Premature Ejaculation

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's 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
• Are 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

Talk with your doctor if you ejaculate sooner than you wish during most sexual encounters. It's common for men to feel embarrassed about discussing sexual health concerns, but don't let that keep you from talking to your doctor. Premature ejaculation is a common and treatable problem.

The exact cause of premature ejaculation isn't known.

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.
• Anxiety.
• Relationship problems

A number of biological factors may contribute to premature ejaculation, including:
• Abnormal hormone levels
• Abnormal levels of brain chemicals called neurotransmitters
• Abnormal reflex activity of the ejaculatory system
• Certain thyroid problems
• Inflammation and infection of the prostate or urethra
• Inherited traits
• Nerve damage from surgery or trauma (rare)

Treatment Approaches

Behavioral techniques

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:
1. Begin sexual activity as usual, including stimulation of the penis, until you feel almost ready to ejaculate.
2. 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.
3. 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.
4. If you again feel you're about to ejaculate, have your partner repeat the squeeze process.


Topical anesthetics

Oral medications
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.
• Analgesics.
• Phosphodiesterase-5 inhibitors.

Counseling
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