Premature ejaculation: Treatments and causes

Premature ejaculation is a form of sexual dysfunction that can adversely affect the quality of a man’s sex life. It is when an orgasm or “climax” occurs sooner than wanted.

There may occasionally be complication with reproduction, but premature ejaculation (PE) can also adversely affect sexual satisfaction, both for men and their partners.

In recent years, the recognition and understanding of male sexual dysfunction has improved, and there is a better understanding of the problems that can result from it.

The information here aims to demystify the causes of PE and outline effective treatment options.

Fast facts on premature ejaculation

Here are some key points about premature ejaculation.

In the majority of cases, an inability to control ejaculation is rarely due to a medical condition, although doctors will need to rule this out.

PE can lead to secondary symptoms such as distress, embarrassment, anxiety, and depression.

Treatment options range from reassurance from a doctor that the problem might improve in time, through to home methods of “training” the timing of ejaculation.

Treatment

[Man looking sad about premature ejaculation]
Premature ejaculation, in some cases, can lead to depression.

In most cases, there is a psychological cause, and the prognosis is good.

If the problem occurs at the beginning of a new sexual partnership, the difficulties often resolve as the relationship goes on.

If, however, the problem is more persistent, doctors may recommend counseling from a therapist specializing in sexual relationships, or “couples therapy.”


No medications are officially licensed in the United States for treating PE, but some antidepressants have been found to help some men delay ejaculation.

A doctor will not prescribe any medicines before taking a detailed sexual history to reach a clear diagnosis of PE. Drug treatments can have adverse effects, and patients should always discuss with a doctor before using any medication.

Dapoxetine (brand name Priligy) is used in many countries to treat some types of primary and secondary PE. This is a rapid-acting SSRI that is also licensed to treat PE. However, certain criteria must be met.

It can be used if:

vaginal sex lasts for less than 2 minutes before ejaculation occurs

ejaculation persistently or recurrently happens after very little sexual stimulation and before, during, or shortly after initial penetration, and before he wishes to climax

there is marked personal distress or interpersonal difficulty because of the PE

there is poor control over ejaculation

most attempts at sexual intercourse in the past 6 months have involved premature ejaculation

Side-effects from dapoxetine include nausea, diarrhea, dizziness, and headache.

Topical drugs

Some topical therapies may be applied to the penis before sex, with or without a condom. These local anesthetic creams reduce stimulation.

Examples include lidocaine or prilocaine, which can improve the amount of time before ejaculation.

However, longer use of anesthetics can result in numbness and loss of erection. The reduced sensation created by the creams may not be acceptable to the man, and the numbness can affect the woman, too.

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Home remedies

Two methods that can be helpful for men are:

The start-and-stop method: This aims to improve a man’s control over ejaculation. Either the man or his partner stops sexual stimulation at the point when he feels he is about to have an orgasm, and they resume once the sensation of impending orgasm has subsided.

The squeeze method: This is similar, but the man gently squeezes the end of his penis, or his partner does this for him, for 30 seconds before restarting stimulation.

A man tries to achieve this upward of three or four times before allowing himself to ejaculate.

Practice is important, and if the problem continues, it may be worth talking to a doctor.

Exercises

Researchers have found that Kegel exercises, which aim to strengthen the pelvic floor muscles, can help men with lifelong PE.

Forty men with the condition underwent physical therapy involving:

physio-kinesiotherapy to achieve muscle contraction

electrostimulation of the perineal floor

biofeedback, which helped them understand how to control the muscle contractions in the perineal floor

They also followed a set of individualized exercises.

After 12 weeks of treatment, over 80 percent of the participants gained a degree of control over their ejaculation reflex. They increased the time between penetration and ejaculation by at least 60 seconds.

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