Premature Ejaculation” Prevalent but Poorly understood- The facts

Premature ejaculation is a common disorder in men of all ages. Because the condition is often not reported, surveys of premature ejaculation reveal a low prevalence. Almost all males report of having had an episode(s) of premature ejaculation at some point in time. However, the sensitive nature of the disorder means all data are underestimates as most men are unlikely to brag about this ailment.

Most data falsely indicate that the disorder is common only in Caucasians. However, because of cultural values, social taboos and lack of medical access, Blacks, Hispanics and Asians are underrepresented in most studies. Anecdotal reports indicate that premature ejaculation is present in all cultures and communities. As men start to come out of their closets, it is becoming realized that premature ejaculation is much more common than previous estimates.

The Pathology

The majority of men have experienced premature ejaculation at least once in their lives. Frequently, adolescent teenagers and young men experience "premature" ejaculation during their initial sexual encounters. The vast majority learn how to control the problem and a few start experimental home based therapies.

One episode of premature ejaculation is never a problem, however, if it occurs on a very regularly basis than one wishes (usually before intercourse or orgasm), then one has a disorder known as premature ejaculation. Premature ejaculation is the most common male sexual disorder. In the United States, premature ejaculation affects nearly 20% of males between the ages of 18-60. The major cause of premature ejaculation is believed to be psychological, but occasionally some organic causes are also responsible.

In a number of cases, premature ejaculation is secondary –mainly due to anxiety, mental stress, preoccupation with satisfying a female and fears about maintaining an erection during sex.  Over the years numerous treatments have been postulated to help treat this condition. Some of these are outright based on quack medicine whereas others may help to some extent.

Signs and symptoms

There are no set guidelines to determine what early ejaculation is. The question remains: “Is the man having an orgasm at his regular time or is the female taking too long to have an orgasm”? The primary sign of the disorder is that ejaculation occurs before either the male or the female can reach orgasm, causing anxiety/distress in one or both the partners. Premature ejaculation is not always a problem associated with sexual intercourse, but may also occur during foreplay, masturbation and even simply fondling or cuddling and may not even involve a partner.

Causes

The majority of causes of premature ejaculation are thought to be psychological. Early sexual experiences, family upbringing, rigid family social life an upbringing where sex is always thought of as dirty, taboo or evil, leads to guilty feelings which eventually may express as premature ejaculation.

Premature ejaculation can be caused by temporary depression, financial stress, unrealistic performance anxiety, history of sexual repression and an overall lack of confidence. Conflicts in interpersonal relationship, emotional torment, unresolved conflicts and dynamics strongly contribute to sexual dysfunction such as premature ejaculation.

Others have claimed that perhaps the genitalia of some men are ultra sensitive to the touch of the female genitalia and perhaps there may be altered levels of hormones. No scientific data supports such theories. Finally, some individuals may be taking some certain medications (anti psychotics) which may cause premature ejaculation.

When to seek medical advice

The major problem with premature ejaculation and treatment is that many males never seek treatment or see a doctor. For whatever reason, the treatment and diagnosis of premature ejaculation is always delayed. Treatment is much easier in the early stages of the disorder and pretty complex when a male presents at much older age.

Screening and diagnosis

The diagnosis of premature ejaculation is based on the individual’s history. The history and the initial interview are the most difficult part of the entire process as intimate sexual details are obtained. However, frank details about the problem, can lead to the most effective treatment. In order to diagnose the cause, sexually intimate questions may involve your:

• religious upbringing
• early sexual experiences
• past and present sexual relationships
• when premature ejaculation started
• conflicts or concerns within your current relationship
• feelings of guilt, anxiety as related to performance
• use of medications
• illicit drug use

Complications

Premature ejaculation is not a life threatening disorder. However, the disorder can have severe repercussions in one‘s personal life and relationship. Sometimes, premature ejaculation can make conceiving difficult if one continues to spurt the sperm on the bed or the floor instead of the vagina.

Treatment

There are varied treatments for this condition and like everything in medicine- one treatment may not be helpful for all individuals. Occasionally a combination of treatments is used. The essence of all treatments is to combine sexual therapy, medications and psychotherapy for the best results.

Sex therapy

Some sexologists recommend that individuals masturbate and hour or two before the sexual intercourse. This enables one to delay the ejaculation during sex. Other sexual activities such as foreplay are encouraged to relieve the anxiety of the actual process of sexual intercourse. Masturbation is infact, used by normal men to prolong their sexual activity. It is believed that masturbation before sexual activity decreases the amount of desire/intensity the individual feels, thereby giving him more control over the penis. However, the results in men with premature ejaculation are variable. Some claim that there is no benefit and others claim that after masturbation, they lose the desire to have sex.

Squeezing techniques

Various squeezing techniques have been developed to prevent premature ejaculation and some have helped. It is recommended that the partner can squeeze the end of the penis when the male is just about to ejaculate. The partner has to maintain the squeeze for a few seconds until the urge to ejaculate diminishes. After the urge is over, the individual can resume the sexual activity and repeat the process. The theory is that by repeating this maneuver numerous times, the male will finally be able to have sexual intercourse without ejaculation. This technique is believed to train the penis to delay ejaculation.

However, follow-up of patients who have used this technique claim that is a poor method to manage premature ejaculation. In short, it sucks.

