Premature Ejaculation

What Is Premature Ejaculation?

Premature Ejaculation (PE) is one of the most prevalent forms of male sexual dysfunction, affecting a significant proportion of men at some point in their lives. It is characterised by a persistent or recurrent pattern of ejaculation that occurs during partnered sexual activity, within approximately one minute of vaginal penetration and before the individual wishes it. This definition, while providing a clinical benchmark, is nuanced; the core of the issue lies in the lack of control over ejaculation and the resulting distress, bother, or frustration it causes for the man and/or his partner.

It's crucial to understand that Premature Ejaculation is a recognised medical condition, not a personal failing or a reflection of masculinity. The impact often extends beyond the bedroom, potentially leading to:

• Emotional distress: Feelings of embarrassment, guilt, anxiety, and low self-esteem.
• Relationship strain: Avoidance of intimacy and communication difficulties with a partner.
• Reduced sexual satisfaction: For both the individual and their partner.

In the UK, studies suggest that up to 1 in 3 men report experiencing Premature Ejaculation, highlighting just how common this issue is. Despite its prevalence, many men are reluctant to seek help due to stigma or embarrassment. However, acknowledging the problem and consulting a healthcare professional is the first and most critical step toward effective management and finding the right Premature Ejaculation treatment. Proper diagnosis is essential to rule out other underlying conditions and to tailor a treatment plan that addresses the specific type and cause of PE.

What Causes Premature Ejaculation?

The exact cause of Premature Ejaculation is often multifactorial, involving a complex interplay of psychological and biological factors. For many years, it was believed to be purely psychological, but modern research confirms that biological mechanisms play a significant role. Understanding these potential causes is key to identifying the most appropriate Premature Ejaculation treatment.

Psychological and Emotional Factors

These are often contributing factors, particularly in cases of Acquired Premature Ejaculation (where PE develops after a period of normal sexual function).

• Performance Anxiety: This is a major contributor. Worrying about satisfying a partner or about previous episodes of PE can create a cycle of anxiety that makes the problem worse.
• Stress and Mental Health: General life stress, financial worries, and work-related pressure can interfere with sexual function. Conditions like depression and anxiety disorders are also strongly linked to PE.
• Relationship Issues: unresolved conflicts, poor communication, or a lack of intimacy with a partner can contribute to sexual dysfunction.
• Early Sexual Experiences: Conditioning from rushed or anxious early sexual encounters, where quick ejaculation was the goal, can sometimes establish a lifelong pattern.
• Guilt or Religious Beliefs: Negative feelings about sex can sometimes manifest as sexual dysfunction.

Biological and Physical Factors

These factors are increasingly recognised as primary drivers, especially in Lifelong Premature Ejaculation.

• Abnormal Serotonin Levels: Serotonin is a key neurotransmitter in the brain that helps regulate mood, sleep, and ejaculation. Research indicates that men with lifelong PE may have lower levels of certain serotonin receptors or altered serotonin activity, leading to a shorter ejaculatory latency (time to ejaculation).
• Hormonal Imbalances: Abnormal levels of thyroid hormones or sex hormones can sometimes contribute to PE.
• Genetic Predisposition: Evidence suggests that PE can run in families, indicating a possible genetic component that influences serotonin pathways or nerve sensitivity.
• Hyperactive Reflexes: A generally overactive ejaculatory reflex may be a primary cause for some men.
• Inflammation and Infection: Conditions such as prostatitis (inflammation of the prostate gland) or urethritis can cause irritation and speed up ejaculation.
• Neurological Conditions: Nerve damage from conditions like multiple sclerosis or after pelvic surgery can sometimes affect ejaculatory control.

Other Contributing Factors

• Erectile Dysfunction (ED): There is a strong link between PE and ED. A man who is anxious about achieving or maintaining an erection may rush sexual intercourse, leading to Premature Ejaculation. Conversely, the anxiety from PE can sometimes trigger ED.
• Substance Use: While alcohol and illicit drugs can sometimes delay ejaculation, withdrawal from certain substances can have the opposite effect.

