MD - Psychiatry
Premature ejaculation occurs when a man ejaculates sooner during sexual intercourse than he or his partner would like. Premature ejaculation is a common sexual complaint. Estimates vary, but as many as 1 out of 3 men say they experience this problem at some time. As long as it happens infrequently, it does not cause for concern.
However, you may meet the diagnostic criteria for premature ejaculation if you:
Always or nearly always ejaculate within one minute of penetration unable to delay ejaculation during intercourse all or nearly all of the time feel distressed and frustrated, and tend to avoid sexual intimacy as a result
Both psychological and biological factors can play a role in premature ejaculation. Although many men feel embarrassed to talk about it, premature ejaculation is a common and treatable condition. Medications, counseling and sexual techniques that delay ejaculation - or a combination of these - can help improve sex for you and your partner
Some doctors believe that early sexual experiences may establish a pattern that can be difficult to change later in life, such as:
Situations in which you may have hurried to reach climax in order to avoid being discovered guilty feelings that increase your tendency to rush through sexual encounters
Other factors that can play a role in causing premature ejaculation include:
Erectile dysfunction. Men who are anxious about obtaining or maintaining an erection during sexual intercourse may form a pattern of rushing to ejaculate, which can be difficult to change. Anxiety. Many men with premature ejaculation also have problems with anxiety - either specifically about sexual performance or related to other issues. Relationship problems. If you have had satisfying sexual relationships with other partners in which premature ejaculation happened infrequently or not at all, it's possible that interpersonal issues between you and your current partner are contributing to the problem. Treatments and drugs
Common treatment options for premature ejaculation include behavioral techniques, topical anesthetics, oral medications, and counseling. Keep in mind that it may take a little time to find the treatment or combination of treatments that will work for you.
In some cases, therapy for premature ejaculation may involve taking simple steps, such as masturbating an hour or two before intercourse so that you're able to delay ejaculation during sex. Your doctor also may recommend avoiding intercourse for a period of time and focusing on other types of sexual play so that pressure is removed from your sexual encounters.
The pause-squeeze technique
Your doctor may instruct you and your partner in the use of a method called the pause-squeeze technique. This method works as follows:
Begin sexual activity as usual, including stimulation of the penis, until you feel almost ready to ejaculate. Have your partner squeeze the end of your penis, at the point where the head (glans) joins the shaft, and maintain the squeeze for several seconds, until the urge to ejaculate passes. After the squeeze is released, wait for about 30 seconds, then go back to foreplay. You may notice that squeezing the penis causes it to become less erect, but when sexual stimulation is resumed, it soon regains full erection. If you again feel you're about to ejaculate, have your partner repeat the squeeze process.
By repeating this as many times as necessary, you can reach the point of entering your partner without ejaculating. After a few practice sessions, the feeling of knowing how to delay ejaculation may become a habit that no longer requires the pause-squeeze technique.
Anesthetic creams and sprays that contain a numbing agent, such as lidocaine or prilocaine, are sometimes used to treat premature ejaculation. These products are applied to the penis a short time before sex to reduce sensation and thus help delay ejaculation. A lidocaine spray for premature ejaculation (promescent) is available over-the-counter.
Although topical anesthetic agents are effective and well-tolerated, they have potential side effects. For example, some men report a temporary loss of sensitivity and decreased sexual pleasure. In some cases, female partners also have reported these effects. In rare cases, lidocaine or prilocaine can cause an allergic reaction.
Many medications may delay orgasm. Although none of these drugs is specifically approved by the food and drug administration to treat premature ejaculation, some are used for this purpose, including antidepressants, analgesics, and phosphodiesterase-5 inhibitors. These medications may be prescribed for either on-demand or daily use, and may be prescribed alone or in combination with other treatments.
Antidepressants. A side effect of certain antidepressants is delayed orgasm. For this reason, selective serotonin reuptake inhibitors (ssris), such as sertraline (zoloft), paroxetine (paxil) or fluoxetine (prozac, sarafem), are used to help delay ejaculation. If ssris don't improve the timing of your ejaculation, your doctor may prescribe the tricyclic antidepressant clomipramine (anafranil). Unwanted side effects of antidepressants may include nausea, dry mouth, drowsiness and decreased libido. Analgesics. Tramadol (ultram) is a medication commonly used to treat pain. It also has side effects that delay ejaculation. It may be prescribed when ssris haven't been effective. Unwanted side effects may include nausea, headache, and dizziness. Phosphodiesterase-5 inhibitors. Some medications used to treat erectile dysfunction, such as sildenafil (viagra, revatio), tadalafil (cialis, adcirca) or vardenafil (levitra, staxyn), also may help premature ejaculation. Unwanted side effects may include a headache, facial flushing, temporary visual changes and nasal congestion.
This approach, also known as talk therapy, involves talking with a mental health provider about your relationships and experiences. These sessions can help you reduce performance anxiety and find better ways of coping with stress. Counseling is most likely to help when it's used in combination with drug therapy.