& Premature Ejaculation
Many men occasionally ejaculate sooner during sexual
intercourse than they or their partner would like.
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 such
as before intercourse begins or shortly afterward
you may have a condition known as premature
Premature ejaculation is a common sexual disorder.
Estimates vary, but some experts think it affects as
many as one out of three men. Even though it's a
common problem that can be treated, many men feel
embarrassed to talk to their doctors about it or
Once thought to
be purely psychological, experts now know that
biological factors also play an important role in
premature ejaculation. In some men, premature
ejaculation is related to erectile dysfunction.
You don't have to live with premature ejaculation
treatments including medications, psychological
counseling and learning sexual techniques to delay
ejaculation can improve sex for you and your
partner. For many men, a combination of treatments
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 concern or distress. The problem
may occur in all sexual situations, including during
masturbation or it may only occur during sexual
encounters with another person.
Doctors often classify premature ejaculation as
either primary or secondary:
You have primary premature
ejaculation if you've had the problem for as
long as you've been sexually active.
You have secondary premature
ejaculation if you developed the condition
after having had previous, satisfying sexual
relationships without ejaculatory problems.
Experts are still trying to determine exactly what
causes premature ejaculation. While it was once
thought to be only psychological, we now know
premature ejaculation is more complicated and
involves a complex interaction of both psychological
and biological factors.
believe that early sexual experiences may establish
a pattern that can be difficult to change later in
life such as:
Other factors that can play a role in causing
premature ejaculation include:
dysfunction. Men who are anxious about
obtaining or maintaining their erection during
sexual intercourse may form a pattern of rushing
to ejaculate which can be difficult to change.
Many men with premature ejaculation also have
problems with anxiety either specifically about
sexual performance, or caused by other issues.
Experts believe a number of biological factors may
contribute to premature ejaculation, including:
levels of brain chemicals called
reflex activity of the ejaculatory system.
and infection of the prostate or urethra.
Rarely, premature ejaculation is caused by:
system damage resulting from surgery or trauma.
Withdrawal from narcotics or a
drug called trifluoperazine (Stelazine), used to
treat anxiety and other mental health problems.
Although both biological and psychological factors
likely play a role in most cases of premature
ejaculation, experts think a primarily biological
cause is more likely if it has been a lifelong
problem (primary premature ejaculation).
Various factors can increase your risk of premature
You may be at increased risk of premature
ejaculation if you occasionally or consistently
have trouble getting or maintaining an erection.
Fear of losing your erection may cause you to
rush through sexual encounters. As many as one
in three men with premature ejaculation also
have trouble maintaining an erection.
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.
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.
medications. Rarely, drugs that influence
the action of chemical messengers in the brain (psychotropics)
may cause premature ejaculation.
Seek Medical Advice
Talk with your doctor if you ejaculate sooner than
you and your partner wish during most sexual
encounters. Although you may feel you should be able
to fix the problem on your own, you may need
treatment to help you achieve and sustain a
satisfying sex life.
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 sex, 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.
Your doctor will
want to know about your health history, and may
perform a general physical exam. You doctor may ask
you questions about:
How often you
have premature ejaculation.
have premature ejaculation only with a specific
partner or partners.
have premature ejaculation every time you have
How often you
How you feel
premature ejaculation affects your enjoyment of
sex and your quality of life.
also have trouble getting and maintaining an
erection (erectile dysfunction).
Your use of
prescription medications and recreational drugs.
whether psychological factors may influence your
premature ejaculation, your doctor or mental health
professional may also want to know about:
relationships, past and present.
or concerns within your current relationship.
you have both premature ejaculation and trouble
getting or maintaining an erection, your doctor may
order blood tests to check your male hormone
(testosterone) levels or other tests.
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
relationship stress. If premature ejaculation is
straining your relationship, ask your doctor
about including couple's therapy in your
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.
for premature ejaculation include sexual therapy,
medications and psychotherapy. For many men, a
combination of these treatments works best.
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 may also recommend avoiding intercourse
for a period of time and focusing on other types of
sexual play so that pressure is removed from your
Your doctor may
instruct you and your partner in the use of a method
called the squeeze technique. This method works as
Step 1. Begin
sexual activity as usual, including stimulation
of the penis, until you feel almost ready to
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 30
seconds, 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.
antidepressants and topical anesthetic creams are
used to treat premature ejaculation. Although none
of these drugs are specifically approved by the Food
and Drug Administration to treat premature
ejaculation, some treatment guidelines recommend
their use for this purpose. You may need to try
different medications or doses before you and your
doctor find a treatment that works for you.
A side effect of
certain antidepressants is delayed orgasm. Doctors
suggest men who have premature ejaculation can take
antidepressants to benefit from this specific side
may prescribe one of several selective serotonin
reuptake inhibitors (SSRIs) such as sertraline
(Zoloft), paroxetine (Paxil) or fluoxetine
(Prozac) to help 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 every day to
prevent premature ejaculation. Taking a low dose
several hours before you plan to have sexual
intercourse may be enough to improve your
effects of these antidepressants can include nausea,
dry mouth, drowsiness and decreased libido.
Topical Anesthetic Creams
anesthetic creams containing lidocaine or prilocaine
dull the sensation on the penis to help delay
ejaculation. Applied a short time before
intercourse, these creams are wiped off when your
penis has lost enough sensation to help you delay
Some men using
topical anesthetic creams report reduced sexual
pleasure because of lessened sensitivity. Although
the cream is wiped off before intercourse, in some
studies female partners reported that it also
reduced their genital sensitivity and sexual
pleasure. In rare cases lidocaine or prilocaine can
cause an allergic reaction.
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 reduce performance anxiety or
find effective ways of coping with stress 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 lack of
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
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
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. Taking the emphasis off intercourse can
remove the worry about ejaculating too soon and it
can help lay the foundation for a more fulfilling
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