Many men occasionally ejaculate sooner than they or their partner would like during sexual intercourse. As long as it happens infrequently, it's probably not cause for concern. However, if you regularly ejaculate sooner than you and your partner wish — usually, before intercourse begins or shortly afterward — you may have a condition known as premature ejaculation.
Premature ejaculation is the most common male sexual dysfunction. In the United States, premature ejaculation affects about one in five men ages 18 to 59. Although the problem is often assumed to be psychological, biology also may play a role.
In some cases, premature ejaculation is a secondary problem related to erectile dysfunction. Men who are anxious about obtaining or maintaining their erection during sexual intercourse may form a pattern of rushing to ejaculate.
Numerous treatments, often used in combination, are available to improve premature ejaculation.
Signs and symptoms
There's no medical standard for how long it should take a man to ejaculate. The primary sign of premature ejaculation is ejaculation that occurs before both partners wish in the majority of sexual encounters, causing distress for one or both partners. The problem can occur in all sexual situations, including masturbation, or may only occur during sexual encounters with another person.
Doctors often classify premature ejaculation as either primary or secondary:
·Primary premature ejaculation. You have primary premature ejaculation if you've experienced the problem for as long as you've been sexually active.
·Secondary premature ejaculation. You have secondary premature ejaculation if you developed the condition after having had previous, satisfying sexual relationships without ejaculatory problems.
Premature ejaculation is considered a psychological problem in some cases. Some doctors believe that early sexual experiences, especially those in which you may have hurried to reach climax in order to avoid being discovered, may establish a lifelong pattern. If you grew up in a family that considered sex dirty or sinful, you may also have developed guilty feelings that increase your tendency to rush through sexual encounters.
However, biological factors also may cause premature ejaculation. Some studies comparing men who experience premature ejaculation with those who don't have found differences between the two groups in certain hormone levels and in the sensitivity of their genitalia.
Various factors can increase your risk of premature ejaculation, including:
·Impotence. You may be at increased risk of premature ejaculation if you occasionally or consistently experience impotence. Fear of losing your erection may cause you to rush through sexual encounters.
·Health problems. If you have a medical concern that causes you to feel anxious during sex, such as a heart problem, you may have an increased likelihood of hurrying to ejaculate.
·Stress. Emotional or mental strain in any area of your life can play a role in premature ejaculation, often limiting your ability to relax and focus during sexual encounters.
·Certain medications. Rarely, drugs that influence the action of chemical messengers in the brain (psychotropics) may cause premature ejaculation.
When to seek medical advice
Talk with your doctor if you ejaculate sooner than you and your partner wish during most sexual encounters. The problem is common, and although you may feel you should be able to fix it on your own, you may need medical treatment to achieve and sustain a satisfying sex life.
Screening and diagnosis
Doctors diagnose premature ejaculation based on a detailed interview about your sexual history. Your doctor may ask a number of very personal questions and may want to include your partner in the interview. While it may be uncomfortable for both of you to talk frankly about sexual matters, the details you provide will help your doctor determine the cause of your problem and the best course of treatment. A mental health professional may help make the diagnosis.
Be prepared to answer questions about:
·Your religious upbringing
·Your early sexual experiences
·Your sexual relationships, past and present
·The circumstances in your life and in your sexual relationship at the time you began experiencing premature ejaculation
·Any conflicts or concerns within your current relationship
Your doctor will also want to know about your health history, including your use of prescription or recreational drugs, and may perform a general physical exam.
If you're experiencing premature ejaculation and erectile dysfunction, your doctor may order blood tests to check your male hormone levels.
While premature ejaculation doesn't increase your risk of serious health problems, it can cause distress in your personal life, including:
·Relationship strains. The most common complication of premature ejaculation is conflict between you and your partner. If premature ejaculation is straining your relationship, ask your doctor about including couple's therapy in your treatment program.
·Fertility problems. Premature ejaculation can occasionally make fertilization difficult or impossible for couples who are trying to become pregnant. If premature ejaculation isn't effectively treated, you and your partner may need to consider infertility treatment.
Treatment options for premature ejaculation include sexual therapy, medications and psychotherapy. Two or more of these treatment approaches often are used in combination.
