Premature ejaculation is a condition that hinders men from having fulfilled sexual activities. It is part of the most prevalent male sexual disorders worldwide, with one in three men in the 18 to 59 age group having this form of sexual dysfunction as mentioned by the American Urologic Association (AUA).
Ejaculation occurs naturally upon the peak of any sexual activity when the penis ejects semen. However, in Premature ejaculation (PE), this climax happens at an earlier time than one would expect. Men with ejaculation times that are satisfactory, or men who only experience PE occasionally may only be experiencing a normal variable PE— something that happens regularly due to fluctuations in sexual performance and not necessarily because of sexual dysfunction. However, if one experiences PE on a regular basis, it is best advised to talk with a health professional to assess better one’s medical condition.
Premature ejaculation is categorized into two types: primary and secondary. Primary PE involves conditions which were first observed a long time ago, dating back to one’s first sexual encounter. Secondary PE, meanwhile, focuses on conditions that are only observed recently. Men who are struggling with secondary PE have experienced normal ejaculation in the past and only gradually developed the condition in recent times.
It was only in 2014 when a formal definition of the condition was constructed. As stated by the International Society for Sexual Medicine (ISSM), one may have PE if:
- One frequently or often reaches climax within only a minute of sexual penetration (for primary types) or within only three minutes of sexual penetration (for secondary PE).
- One finds it hard to manipulate ejaculation time (i.e. to control or delay climax) during sexual activities.
- One is experiencing feelings of discomfort, frustration, stress, and/or avoidance when it comes to sexual intimacy
In order for one to be given a correct diagnosis of the condition, and eventually a proper treatment for it, one needs to disclose pertinent symptoms to one’s healthcare provider of choice. Questions in these check-up discussions may be uncomfortable for some, but these are needed to ensure a diagnosis that tackles the root of the condition. Oftentimes, the healthcare professional would diagnose premature ejaculation through a physical exam and through a thorough discussion of one’s sexual frustrations.
Premature ejaculation is theorized to have originated from psychological and biological causes. Although the exact cause is not yet concluded, it is hypothesized that it is because of both medical and psychological factors.
It may be important to know that one of the causes of anxiety and depression is by having PE. The interrelation of depression, anxiety, and PE is being extensively studied by different medical professionals in the same line of expertise.
Some of the causes that have been proposed that may lead to the development of PE include underlying health conditions. It is observed that some men who have their underlying medical conditions treated also showed significant improvement with their PE. However, research about the topic is still limited. As of writing, there are still no published research that looks into the following factors:
- The amount of brain proteins (or neurotransmitters) that are being produced and transmitted to the brain. These neurotransmitters include the happy and pleasure hormones dopamine, serotonin, and oxytocin. It is speculated that the levels of these neurotransmitters affect the duration before climax. Increased serotonin is said to delay it while low levels may lead to a faster time for ejaculation. In fact, inconsistent serotonin levels are said to be the cause of primary PE in about 5% cases of men worldwide. In a similar manner, the neurotransmitters dopamine and oxytocin are said to affect the duration before climax, although further studies are still in development.
- Increased sensitivity of the penis’ glans region (or head)
- An inflammation of the prostate gland, medically known as prostatitis, is seen to contribute to PE, although there is no clear-cut statistic available that correlates the two.
- Imbalances of thyroid hormone levels are seen to cause a form of sexual dysfunction in most patients. Men should undergo routine checkups to determine thyroid hormone levels so that the possibility of acquiring PE from thyroid involvement is ruled out.
- Abnormal testosterone levels are also seen to be correlated with PE, as testosterone is the predominant hormone associated with men’s sexual behavior.
People sometimes fail to differentiate premature ejaculation and erectile dysfunction (ED). Erectile Dysfunction in men is characterized by a penis that is unable to get hard or stay firm during intercourse. It is said to be caused by an underlying medical condition. Men who suffer from ED force themselves to ejaculate at a much earlier time just before their penis starts to lose their firmness. This is deliberately intentional but may progress into PE much later on due to the development of a performance anxiety. Although different, both PE and ED may be present in an individual. In some cases, treating one condition also leads to improved conditions for the other.
And in another manner, some men have developed the idea that aging contributes to the progression of PE. This is false. While aging may cause significant changes in one’s ejaculation time or hard-on, it is not seen to be a direct cause of PE.
After careful diagnosis, one may now consider undergoing a treatment plan to alleviate the symptoms of the condition. The AUA claims that about 95% of men recover from PE once treatment is considered. These treatments are varied and may include one or a mix of the following: psychological, behavioral, or medical.
Psychological therapy is done with the male or with the male and his partner. It is akin to sex counseling, where the counselor addresses underlying issues that may have risen from PE such as performance anxiety, diminished self-confidence, and other personal or relationship problem. These issues are very much frequent but may be resolved once the couple decide to undergo psychological therapy at the expense of their time and finances.
Behavioral therapy involves conditioning the brain and the body to respond differently to certain stimuli. These include the stop-start method and the squeeze technique. In the stop-start method, sex is stopped when the male feels that he is near climax. Once the urge subsides, sexual intercourse resumes. The squeeze technique is similar to that. However, when the male is near climax, the partner instead squeezes the male’s penis at the point where the head meets the shaft until the urge to release subsides. Sexual intercourse then resumes after that.
Behavioral therapy may also include physical conditioning such as pelvic floor exercises and masturbation before sex. Pelvic floor exercises or Kegel exercises develop the strength of the muscles involved in the process of ejaculation. These are the very same muscles that stop one from releasing gas (farting) or stopping urine mid-way of urination. Meanwhile, masturbation before sex decreases sensitivity of the male organ which may allow for better control and manipulation of the climax.
Medical therapy is another term for medication intake. Some of the prescribed medication for PE include antidepressants and ED medications. Antidepressants like paroxetine and dapoxetine which are selective serotonin reuptake inhibitors (SSRIs) may inhibit PE in men. Tricyclic antidepressants like clomipramine work in a similar manner.
Clinical numbing creams and sprays that are over-the-counter medication may also be used to treat PE. These all numb the male organ so that the person would have decreased sensitivity to pleasure upon penetration and thus would last longer.
Conclusion The condition of premature ejaculation is something that concerns men globally although no definite conclusion has been made regarding its origin or cause. If you suspect yourself to be suffering from premature ejaculation, the best course of action is to talk to your reliable healthcare professional for proper diagnosis and proceed to a feasible treatment plan of choice.