Premature ejaculation
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Premature ejaculation, also known as rapid ejaculation, or by the Latin term ejaculatio praecox, is the most common sexual problem in men, characterized by a lack of voluntary control over ejaculation. Masters and Johnson stated that a man suffers from premature ejaculation if he ejaculates before his partner achieves orgasm in more than fifty percent of his sexual encounters. Other sex researchers have defined premature ejaculation as occurring if the man ejaculates within two minutes of penetration; however, a survey by Alfred Kinsey in the 1950s demonstrated that three quarters of men ejaculated within two minutes of penetration in over half of their sexual encounters. Today, most sex therapists understand premature ejaculation as occurring when a lack of ejaculatory control interferes with sexual or emotional well-being in one or both partners. An estimated thirty percent of men suffer from premature ejaculation on a consistent basis.
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Causes
Most men experience premature ejaculation at least once in their lives. Often adolescents and young men experience premature ejaculation during their first sexual encounters, but eventually learn ejaculatory control. Because there is great variability in both how long it takes men to ejaculate and how long both partners want sex to last, researchers have begun to form a quantitative definition of premature ejaculation. Current evidence supports an average intravaginal ejaculation latency time (IELT) of five to seven minutes. If the disorder is defined as an IELT percentile below 2.5, then premature ejaculation could be suggested by an IELT of less than about one and a half minutes.
Scientists have long suspected a genetic link to premature ejaculation. In one study, ninety-one percent of men who suffered from lifelong premature ejaculation also had a first-relative with lifelong premature ejaculation. Other researchers have noted that men who suffer from premature ejaculation have a faster neurological response in the pelvic muscles. Simple exercises commonly suggested by sex therapists can significantly improve ejaculatory control for men with premature ejaculation caused by neurological factors. Often, these men may benefit from anti-anxiety medication or selective serotonin reuptake inhibitors, such as sertraline or paroxetine. Some men prefer using anaesthetic creams; however, these creams may also deaden sensations in the man's partner, and are not generally recommended by sex therapists.
Psychological factors also commonly contribute to premature ejaculation. While men sometimes underestimate the relationship between sexual performance and emotional well-being, premature ejaculation can be caused by temporary depression, stress over financial matters, unrealistic expectations about performance, a history of sexual repression, or an overall lack of confidence. Interpersonal dynamics strongly contribute to sexual function, and premature ejaculation can be caused by a lack of communication between partners, hurt feelings, or unresolved conflicts that interfere with the ability to achieve emotional intimacy. Neurological premature ejaculation can also lead to other forms of sexual dysfunction, or intensify the existing problem, by creating performance anxiety. In a less pathological context, premature ejaculation could also be simply caused by extreme arousal.
Some physical illnesses, such as a prostate infection, are also known to induce premature ejaculation. In other instances, premature ejaculation is caused by a physical injury that affects the nervous system. Certain medications, such as cold medications containing pseudoephedrine, also cause premature ejaculation. Sexual dysfunction is a common symptom of psychiatric afflictions ranging from bipolar disorder to post-traumatic stress disorder. In these cases, it is best to discuss the issues openly with a physician.
Treatment
The following information is NOT intended to replace the advice of a doctor.
Depending on severity, chronic premature ejaculation can be significantly reduced, or completely cured. Most sex therapists prescribe a series of exercises to enable the man to gain ejaculatory control. While the exercises are intended for men who suffer from premature ejaculation, other men can use the exercises to enhance their sex lives.
By far the most common exercise is the so-called start-stop technique. While the technique varies, the purpose is to get the male accustomed to maintaining an erection for an extended period of time while gradually increasing sexual tolerance. In doing this exercise, the male obtains an erection through self-stimulation, or masturbation. After achieving an erection, he stops stimulating himself until he begins to lose his erection; at that point, he begins to stimulate himself again. Gradually, over a period of several weeks, he is able to stimulate himself for longer periods of time, eventually gaining ejaculatory control. In order for this technique to be successful, the male should avoid feeling discouraged if he ejaculates rapidly; instead, he should use his sexual responses to learn how to vary the technique in a way that most benefits him. The male can choose to integrate his partner into these exercises.
Kegel exercises, which consist of flexing the pelvic muscle, also play an extremely important role in achieving ejaculatory control. A person can locate his or her pelvic muscle by using it to abruptly stop the flow of urine while urinating.
Kegel exercises are easy and can be performed inconspicuously at any time, unlike the more difficult start-stop technique. The exercises vary, but their aim is to strengthen the pelvic muscle. The male might flex his pelvic muscle for ten seconds, relax for ten seconds, and then repeat the cycle for as long as he can. Or he might flex the muscle ten times, relax, and flex it ten more times, and so forth. Eventually he will be able to flex his pelvic muscle for longer periods of time. Together with these exercises, he should practice learning to release all pressure from the pelvic muscle, which enables the relaxation necessary for sexual satisfaction. The male might also benefit from performing these exercises while erect. While Kegel exercises are helpful in overcoming premature ejaculation, they have been shown to improve the sexual response in both men and women.
The male's partner is usually integrated into the exercises. He or she can stimulate the partner using the stop-start technique. When the male has achieved some level of ejaculatory control, he can insert his penis into his partner's vagina or anus without thrusting. After his penis becomes accustomed to his partner's vagina or anus, thrusting can be gradually included, according to the male's abilities, using the stop-start technique. In less severe cases, the male might overcome his premature ejaculation early on, making exercises with his partner superfluous.
Men who suffer from premature ejaculation should also practice other forms of relaxation, such as taking long, deep breaths. SSRI antidepressants have been shown to delay ejaculation in twenty to sixty percent of men. While drug and alcohol abuse are linked to several forms of sexual dysfunction, men who suffer from premature ejaculation might benefit from alcohol in very moderate amounts prior to intercourse, such as a glass of wine over dinner. Other pharmaceutical products known to delay male orgasm are; opioids, cocaine, and diphenhydramine.
The male's partner plays an essential role in enabling him to overcome premature ejaculation. Without understanding and emotional support, the male is unlikely to obtain the level of relaxation required for sexual satisfaction. Both the male and his partner should communicate their feelings openly and with sensitivity. The male should learn to sexually satisfy his partner, orally or otherwise, while he or she works with him to overcome his premature ejaculation.
With the correct motivation, premature ejaculation can usually be treated and totally cured.
Drug treatment
Although anti-anxiety medications such as the benzodiazepines and selective serotonin reuptake inhibitors (SSRIs) are already used in the treatment of premature ejaculation, they are not drugs specifically targeted to treat this condition.
A serotonin transport inhibitor drug intended to specificially target premature ejaculation, with the generic name of dapoxetine, is currently undergoing Phase III clinical evaluation.
References
- Metz, Michael E. and Barry W. McCarthy. Coping with Premature Ejaculation. Oakland, CA: New Harbinger Publications. 2003.
- Waldinger MD, Quinn P, Dilleen M, Mundayat R, Schweitzer DH, Boolell M. A multinational population survey of intravaginal ejaculation latency time. J Sex Med. 2005 Jul;2(4):492-7.
- Waldinger MD, Zwinderman AH, Olivier B, Schweitzer DH. Proposal for a definition of lifelong premature ejaculation based on epidemiological stopwatch data. J Sex Med. 2005 Jul;2(4):498-507.
See also
External links
- Premature ejaculation on emedicine.com
- xessentials.co.uk (commercial) website a range of "delay" condoms containing benzocaine to desensitize the penis and help delay ejaculation.Template:Link FA
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