Premature Ejaculation?

 

What is Premature Ejaculation?

Premature ejaculation (PE) is when ejaculation happens sooner than a man or his partner would like during sex, within a defined period of time, usually less than 2 to 3 minutes. Occasional PE is also known as rapid ejaculation, premature climax or early ejaculation.PE might not be a cause for worry. But, it can be frustrating if it makes sex less enjoyable and impacts relationships. If it happens often and causes problems, your health care provider can help.

Some people think premature ejaculation (PE) is a disease or a problem that cannot be fixed. Others may think certain men are born with better control than others. These ideas are simply not true.

Many men feel stressed if they experience PE for any period of time. Men with PE and their partners can feel unhappy or embarrassed about their sexual relations. Treatment is available and these feelings can change.

If PE causes you (or your loved one) to worry or to feel stressed, then you should ask your health care provider for help. Remember that you are not alone, and your provider knows what to do. Together, you can find the underlying cause and find treatment.

How Does Ejaculation Work?

Ejaculation is the sudden, pleasurable release of semen through the penis. It is controlled by your brain (your central nervous system).When you are sexually stimulated, signals are sent up your spinal cord to your brain. When you reach a certain level of excitement, your brain tells your reproductive organs to “go!” This causes semen to be ejected through the penis (ejaculation).

Ejaculation has two phases: emission and expulsion.

• Phase 1: Emission
  Emission is when sperm moves from the testicles to the prostate. There it mixes with seminal fluid to make semen. The vasa deferentia are the tubes that help move the sperm from the testicles through to the prostate to the base of the penis. (When you are talking about just one of these tubes, it is called a vas deferens.)
• Phase 2: Expulsion
  Expulsion is when the muscles at the base of the penis contract. This forces semen out of the penis. Often, ejaculation and orgasm (climax) happen at the same time. Some men climax without ejaculating. In most cases, erections go away after this phase.

Premature Ejaculation and Erectile Dysfunction (ED) 

§  Sometimes PE is a problem for men who have erection problems like erectile dysfunction (ED).This is when men are not able to get or keep an erection that is firm enough for sex. Since an erection goes away after ejaculation, it can be tough to know if the problem is PE or ED. It is best to treat ED first because PE may not be a problem once the ED is treated.

     What causes premature ejaculation?

The exact cause of PE is not known, but there are many reasons why a man may have PE. There may be biological, chemical or emotional reasons. Below are some more specific causes.

Serotonin 

Serotonin is a natural substance in your body made by nerves. It helps to control the way the brain manages mood, emotion, sleep and sexual desire. High amounts of serotonin in the brain increase the time to ejaculation. Low amounts can shorten the time to ejaculation, and lead to PE.

Psychological Issues 

Psychological, or mental health, issues can be involved with PE and may include:

• Depression
• Anxiety
• Stress
• Guilt
• Unrealistic expectations about sex
• Lack of confidence
• History of sexual repression (blocked or bottled-up sexual feelings)
• Relationship problems

Taking care of emotional problems often helps.

Physical, chemical and emotional/psychological factors cause premature ejaculation.

Physical and chemical problems include:

• An underlying erectile dysfunction diagnosis.
• A hormonal problem with oxytocin levels, which has a role in sexual function in men. Other hormone levels that play a role in sexual function include luteinizing hormone (LH), prolactin and thyroid stimulating hormone (TSH)
• Low serotonin or dopamine levels, chemicals in the brain that are involved in sexual desire and excitement.
• A penis that is extra sensitive to stimulation.

Emotional or psychological causes include:

• Performance anxiety. Could be due to the nervousness of being with a new partner, anxiousness of having sex again after a long period of abstinence, lack of confidence, guilt, being overly excited or stimulated or other reasons.
• Stress.
• Relationship problems.
• Depression.

How is premature ejaculation diagnosed?

