Premature ejaculation, abbreviated to PE, affects as many as 30% to 40% of the male population according to WebMD, and is reported as frequently as erectile dysfunction.
What Is Premature Ejaculation?
DSM-5, the current edition of the handbook used by doctors worldwide, defines premature ejaculation as a sexual disorder that meets all of the following criteria:
- Intravaginal ejaculatory latency time (IELT – the time between penetration and ejaculation) is under 1 minute or ejaculation takes place before the intercourse.
- The condition has been experienced by the patient in 75% - 100% of all intercourses within the past 6 months or more.
- The condition leaves the patient in distress or causes tension between the patient and their sexual partner.
- The condition cannot be qualified as a side effect of some medication or substance or a symptom of another medical/mental condition.
According to the World Health Organization, there’s another important factor to be considered: PE is a condition over which the patient has little or no voluntary control.
Chris McMahon also claims that PE may be diagnosed even when IELT equals to 2 minutes or less (0-1 minute is ‘severe PE’).
Causes of PE and available treatments
There are 4 main subtypes of premature ejaculation:
- Lifelong – PE has always been experienced by the patient starting from the first ever sexual activity;
- Acquired – PE that develops at a certain moment of the patient’s life;
- Natural variable – early ejaculation is experienced only occasionally;
- Premature-like ejaculatory dysfunction – ejaculation time is perceived as rapid although it is actually normal.
Chris McMahon, Marcel Waldinger, Yu-Chao Hsu et al agree that lifelong premature ejaculation is due to physiological factors whereas acquired PE, natural variable PE and premature-like ejaculatory dysfunction may be caused by psychological factors. Erectile dysfunction and urinary tract infections may also cause acquired PE in some cases.
Physiological causes of PE
Low Levels of Serotonin or Other Serotonin-Related Conditions
Evidence shows that PE may be observed more frequently in men with low levels of serotonin in the brain or in those in whom serotonin doesn’t function properly – like in a genetically determined condition that causes hypersensitivity of serotonin receptors in a man’s central nervous system. These conditions can be managed with the help of selective serotonin-reuptake inhibitors (SSRIs) – the medications usually classified as antidepressants but showing proven efficacy in increasing the duration of intercourse.
Dapoxetine, a common SSRI developed specifically for fighting PE, is the first-line treatment for patients with serotonin deficiency or other related conditions.
Priligy, a dapoxetine-based medication, is taken 1-3 hours prior to expected intercourse, one 30mg tablet at a time. Its efficacy is high with 70% of the patients describing their control over ejaculation and the duration of intercourse as “fair”, “good” or “very good” after treatment, according to McCarty and Dinsmore.
Increased Penis Sensitivity
Increased sensitivity of penile head that leads to premature ejaculation can be managed with the help of topical anesthetics: lidocaine and prilocaine. Remember that local numbing agents can also reduce your partner’s sensitivity, so it’s best to apply these before wearing a condom or shower after their use and before sex.
Up to 50% of men with this thyroid dysfunction are also diagnosed with PE, as reported by The Journal of Clinical Endocrinology and Metabolism. The research by Cihan et al shows that patients who have been treated for hyperthyroidism and achieved euthyroidism report a statistically significant increase in intercourse duration.
Urinary Tract Infections
There is a proven correlation between acute or chronic UTIs as well as prostate infections and PE. The available treatment options include antibacterial medications and BPH therapy. The choice of the appropriate antibiotic depends on what exact microorganism is causing the infection, so treatment should only be administered after the cause of the UTI has been determined. BPH therapy may include medical treatment with alpha blockers, 5-alpha reductase inhibitors or tadalafil (Cialis), or surgery to remove parts of enlarged prostate tissue.
ED contributes to premature ejaculation, as stated by Laumann et al. Men with ED know they may lose erection during the intercourse and rush to ejaculate early. ED treatment helps to extend the duration of intercourse and get rid of premature ejaculation. The treatment may involve the use of PDE-5 inhibitors (often together with SSRIs), Alprostadil injections or suppositories, vacuum devices, penile implants or surgery.
Psychological causes of PE
- Performance Anxiety
- Relationship Problems
- Previous Negative Experience or Feeling of Guilt or Shame that makes men rush through intercourse. Typical for cultures and social groups where sex in considered to be something shameful or intended solely for procreation, not physical pleasure
- Early Conditioning when boys who try to ejaculate as quickly as possible during masturbation to avoid getting caught may tend to suffer from premature ejaculation in adulthood
These psychological conditions can be managed with the help of counseling and do not require medical treatment, except for severe cases of anxiety, depression, etc. Psychology Today also recommends using “squeeze” and “stop-start” techniques, which, when used during the intercourse, may help you reach the desirable duration thereof.
When using the “squeeze” technique, a man gently squeezes the part of his penis where the head joins the shaft when he feels he is about to orgasm. Holding the penis like this for 10-20 seconds dulls the sensation and makes it possible to continue the intercourse. The process may be repeated as many times as needed.
The “stop-start” technique involves pausing the intercourse when the man feels he is about to ejaculate and continuing it again after the urge to orgasm goes away.
Studies report overall PE treatment success rates of over 89%.
- 30% - 40% of all men have PE - https://www.webmd.com
- Criteria for diagnosis of premature ejaculation - https://www.theravive.com
- PE definition by WHO - https://www.sciencedirect.com
- PE may be characterized by IELT of up to 2 minutes according to Chris McMahon - https://www.ncbi.nlm.nih.gov
- 4 types of premature ejaculation - https://www.ncbi.nlm.nih.gov
- Etiology of acquired PE - https://www.ncbi.nlm.nih.gov
- Etiology of lifelong PE - https://www.ncbi.nlm.nih.gov
- Etiology of different types of PE - https://www.sciencedirect.com
- Serotonin and premature ejaculation - https://www.europeanurology.com
- Efficacy of PE treatment with dapoxetine - https://www.ncbi.nlm.nih.gov
- 50% of men with hyperthyroidism also have premature ejaculation - http://www.cenegenics.com
- Hyperthyroidism treatment increases intercourse duration - https://www.ncbi.nlm.nih.gov
- Association between UTI and PE - https://www.jurology.com
- Association between ED and PE - https://www.nature.com
- Early conditioning as a factor of developing ejaculative disorders in adulthood - http://www.medic8.com
- Using “squeeze” and “stop-start” techniques to manage PE - https://www.psychologytoday.com
- PE treatment works in 89.2% of the patients - https://www.ncbi.nlm.nih.gov