What Are The Types of Premature Ejaculation?

Clinicians typically classify Premature Ejaculation into two main types, which helps guide the Premature Ejaculation treatment approach. Understanding which type you may be experiencing is a crucial part of the diagnostic process.

In addition to these two primary types, some men may experience what is sometimes called Natural Variable Premature Ejaculation. This is not a true dysfunction but rather irregular episodes of rapid ejaculation that can occur in any man due to factors like long periods of abstinence, intense arousal, or situational stress. It does not typically require medical Premature Ejaculation treatment.

How Is Premature Ejaculation Diagnosed?

Diagnosing Premature Ejaculation is primarily based on a detailed medical and sexual history. There is no single blood test or scan that can confirm PE. A healthcare professional, such as a GP or a specialist in sexual medicine, will conduct a confidential and non-judgmental conversation to understand your specific situation.

The diagnosis is typically made if the following criteria are met, as per international guidelines (such as those from the International Society for Sexual Medicine):

1. Short Ejaculatory Latency: Ejaculation consistently occurs within approximately one minute of vaginal penetration. (It's important to note that this is a guideline; the subjective feeling of lack of control is equally important).
2. Lack of Control: A persistent or recurrent inability to delay ejaculation during all or nearly all vaginal penetrations.
3. Negative Personal Consequences: The condition causes significant distress, bother, frustration, and/or the avoidance of sexual intimacy.

What to Expect During a Consultation

Your doctor will likely ask you a series of questions, which may include:

• How long has this been a problem for you?
• Does it happen every time you have sex, or only sometimes?
• Has it been a lifelong issue or did it start recently?
• Do you have any underlying medical conditions like diabetes or thyroid problems?
• Are you currently taking any medications, including over-the-counter supplements?
• How is your relationship with your partner? Are you experiencing any stress or anxiety?
• Do you have any difficulties getting or maintaining an erection?

In most cases, a physical examination is not necessary. However, if your doctor suspects an underlying physical cause (such as a hormonal issue or prostatitis), they may perform a physical exam, including a genital exam, or order blood tests to check your hormone levels. For more information on the diagnostic process, you can refer to this patient leaflet from the Wrightington, Wigan and Leigh Teaching Hospitals NHS Foundation Trust.

How To Manage and Prevent Premature Ejaculation Flare-ups?

While Premature Ejaculation may not be completely "preventable" in the traditional sense, especially in its lifelong form, there are numerous strategies you can adopt to manage the condition effectively and reduce the frequency and impact of episodes. For men with acquired PE, these strategies can be particularly powerful in regaining control and complementing any formal Premature Ejaculation treatment.

• Open Communication with Your Partner: This is perhaps the most important management tool. Talking openly about PE can relieve immense pressure, reduce anxiety, and foster a sense of teamwork. When your partner understands the condition, they are more likely to be supportive and patient.
• Practice Mindfulness and Stress Reduction: Since anxiety is a major trigger, techniques like meditation, deep breathing exercises, and yoga can help calm the nervous system and improve your ability to stay present during sex, rather than being trapped in anxious thoughts.
• Strengthen Your Pelvic Floor Muscles: The pubococcygeus (PC) muscles are involved in ejaculation. Kegel exercises, which involve repeatedly contracting and relaxing these muscles, can improve ejaculatory control over time. To identify them, try to stop the flow of urine mid-stream; the muscles you use are your PC muscles.
• Use Thick Condoms or Delay Sprays: Over-the-counter condoms designed for "prolonged pleasure" often contain a small amount of benzocaine, a mild anaesthetic. These can be a simple first step to try, though they are generally less potent than prescription topical treatments.
• Experiment with Sexual Techniques: Changing positions, taking breaks during intercourse, and focusing on mutual pleasure rather than just penetrative sex can reduce performance pressure and help manage ejaculatory timing.
• Maintain a Healthy Lifestyle: Regular exercise, a balanced diet, and adequate sleep contribute to overall physical and mental well-being, which in turn supports healthy sexual function.
• Avoid Excessive Alcohol and Recreational Drugs: While a drink might seem to calm nerves, excessive alcohol can actually disrupt sexual function and is not a reliable long-term solution.
• Seek Professional Help Early: Don't wait for the problem to damage your self-esteem or relationship. Consulting a GP or using a reputable online doctor service like Chemist Doctor is a proactive step towards management. Organisations like the British Association of Urological Surgeons (BAUS) also provide valuable patient information on Premature Ejaculation.

