Premature ejaculation

Definition

Premature ejaculation occurs when a man has an orgasm sooner during intercourse than he or his partner wishes.

Causes, incidence, and risk factors

Premature ejaculation is a common complaint. It is only rarely caused by a physical problem.

Premature ejaculation early in a relationship is most often caused by anxiety and too much stimulation. Guilt and other psychological factors may also be involved. The condition usually improves without treatment.

Symptoms

The man ejaculates before he or his partner would like (prematurely). This may range from before penetration to a point just after penetration. It may leave the couple feeling unsatisfied.

Signs and tests

There usually are no abnormal findings with the condition. The health care provider can get more useful information from interviewing the person or couple.

Treatment

Practice and relaxation should help you deal with the problem. Some men try to distract themselves by thinking nonsexual thoughts (such as naming baseball players and records) to avoid getting excited too fast.

There are several helpful techniques you can try.

The "stop and start" method:

• This technique involves sexually stimulating the man until he feels like he is about to reach orgasm. Stop the stimulation for about 30 seconds and then start it again. Repeat this pattern until the man wants to ejaculate. The last time, continue stimulation until the man reaches orgasm.

The "squeeze" method:

• This technique involves sexually stimulating the man until he recognizes that he is about to ejaculate. At that point, the man or his partner gently squeezes the end of the penis (where the glans meets the shaft) for several seconds. Stop sexual stimulation for about 30 seconds, and then start it again. The person or couple may repeat this pattern until the man wants to ejaculate. The last time, continue stimulation until the man reaches orgasm.

Antidepressants such as Prozac and other selective serotonin reuptake inhibitors (SSRIs) may be helpful because one of their side effects is to prolong the time it takes to reach ejaculation.

You can apply a local anesthetic cream to the penis to reduce stimulation. Decreased feeling in the penis may delay ejaculation. Condom use may also have this effect for some men.

If these distraction techniques cause difficulty maintaining an erection, medications used for erectile dysfunction may help.

Evaluation by a sex therapist, psychologist, or psychiatrist may help some couples.

Expectations (prognosis)

In most cases, the man is able to learn how to control ejaculation through education and by practicing the simple techniques outlined. Chronic premature ejaculation may be a sign of anxiety or depression. A psychiatrist or psychologist can help treat these conditions.

Complications

• Very early ejaculation, before the man is able to enter the vagina, may prevent a couple from achieving a pregnancy.
• A continued lack of control over ejaculation may cause one or both partners to feel sexually dissatisfied. It may be lead to sexual tension or discord in the relationship.

Calling your health care provider

Call for an appointment with your health care provider if you are having a problem with premature ejaculation and it does not respond to techniques such as those described above.

Prevention

There is no way to prevent this disorder. However, relaxation can make it less likely to occur.

References

Lue TF, Broderick GA. Evaluation and nonsurgical management of erectile dysfunction and premature ejaculation. In: Wein AJ, ed. Campbell-Walsh Urology. 9th ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 22.

Shafer LC. Sexual disorders and sexual dysfunction. In: Stern TA, Rosenbaum JF, Fava M, Biederman J, Rauch SL, eds. Massachusetts General Hospital Comprehensive Clinical Psychiatry. 1st ed. Philadelphia, Pa: Mosby Elsevier; 2008:chap 36.