Premature ejaculation

How is premature ejaculation diagnosed?

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 have problems delaying ejaculation.

• You find sex frustrating or distressing and tend to avoid it, or the issue is affecting your relationship or your life.

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 new sexual relationships, in which case it often gets better with time.

• Factors such as anxiety about sex (such as performance anxiety) or your feelings during your first sexual activity may contribute to symptoms of premature ejaculation.

• Some medicines (eg, cabergoline used for the treatment of illnesses such as Parkinson's disease) can possibly cause early 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.

• Hyperthyroidism and nervous system diseases, such as multiple sclerosis and peripheral neuropathy, can be a cause of acquired premature ejaculation.

Is premature ejaculation common?

Premature ejaculation (PE) is difficult to study because people may have trouble talking about sex as well as experiencing PE in different ways. This makes it hard to say accurately how many men have the problem. However it is widely accepted to be the most common male sexual problem and when studies have been done they estimate that between 3 men out of 10 worldwide may experience premature ejaculation.

• 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 method'. 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 treatment options are sometimes used in treating premature ejaculation 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.

If you have acquired premature ejaculation (because of another health problem, as above) the first goal is to treat that health problem.

If you have had lifelong PE the current guidelines suggest that medication should be the basis of your treatment. The options are tablets and local anaesthetic spray.

Behavioural and psychosexual therapy is also used but there is only weak and inconsistent evidence that this helps. Sometimes psychotherapy and medication are used together.

Dapoxetine is a new SSRI tablet 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.

If you don't want to take tablets, local anaesthetic creams and sprays are available which help to reduce the sensitivity of the penis. The medicines are called lidocaine or prilocaine and some options may be bought over the counter and some are available on prescription.

Other selective serotonin reuptake inhibitor (SSRI) antidepressants such as paroxetine, citalopram, escitalopram, fluoxetine and sertraline have also been offered in the past, but this is an unlicensed use of the tablet. 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. They may also give you some unpleasant side-effects such as sickness and dizziness.

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.