Medications

Numerous antidepressants drugs have been shown to delay ejaculation in men treated for various psychiatry disorders. The SSRIs class are considered the most effective treatment for premature ejaculation. The drugs include paroxetine, fluoxetine and sertraline. The prolonged use of these drugs is only limited by their side effects. Recently a new SSRI (dapoxetine) that can be taken only when needed is undergoing going clinical trials.

Other medical agents known to delay ejaculation are opioids, cocaine, and marijuana. However, this may not be appropriate as the drugs are addictive and have legal implications.

The majority of these medications do not have to be taken on a daily basis to prevent premature ejaculation. One takes the medication an hour before planning to have sexual intercourse. For those who initially do not respond to these drugs, the dose may be adjusted or another medication can be tried.

Topical creams

Various topical anesthetic creams are available that may help improve premature ejaculation. The local anesthetic work by decreasing the sensation in the penis. One usually applies the local anesthetic 30-45 minutes before sex. The local anesthetic causes the penis to loose sensation. One has to wipe the anesthetic off before intercourse. Using the anesthetic cream as a lubricant will also cause numbness of the female vagina and cervix. This is a poor man’s version of drug treatment. The effect of the local anesthetic is very short lived and it often fails to work. Most women hate these creams because it numbs their genitalia. Best to leave these topical anesthetic creams to numb the painful hemorrhoids.

Psychotherapy

Psychotherapy or counseling, with the partner is an essential component of treatment.  With understanding and emotional support, the male is likely to obtain the level of relaxation required for sexual satisfaction. Both the male and the partner are encouraged to communicate freely and with sensitivity. While the premature ejaculation is being treated, the male is encouraged to satisfy the partner orally, or if the partner wants, anally.

By increasing the knowledge of both partners about their sexual responses and responsibilities, the sexual tension can greatly be reduced. All sexual activity should be done without any pressure or tension and performed in a private relaxed environment.

Latex sheaths

Today, various types of external latex rigid sheathes are available. Basically these devices are worn over the penis and fastened around the pelvis with a belt. The penis is placed inside a plastic dildo and it is the actual sheath which is placed inside the vagina. The sheath prevents the penis from getting stimulated from the vagina walls and helps regain control of their ejaculation. This technique has not been useful as many women claim that they would rather use a “dildo” instead- and millions do.

Condoms

Wearing ultra thick condoms has also been suggested as a remedy for premature ejaculation. The condom reduces the sensitivity of the penis and prevents rapid arousal. Some claim that wearing two condoms may be required at times to decrease the penile sensitivity. Condom use also protects against STDs. However, many individuals do claim that frequently they ejaculate while trying to get the condom on.

Sexual positions

Some sexologists maintain that the entire problem can be solved by changing the position for sex. It is said that the "missionary" position (man on top of the female) is not the best position while attempting to control ejaculation. One should reverse the position by letting the female be on top. Everyone agrees that ejaculation is delayed in this position, but females claim that they have a difficult reaching orgasm in this position. So alternating the position and squeezing the tip of the penis may be part of the answer.

Hypnosis

Some individuals indicate that hypnosis has been helpful in the treatment of premature ejaculation. However all these data are anecdotal and have no scientific basis. As to how hypnosis prevents premature ejaculation remains a mystery. Some claim that in the lethargic or sedated state they are no longer able to have an erection nor have any sexual desire. This is not a recommended therapy today.

Prostate massage

Based on the technique of squeezing the tip of the penis prior to ejaculation, some even recommend squeezing the prostate or pulling the testis downwards. The testis and prostate gland do play a very important role in sexual arousal. The glands do get engorged and become sensitive during intercourse. The advocates of prostate squeezing claim that the prostate should be massaged just prior to ejaculation. The squeezing of the prostate is done to decrease the pleasurable sensations and prevent the ejaculation. This completely fool hardy idea should not be propagated. Prostate squeezing and testicle pulling is not safe and can cause serious injuries to internal organs and be very painful. The advocates for this technique, have obviously, never had their prostate/testes squeezed.

Nutrition supplements

Everyday on the internet and glossy magazines, there are ads about nutrition supplements to treat premature ejaculation. The majority of these supplements are based on the science of quackery and do not work. If one is interested in getting adequately treated, the best advice is to avoid this hodgepodge of non tested chemicals and see a physician. Not only are these supplements expensive but a large percentage of them are fake pills. Like most things in America- buyer beware.

Conclusion

Premature ejaculation is one of the most common sexual problems. The condition is most often described as being an inability to delay ejaculation to a point when it is mutually desirable for both partners. The definition of when ejaculation is premature is subjective. While some men have difficulty controlling their orgasm before entry, females think 5-10 minutes of copulation is too little time. How long a man is able to last is not the important factor in diagnosing premature ejaculation. The crucial issue is if both partners are satisfied with the length of coitus.

In some cases, premature ejaculation may be caused by poor communication between partners and unrealistic expectations. Many men and women have little knowledge of their partner’s sexual needs and what satisfies them. Women typically require more foreplay and prolonged stimulation than men do to reach orgasm, and this lack of understanding causes tension and undue stress. For many men, feeling anxiety and the pressure to perform frequently leads to premature ejaculation. Drug treatment is not always the answer, and a visit to a psychologist or sex therapist may help resolve the problem.