If premature ejaculation is interfering with your sex life, talk to your doctor. They will perform a physical exam and ask you some questions. Based on your answers, your doctor may order some lab work and will provide a diagnosis. They will also be able to answer your questions and reassure you that this is a common problem.  Your health care provider asks about your sex life and your health history. Your provider might also do a physical exam. If you have both early ejaculation and trouble getting or keeping an erection, your provider might order blood tests. The tests may check your hormone levels.

How is premature ejaculation treated?

There are many different treatments options for premature ejaculation depending on the cause. These include behavioral therapy, counseling and medications. Most causes of premature ejaculation are usually treated first with behavior therapy and/or counseling to help with emotional concerns, performance anxiety or stressors that may be contributing. Often more than one treatment approach may be tried at the same time.

Behavioral therapy

Behavioral therapy involves trying different methods to delay your orgasm. Its goal is to teach you how to control your body and your feelings. Methods include:

• Start and stop: With this technique, you or your partner stimulates your penis close to the point of orgasm then stops the stimulation for about 30 seconds until you regain control of your response. Repeat this “start and stop” approach three or four times before allowing yourself to orgasm. Continue practicing this method until you have gained good control.
• Squeeze therapy: With this technique, you or your partner stimulates your penis close to the point of orgasm then gently squeezes the head of your penis for about 30 seconds so that you begin to lose your erection. Repeat this technique a few times before allowing yourself to orgasm. Continue practicing this technique until you have gained control in delaying your orgasm.
• Distracted thinking: With this technique, the idea is to focus your attention on ordinary nonsexual things while you’re being sexually stimulated. Naming sequences are a good way to focus your attention. For example, visualize naming all the businesses you pass on your drive to the gym, naming all the players on your favorite sports team or naming all the products on the aisles of your favorite store.

Medical treatments

Several medical treatments may help people who have premature ejaculation. Some antidepressants seem to help delay ejaculation, including antidepressants called selective serotonin reuptake inhibitors (SSRIs). These antidepressants are available with your doctor’s prescription. However, the U.S. Food and Drug Administration (FDA) has not approved the use of these medicines to treat premature ejaculation. Also, antidepressants may cause side effects such as nausea, dry mouth and drowsiness. Antidepressants may also decrease your desire to have sex. Your doctor can help you decide if an antidepressant is right for you.

Medicines used to treat erectile dysfunction may also help prevent premature ejaculation. Your doctor may prescribe one of these medicines alone or in combination with an antidepressant.

Anesthetic creams can also be used to prevent premature ejaculation. These creams are applied to the head of the penis to make it less sensitive. Usually, the cream is applied about 30 minutes before sex and then washed off once it has decreased the feeling in your penis. The cream must be washed off before sex. If it is left on, it can cause a loss of erection and vaginal numbness.

Can premature ejaculation be prevented or avoided?

Premature ejaculation can be prevented or avoided, depending on what is causing it. Most of the time, using the behavioral methods listed below will work to prevent it.

Behavioral methods

Behavioral methods are helpful for more than 50% of people who have premature ejaculation.  In this type of treatment, you practice controlling your ejaculation, either alone or with a partner.

 In the start-and-stop method, you or your partner will stimulate your penis until you feel like you are about to have an orgasm. Then the stimulation stops for about 30 seconds. Once you regain control of your response, stimulation begins again. This process is repeated 3 or 4 times before you allow yourself to have an orgasm.

·         The squeeze method works in a similar way. When you feel like you are about to ejaculate, you or your partner will gently squeeze the head of your penis for about 30 seconds so that you begin to lose your erection. You repeat this process several times before you allow yourself to reach orgasm.

In addition to using a behavioral method, you may want to try thought distractions. For example, while you’re being sexually stimulated, think about the names of players on your favorite sports team.

Psychological assistance

Anxiety, depression, and other emotional issues can lead to premature ejaculation. For these issues, seeking the help of a psychologist, psychiatrist, or sex therapist may be helpful. Couples therapy may also help if relationship problems may be the cause.