Premature Ejaculation
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Premature Ejaculation

(Rapid Ejaculation)

En Español (Spanish Version)

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. Persistent premature ejaculation usually results from a man's inability to recognize that he is about to ejaculate. (Ejaculation occurs automatically after a certain degree of sexual stimulation.) This inability prevents him from taking steps to delay the process.

Psychological factors that may contribute include:

  • Guilt about sex
  • Fear of causing pregnancy
  • Fear of getting a sexually transmitted disease
  • Concerns about sexual performance
  • Interpersonal difficulties between sexual partners
  • Early sexual experiences that condition a man to rapid ejaculation. This includes fear of "being caught" having sex.

In rare cases, premature ejaculation can be caused by:

  • Prostate problems, such as prostatitis
  • A neurological problem
  • Medications that increase sexual stimulation
  • Certain medical conditions (eg, thyroid problems)

Prostate

Anatomy of the Prostate Gland

© 2008 Nucleus Medical Art, Inc.

Risk Factors

A risk factor is something that increases your chance of getting a disease or condition. Risk factors 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
  • Interpersonal problems between sexual partner
  • Early sexual experiences that precondition a man to rapid ejaculation

Symptoms

The primary symptom is persistent episodes of premature ejaculation during sex. Secondary symptoms may include:

  • Feelings of guilt, inadequacy, or self-doubt
  • New or increased interpersonal problems with a sexual partner

Diagnosis

Most men experiencing premature ejaculation will notice the condition themselves. If you see a doctor about the condition, the doctor will ask about your symptoms and medical history, and perform a physical exam.

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 that a man can apply to his 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 and they need to be taken daily.

Another medication that showed some promise in treating the condition is dapoxetine. Contrary to other anti-depressants it is taken 1-3 hours before intercourse. Its use for premature ejaculation has not been FDA approved.

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
http://www.auanet.org

Men's Health Network
http://www.menshealthnetwork.org

CANADIAN RESOURCES:

Health Canada
http://www.hc-sc.gc.ca/index_e.html

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

References:

American Academy of Family Physicians website. Available at: http://www.aafp.org/online/en/home.html . Accessed March 25, 2007.

American Psychiatric Association website. Available at: http://www.psych.org/ . Accessed March 25, 2007.

American Urological Association website. Available at: http://www.urologyhealth.org/adult/index.cfm?cat=11&topic=670 . Accessed March 25, 2007.

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

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.

The Merck Manual of Medical Information—Home Edition . Simon and Schuster, Inc.; 2000.



Last reviewed March 2008 by Marcin Chwistek, MD

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.


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