Premature ejaculation is the term used when a man comes (ejaculates) more quickly than he and/or his partner would like. It means you ejaculate very soon after putting your penis inside (penetrating) your partner, or even before penetration. It is not really known what causes premature ejaculation. Men with premature ejaculation should not be embarrassed about discussing it with their doctor, as it can be helped by a variety of means. There are tablets which may be helpful, either taken regularly or as needed. Creams or sprays that numb the penis may also be used. Other treatments include certain techniques used during sex, and psychological treatments.
What is premature ejaculation?
Premature ejaculation occurs when you come (achieve orgasm) soon after, or even before, putting your penis inside your partner. Doctors use three features to decide whether a person has premature ejaculation. These are:
- Ejaculation occurs always or nearly always within a minute of penetration, and always has done since first having sex. (Or up to three minutes if it is a new problem which you have not previously experienced.)
- You feel you are always or usually unable to delay ejaculation.
- You find sex frustrating or distressing and tend to avoid it, or the issue is affecting your relationship or your life.
How common is premature ejaculation?
Many men do not seek help from their doctor for this problem so it is not known how common it is. Surveys that have been done suggest it affects about one to three out of every one hundred men. Some studies suggest it can be as common as thirty in a hundred men.
What causes premature ejaculation?
It is not well understood what causes premature ejaculation and in most cases doctors do not know. Sometimes one or more of the following may be a cause.
- It is more likely to happen if you are young and in the early stages of a relationship, in which case it often gets better with time.
- Factors such as anxiety about sex or your feelings during your first sexual experience may contribute.
- Some medicines (eg, cabergoline used for the treatment of illnesses such as Parkinson's disease) can possibly cause premature ejaculation.
- Premature ejaculation can be caused by some recreational drugs such as cocaine and amfetamine.
- Persistent infection or inflammation of the prostate gland (chronic prostatitis) is known to be sometimes associated with premature ejaculation.
- Nervous system diseases, such as multiple sclerosis and peripheral neuropathy, can also be a cause. Multiple sclerosis is a condition resulting from unwinding of the covering of nerves and peripheral neuropathy is a condition where there is damage to the nerves supplying the peripheral nerves of the body.
What is the treatment for premature ejaculation?
- Don't be embarrassed to discuss the problem with your doctor, either at your surgery or at a sexual health clinic.
- Premature ejaculation is sometimes temporary and in some cases gets better on its own.
- You may find that increasing the frequency of sex (either intercourse or masturbation) solves the problem. After one orgasm, it is normal for the next one to take a little longer. Some men find it helpful to masturbate first (with or without their partner) so it takes longer to have an orgasm whilst having sex.
- Wearing a condom reduces sensation and this may be helpful.
- Premature ejaculation is less likely if you have sex with your partner on top.
- You may want to try the 'squeeze technique'. Just before ejaculation, the head of the penis should be squeezed for 1-20 seconds. Either you or your partner can do this. The squeezing is usually done during masturbation (stimulation) of the penis but also can be done by stopping during intercourse. The squeezing reduces an erection and delays your orgasm. The process must be repeated three times before having an orgasm. It requires a lot of practice.
- The 'start-stop' technique is similar but you simply stop the stimulation or the intercourse just before ejaculating. Wait for your erection to subside a little, before carrying on. Again, the idea is to repeat three times before having an orgasm. You need practice to recognise the moment just before an orgasm in order to be able to stop in time.
- Psychological treatments are sometimes used but no one is sure just how effective they are.
- Studies have shown these techniques can be effective but results are very variable. You may prefer to try a cream or a tablet, as discussed below.
Medication for premature ejaculation
Various medicines have been found to be helpful. These include:
- Selective serotonin reuptake inhibitor (SSRI) antidepressants such as paroxetine, citalopram, escitalopram, fluoxetine and sertraline. You need to take these daily for at least one or two weeks to get the full effect and you may find they start to wear off after 6-12 months.
- If you cannot tolerate the side-effects of SSRIs (which can include sickness, dizziness and drowsiness), you could try taking another antidepressant called clomipramine just when you are going to have sex.
- Dapoxetine is a new SSRI which has specially been developed for the treatment of premature ejaculation. It starts to work very quickly, so it can be taken just when you are going to have sex, rather than every day. You have to take it 1-3 hours before you have sex.
- Medicines used for erection problems, such as sildenafil, may sometimes also be useful for premature ejaculation. It is sometimes taken in combination with an SSRI.
- If you don't want to take tablets, local anaesthetic creams and sprays are available which help to reduce the sensitivity of the penis. Take the advice of your GP or pharmacist because there are many preparations advertised in magazines and on the internet, some of which are more effective than others. Some may be available on prescription.
Surgery has occasionally been helpful in men who have a short frenulum. This is the bridge of skin joining the head of the penis to the shaft. It is not a common treatment for premature ejaculation.
Further reading and references
Premature ejaculation (PE) Guidelines Update November 2012; British Association for Sexual Health and HIV (BASHH)
Guidelines on Male Sexual Dysfunction: Erectile dysfunction and premature ejaculation; European Association of Urology (2015)
Cooper K, Martyn-St James M, Kaltenthaler E, et al; Interventions to treat premature ejaculation: a systematic review short report. Health Technol Assess. 2015 Mar19(21):1-180, v-vi. doi: 10.3310/hta19210.
Graziottin A, Althof S; What does premature ejaculation mean to the man, the woman, and the couple? J Sex Med. 2011 Oct8 Suppl 4:304-9. doi: 10.1111/j.1743-6109.2011.02426.x.
Morales A; Evolving therapeutic strategies for premature ejaculation: The search for on-demand treatment - topical versus systemic. Can Urol Assoc J. 2012 Oct6(5):380-5. doi: 10.5489/cuaj.12002.
Gallo L, Perdona S, Gallo A; The role of short frenulum and the effects of frenulectomy on premature ejaculation. J Sex Med. 2010 Mar7(3):1269-76. doi: 10.1111/j.1743-6109.2009.01661.x. Epub 2010 Jan 14.
Melnik T, Althof S, Atallah AN, et al; Psychosocial interventions for premature ejaculation. Cochrane Database Syst Rev. 2011 Aug 10(8):CD008195. doi: 10.1002/14651858.CD008195.pub2.
Premature ejaculation: Dapoxetine; Nice advice, May 2014
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