• Premature Ejaculation

    (Rapid Ejaculation)

    Definition

    Ejaculation occurs when a man reaches sexual climax and semen is ejected from his penis. Premature ejaculation is:
    • Ejaculation occurs before the man wishes it to occur.
    • Ejaculation occurs too quickly to sexually satisfy his partner.

    Causes

    Many men experience premature ejaculation at one time or another. For example, some men experience it after not having had sex for a long period of time. Premature ejaculation is only a problem when it becomes a persistent condition.
    Ejaculation occurs automatically after a certain degree of sexual stimulation. Persistent premature ejaculation usually results from a man's inability to recognize that he is about to ejaculate. This inability prevents him from taking steps to delay the process.
    Psychological factors that may contribute to premature ejaculation. This may include difficulty in relationship with partner, guilt about sex or fears related to sex.
    In rare cases, premature ejaculation can be caused by:
    • Prostate problems, such as prostatitis
    • A problem with the nerves
    • Medications that increase sexual stimulation
    • Certain medical conditions (eg, thyroid problems)
    Prostate
    Anatomy of the Prostate Gland
    © 2011 Nucleus Medical Media, Inc.

    Risk Factors

    Factors that increase your risk for premature ejaculation include:
    • Lack of sexual experience
    • Lack of knowledge of male and female sexual responses
    • Fear of:
      • Causing pregnancy
      • Contracting a sexually transmitted disease
      • Poor sexual performance
    • Guilt about sex
    • Interpersonal problems between sexual partner
    • Early sexual experiences that precondition a man to rapid ejaculation, usually from fear of being caught

    Symptoms

    The primary symptom is persistent episodes of premature ejaculation during sex.

    Diagnosis

    Most men experiencing premature ejaculation will notice the condition themselves. The doctor will ask about your symptoms and medical history. A physical exam will be done.
    The doctor may search for an underlying medical cause if:
    • You suddenly developed persistent premature ejaculation and have never experienced it before.
    • You have other neurological symptoms.
    • You are taking medication that may cause premature ejaculation.
    • The condition is getting much worse or causing severe problems for you.

    Treatment

    Treatments may include:

    Behavior Therapy

    This aims to improve your ability to:
    • Recognize when you are about to ejaculate
    • Take steps to delay it
    It may include:
    • Biofeedback—electrical feedback that helps you learn to control the muscles that cause ejaculation.
    • Start and stop method—stopping sexual stimulation for 30 seconds when nearing climax, then resuming.
    • Squeeze method—same as start and stop method, but includes gently squeezing the base of penis before the 30-second stop period.
    • Sexual positions—trying different sexual positions that may allow greater control over the muscles that cause ejaculation.

    Psychological Counseling

    Counseling may be offered for an individual or for a couple. It is aimed at identifying and treating:
    • Fears or guilt
    • Interpersonal problems with your partner that may contribute to the condition

    Medication

    In some cases, a doctor may prescribe a desensitizing cream. It can be applied to the penis to lessen sexual stimulation.
    In other cases, a doctor may prescribe an antidepressant medicine such as Zoloft or Prozac , or Clomipramine. Such antidepressants have been found to prolong the interval from intromission to ejaculation. However, these drugs do not cure the underlying cause of premature ejaculation.

    Prevention

    To help prevent premature ejaculation:
    • Learn how male and female sexual responses work.
    • Improve communication with your partner before engaging in sexual activity.
    • Have sex in situations that are private and relaxed.

    RESOURCES

    American Urological Association Foundation http://www.urologyhealth.org/

    The American Academy of Family Physicians http://familydoctor.org/

    CANADIAN RESOURCES

    Health Canada http://www.hc-sc.gc.ca/index%5Fe.html

    Sex Information and Education Council of Canada http://www.sieccan.org/

    References

    Premature ejaculation. American Academy of Family Physicians website. Available at: http://familydoctor.org/familydoctor/en/diseases-conditions/premature-ejaculation.html . Updated February 2011. Accessed September 14, 2012.

    Premature ejaculation. American Urological Association website. Available at: http://www.urologyhealth.org/urology/index.cfm?article=122 . Updated January 2011. Accessed September 14, 2012.

    Premature ejaculation. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what.php . Updated August 28, 2012. Accessed September 14, 2012.

    Pryor, JL, Althof, SE, Steidle, C, et al. Efficacy and tolerability of dapoxetine in treatment of premature ejaculation: an integrated analysis of two double-blind, randomised controlled trials. Lancet 2006; 368:929.

    Montague, DK, Jarow, J, Broderick, GA, et al. AUA guideline on the pharmacologic management of premature ejaculation. J Urol 2004; 172:290.

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