How Is Premature Ejaculation Treated?

The good news is that Premature Ejaculation is a highly treatable condition. The choice of Premature Ejaculation treatment depends on the type of PE (lifelong vs. acquired), its underlying causes, and your personal preference. A combination of approaches is often the most effective strategy. Treatment plans are tailored to individual needs, and while some men may require only one type of intervention, others may benefit from a multifaceted approach.

1. Behavioural and Psychological Techniques

These are often the first-line treatments, especially for men with Acquired PE linked to psychological factors. They involve learning to control arousal and delay ejaculation.

• The Stop-Start Method (Semans Technique): This involves the man or his partner stimulating him until he feels the urge to ejaculate. At that point, all stimulation stops for about 30 seconds, allowing the feeling to subside. Stimulation then resumes. This cycle is repeated 3-4 times before allowing ejaculation to occur. Over time, this can help improve awareness of the pre-ejaculatory sensations and increase control.
• The Squeeze Technique: Similar to the stop-start method, but when the urge to ejaculate is felt, the man or his partner firmly squeezes the head of the penis for several seconds. This reduces the erection slightly and dampens the ejaculatory urge. Stimulation is resumed after a pause.
• Psychotherapy and Counselling: Speaking with a therapist can be incredibly beneficial, especially if anxiety, depression, or relationship issues are central to the problem. Cognitive Behavioural Therapy (CBT) can help identify and change negative thought patterns that contribute to performance anxiety.
• Couples Therapy: If relationship dynamics are a factor, involving your partner in therapy can improve communication, reduce pressure, and foster a more supportive sexual environment.

2. Topical Anaesthetics

These are creams, sprays, or wipes that contain a local anaesthetic (such as Lidocaine or Prilocaine). They are applied to the head of the penis before sex to reduce sensitivity and help delay ejaculation.

• How they work: By numbing the sensation in the penis, they decrease the intensity of stimulation, thereby prolonging the time to ejaculation.
• Considerations: It is crucial to follow the instructions carefully. Applying too much or not washing it off before intercourse can lead to numbness for your partner. A product like Emla Cream is a well-known example of a topical anaesthetic that can be used for this purpose, under medical guidance.

3. Prescription Medications

For men with Lifelong PE or cases where behavioural techniques are not effective, prescription medications can be a highly effective Premature Ejaculation treatment.

• Selective Serotonin Reuptake Inhibitors (SSRIs):
  • How they work: SSRIs are primarily antidepressants, but a common side effect is delayed ejaculation. This side effect is harnessed therapeutically for treating PE. They work by increasing serotonin levels in the brain, which helps to inhibit the ejaculatory reflex.
  • On-Demand vs. Daily: Some SSRIs need to be taken daily to be effective for PE. However, Priligy (Dapoxetine) is the first and only SSRI specifically designed and licensed for on-demand treatment of PE in the UK. It is taken 1-3 hours before anticipated sexual activity.
• Phosphodiesterase-5 (PDE5) Inhibitors: Drugs like Sildenafil (Viagra) are primarily for Erectile Dysfunction. However, they can sometimes be helpful for men who experience PE alongside ED, as improving the erection can reduce anxiety and help with ejaculatory control.

4. Combination Treatments

Often, the most successful Premature Ejaculation treatment combines different modalities. For example, a man might use a prescription medication like Priligy while also practising the stop-start technique with his partner. This addresses both the biological and psychological aspects of the condition simultaneously.

It is vital to remember that all prescription treatments for Premature Ejaculation should only be used under the supervision of a qualified healthcare professional who can ensure they are safe and appropriate for you. The NHS website provides further information on ejaculation problems and their treatment.