Male Sexual Health

What is ejaculation?

It is the release of semen from the penis at orgasm. Semen is made up of sperm and fluid from testes (singular testis), seminal vesicles and prostate gland.

When a man is sexually stimulated, the brain sends signals to the genital area through nerves in spinal cord that causes contraction of pelvic muscles. Waves of pelvic muscle contractions transport the semen from the testes to tip of penis through vas deferens. This is called ejaculation or orgasm (colloquially to cum, shoot, blast or bust).

What is premature ejaculation (PE)?

PE means 'cumming too soon', that is, a man ejaculates before he is ready for it and he has no control over it.

Studies have shown that most men ejaculate between 2-5 minutes after penetration. This time frame is again arbitrary since it can differ from men to men, couple to couple, between cultures and other factors. So, for practical reason, if ejaculation occurs within 1 minute of penis entering into a vagina, it is called premature ejaculation. It is the commonest sexual problem in men and affects all ages.

What are the causes?

• Premature ejaculation can be primary or secondary.
• Primary or lifelong PE is when a man has not had control of ejaculation from the time of his first sexual experience. It can be caused by a chemical imbalance in brain centres that lowers the threshold for ejaculation.
• Secondary or acquired PE is usually when there has been a period of normal functioning before premature ejaculation began. Secondary premature PE is often linked to psychological factors like stress, performance anxiety, relationship issues and impotence.

How is it diagnosed?

There are no tests or scans to diagnose PE. If you have premature ejaculation, you need to see your local doctor and a diagnosis is made based on your history.

What treatments are there for premature ejaculation?

Treatment for PE may involve sex therapy, behavioural techniques, medications, local gels and creams, and treatment of other conditions like erectile dysfunction.

Sex therapy is administered by a person called sex therapist. This is particularly important if the cause of premature ejaculation is psychological like relationship issues and anxiety. Sex therapist provides counselling to address these issues.

There are mainly two behavioural techniques that can be used for treating premature ejaculation:

Seman's 'stop start' technique and Masters and Johnson's 'squeeze' technique.

How to perform Seman's 'stop start' technique

• Arouse yourself sexually by playing with your penis or ask your partner to stimulate it for you
• Once you are fully aroused and feel you are close to ejaculation, stop playing
• Wait for some time until the feeling of ejaculation passes away
• Once the feeling has passed, you can restart stimulating your penis
• Repeat this cycle 5-6 times until you finally ejaculate
• Once you feel more confident with this technique, you can actually practice this after entering your partner. Start thrusting your partner until you feel you are close to ejaculation, stop thrusting and divert your attention to something else. Once the ejaculation feeling passes away, resume thrusting and stopping until you finally ejaculate.
• How to perform Masters and Johnson's 'squeeze' technique

Once you are fully aroused and feel you are close to ejaculation, squeeze the tip of the penis between your thumb and index finger (or your partner can squeeze it for you) for several seconds until the feeling of ejaculation passes away. Repeat this squeeze and release technique for as long as you can until you finally ejaculate.

What medications are used to treat PE?

• You need to see your local doctor to get medications prescribed for PE.
• Dapoxetine (Priligy) is the only medication that is specific to the treatment of premature ejaculation. It is taken 'on-demand' only, one to three hours before sexual intercourse.
• Some antidepressants have the side effect of delayed ejaculation and used for premature ejaculation. They include SSRIs like fluoxetine, paroxetine and sertraline and tricyclic antidepressant called clomipramine.
• If PE is associated with erectile dysfunction, Viagra, Cialis or Levitra may be prescribed by your doctor.
• Local anaesthetic creams and gels can reduce penile sensation and help premature ejaculation. They should be applied up to 30 minutes before sexual intercourse.
• Using two condoms can reduce penile sensation and help a man take longer to ejaculate.

Just remember

Premature ejaculation is a very common sexual problem in men and affects all ages. It can cause embarrassment and anxiety and affects a man's self-esteem. It can affect both partners emotionally and sexually. There are many treatments available including sex therapy, behavioural techniques and medications but you need to seek help early. It is very important for partners to discuss this openly and get help from a doctor or other health care professionals.