In some cases, sexual therapy may involve simple steps such as masturbating an hour or two before intercourse so that you're able to delay ejaculation during sex. Your doctor also may recommend avoiding intercourse for a period of time and focusing on other types of sexual play so that pressure is removed from your sexual encounters.
Your doctor may instruct you and your partner in the use of a method called the squeeze technique. This method works as follows:
·Step 1. Begin sexual activity as usual, including stimulation of the penis, until you feel almost ready to ejaculate.
·Step 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.
·Step 3. After the squeeze is released, wait for about half a minute, 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.
·Step 4. If you again feel you're about to ejaculate, have your partner repeat the squeeze process.
By repeating this as many times as necessary, you can reach the point of entering your partner without ejaculating. After a few practice sessions, the feeling of knowing how to delay ejaculation may become a habit that no longer requires the squeeze technique.
Certain antidepressants, including the group called selective serotonin reuptake inhibitors (SSRIs), cause a side effect of delayed sexual climax in many people. Although these drugs aren't approved by the Food and Drug Administration for the treatment of premature ejaculation, studies have shown them to be safe and effective for this condition, and many doctors prescribe them for this purpose.
Your doctor may prescribe one of several selective serotonin reuptake inhibitors (SSRIs), including sertraline (Zoloft), paroxetine (Paxil, Paxil CR) or fluoxetine (Prozac, Prozac Weekly, Serafem), to help you delay ejaculation. If the timing of your ejaculation doesn't improve, your doctor may prescribe the tricyclic antidepressant clomipramine (Anafranil), which also has been shown to benefit men with this disorder.
You may not need to take these medications on a daily basis to prevent premature ejaculation. Taking a low dose several hours before you plan to have sexual intercourse may be sufficient to improve your symptoms. If you are very sexually active or don't respond to as-needed dosing, your doctor may recommend taking your prescribed medication daily. Talk with your doctor to determine the best medication schedule for your needs.
Topical anesthetic creams containing lidocaine and prilocaine also may help improve premature ejaculation by reducing sensation in your penis. Before use, make certain you have no history of a reaction to lidocaine or prilocaine. You can apply an anesthetic cream a short time before intercourse and wipe it off when your penis has lost enough sensation to help you delay ejaculation. Be sure to thoroughly remove the cream before intercourse so that your partner doesn't experience genital numbness.
In many cases, sexual therapy or medications can resolve premature ejaculation. However, if personal issues — such as conflict between you and your partner or mental health problems — appear to play a significant role in causing premature ejaculation, your doctor may recommend psychotherapy.
This approach, also known as counseling or talk therapy, involves talking about your relationships and experiences with a mental health professional. These talk sessions can help you find effective ways of coping with and solving problems. For many couples affected by premature ejaculation, talking with a therapist together may produce the best results.
In some cases, premature ejaculation may be caused by poor communication between partners or a poor understanding of the differences between male and female sexual functioning. Women typically require more prolonged stimulation than men do to reach orgasm, and this difference can cause sexual resentment between partners and add pressure to sexual encounters. For many men, feeling pressure during sexual intercourse increases the risk of premature ejaculation.
Open communication between sexual partners, as well as a willingness to try a variety of approaches to help both partners achieve satisfaction, can help reduce conflict and performance anxiety. If you're not satisfied with your sexual relationship, talk with your partner about your concerns. Try to approach the topic in a loving way and to avoid blaming your partner for your dissatisfaction.
If you're not able to resolve sexual problems on your own, talk with your doctor. He or she may recommend seeing a therapist who can help you and your partner achieve a fulfilling sexual relationship.
Many men who experience premature ejaculation feel frustrated and even ashamed. It may help you to know that this problem is common and often very treatable. Talk to your doctor if it's causing distress for you or your partner.
While you explore treatment options, consider taking the pressure off the sexual side of your relationship. Some doctors recommend avoiding intercourse entirely for a short time and sharing other forms of physical pleasure and affection instead. Connecting in this way can help you re-establish a satisfying physical bond with your partner and lay the foundation for a fulfilling sexual relationship.
Mar 2, 2005
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