and any other related factors. They may also ask about the patient's mental health, stress levels, and relationship dynamics.

Our healthcare provider may also perform a physical exam to check for any underlying medical conditions that could be contributing to the patient's PE. This may include a genital exam to check for abnormalities, such as infection or inflammation, and to rule out any structural issues that could be causing the problem.

What are some of the medical treatment options for premature ejaculation?

There are several medical treatment options available for premature ejaculation, including:

1. Selective serotonin reuptake inhibitors (SSRIs): These medications are commonly used to treat depression and anxiety, but they can also be effective in treating premature ejaculation. SSRIs work by increasing the level of serotonin in the brain, which can help delay ejaculation. Some examples of SSRIs used for premature ejaculation include citalopram, dapoxetine, and paroxetine. Based on available data paroxetine has been shown to be the most effective.
2. Serotonin-norepinephrine reuptake inhibitors (SNRIs):
3. Tricyclic antidepressants (TCA)
4. Tramadol: This is a pain medication that can also help delay ejaculation. It works by inhibiting the reuptake of certain neurotransmitters in the brain, which can help prolong sexual activity.
5. Phosphodiesterase type 5 (PDE5) inhibitors: These medications, such as sildenafil (Viagra), tadalafil (Cialis), and vardenafil (Levitra), are commonly used to treat erectile dysfunction, but they can also help with premature ejaculation by improving the quality of erections and delaying ejaculation.
6. Topical anesthetics: These are creams or sprays that contain a local anesthetic, such as lidocaine or prilocaine, which can help numb the penis and delay ejaculation.
7. Silodosin: Typically used for enlarged prostate and to help pass kidney stones. Based on limited data this has been shown to be an effective medication when taken 2 hours prior to sexual activity.
8. Dorsal nerve modulation: Does have the risk of long-term ED
9. Acupuncture: Small acupuncture needles are inserted in hands, legs, forehead, pubic areas, etc. The effectiveness of acupuncture is questionable based on available data.

Can I treat premature ejaculation at home?

Yes, there are some ways to treat premature ejaculation at home. Here are some techniques you can try:

1. Practice pelvic floor exercises: Kegel exercises can help strengthen the muscles that control ejaculation. These exercises involve contracting and relaxing the pelvic floor muscles, which are the muscles that support the bladder and rectum. An easy way to practice this is to hold urination midstream.
2. Masturbate before sex: Masturbating a few hours before sex can help delay ejaculation during intercourse.
3. Avoid watching porn before or during sexual activity to avoid overstimulation.
4. Try the stop-start technique: This technique involves stopping sexual stimulation when you feel close to orgasm, waiting a few seconds, and then starting again. Repeat this process several times before allowing yourself to climax.
5. Avoid using lubricants to reduce sensation.
6. Use a thicker condom: A thicker condom can help decrease sensitivity and delay ejaculation. Climax-control condoms with benzocaine are specially designed to reduce sensation.
7. Use desensitizing sprays or creams: These products can help reduce sensitivity and delay ejaculation. Lidocaine creams can be used 15 minutes prior to sexual activity. These creams must be thoroughly removed prior to penetration to prevent vaginal desensitization.
8. Communicate with your partner: Talking to your partner about your concerns can help alleviate anxiety and stress, which can contribute to premature ejaculation.

Would circumcision help with premature ejaculation?

There is no clear scientific evidence that circumcision directly helps with premature ejaculation. Some studies suggest that circumcision may reduce sensitivity in the penis and thus potentially help delay ejaculation, but this effect is not universal and may not be significant enough to make a noticeable difference for most men. Additionally, circumcision is a surgical procedure that carries its own risks and potential complications, so it should not be undertaken lightly or without a clear medical indication.

Can Botox injection help with premature ejaculation?

Botulinum neurotoxin injection is a treatment that is used to temporarily paralyze muscles by blocking the release of acetylcholine, a neurotransmitter that signals muscle contractions. While Botox injections have been used for a variety of medical and cosmetic purposes, there is limited evidence to suggest that it is an effective treatment for premature ejaculation.

Some animal and human studies have shown that injection of botulinum neurotoxin into bulbospongiosus muscle delays ejaculation and could be a potential treatment option however, these studies have been small and not replicated Therefore, Botox injection is not currently considered a standard treatment for premature ejaculation. Additionally, Botox injections are not without potential risks and side effects, including pain, swelling, and temporary weakness or paralysis of nearby muscles.

What is the outlook or prognosis for premature ejaculation?

The outlook or prognosis for premature ejaculation is generally good, as there are several effective treatment options available that can help men overcome this condition. With appropriate treatment, most men can learn to control their ejaculation and enjoy longer-lasting sexual experiences.

The success of treatment may depend on the underlying cause of premature ejaculation. For example, if psychological factors such as anxiety or stress are contributing to the problem, counseling or therapy may be necessary to address these issues. On the other hand, if the condition is caused by physical factors such as inflammation or infection, treatment may focus on addressing these underlying health issues.

Overall, the prognosis for premature ejaculation is positive, and many men are able to overcome this condition with the help of their healthcare providers and appropriate treatment. It's important to talk to a healthcare provider about any concerns related to premature ejaculation and to work together to develop an individualized treatment plan.

Raj Singh MD

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