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Premature ejaculationBy Mayo Clinic staff
Original Article: http://www.mayoclinic.com/health/premature-ejaculation/DS00578
Premature ejaculation occurs when a man ejaculates sooner during sexual intercourse than they or their partner would like. As long as it happens infrequently, it's not cause for concern. However, if you regularly ejaculate sooner than you and your partner wish — such as before intercourse begins or shortly afterward it can be considered premature ejaculation.
Premature ejaculation is a common sexual complaint. Estimates vary, but as many as 1 out of 3 men may be affected by this problem at some time.
Both psychological and biological factors can play a role in premature ejaculation. Although many men feel embarrassed to talk about it, premature ejaculation is a common and treatable condition.
Medications, psychological counseling and sexual techniques that delay ejaculation can improve sex for you and your partner. For many men, a combination of treatments works best.
The primary sign of premature ejaculation is ejaculation that occurs before both partners wish, causing concern or stress. However, the problem may occur in all sexual situations, even including during masturbation.
Doctors generally classify premature ejaculation as either lifelong (primary) or acquired (secondary).
According to the International Society for Sexual Medicine, lifelong premature ejaculation is characterized by:
- Ejaculation that always or nearly always occurs within one minute of vaginal penetration
- The inability to delay ejaculation on all or nearly all vaginal penetrations
- Negative personal consequences, such as stress, frustration or the avoidance of sexual intimacy
Secondary premature ejaculation is generally understood to share the same symptoms as lifelong premature ejaculation, but with one key difference:
- Secondary ejaculation develops after you've had previous, satisfying sexual relationships without ejaculatory problems
When to see a doctor
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 yourself, you may need treatment to help you have a satisfying sex life.
For some men, however, a conversation with your doctor may actually reassure you that your occasional premature ejaculation is normal — or possibly not even premature. The average time from the beginning of intercourse to ejaculation is generally about five minutes.
The exact cause of premature ejaculation isn't known. While it was once thought to be only psychological, doctors now know premature ejaculation is more complicated and involves a complex interaction of both psychological and biological factors.
Some doctors believe that early sexual experiences may establish a pattern that can be difficult to change later in life, such as:
- Situations in which you may have hurried to reach climax in order to avoid being discovered
- Guilty feelings that increase your tendency to rush through sexual encounters
Other factors that can play a role in causing premature ejaculation include:
- Erectile 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.
- Anxiety. Many men with premature ejaculation also have problems with anxiety — either specifically about sexual performance or related to other issues.
- Relationship problems. If you have had satisfying sexual relationships with other partners in which premature ejaculation happened infrequently or not at all, it's likely that interpersonal issues between you and your current partner are contributing to the problem.
A number of biological factors may contribute to premature ejaculation, including:
- Abnormal hormone levels
- Abnormal levels of brain chemicals called neurotransmitters
- Abnormal reflex activity of the ejaculatory system
- Certain thyroid problems
- Inflammation and infection of the prostate or urethra
- Inherited traits
Rarely, premature ejaculation is caused by:
- Nervous system damage resulting from surgery or trauma
- Withdrawal from certain medications used to treat mental health problems
Various factors can increase your risk of premature ejaculation, including:
- Erectile dysfunction. 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 consciously or unconsciously hurry through sexual encounters.
- Health problems. A medical concern that causes you to feel anxious during sex, such as a heart problem, may cause you to unknowingly rush 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 contribute to premature ejaculation.
While premature ejaculation doesn't increase your risk of serious health problems, it can cause problems in your personal life, including:
- Relationship strains. A common complication of premature ejaculation is relationship stress. If premature ejaculation is straining your relationship, ask your doctor about including couples 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.
Preparing for your appointment
You're likely to first talk with your family doctor or general practitioner about premature ejaculation, or you may be quickly referred to a urologist. Don't hesitate to bring up the topic with your doctor during a general checkup or a visit for other health concerns. Your doctor knows that a healthy sex life is very important to your well-being, and he or she may ask you about your satisfaction with your sex life before you even have a chance to bring it up.
It's normal to feel embarrassed when talking about sexual problems, but you can trust that your doctor has had similar conversations with many other men. Premature ejaculation is a very common — and treatable — condition.
Being ready to talk about premature ejaculation will help you get the treatment you need to get your sex life back on track. The information below should help you prepare to make the most of your appointment.
Information to write down in advance
- Pre-appointment restrictions. At the time you make your appointment, ask if there are any restrictions you need to follow in the time leading up to your visit.
- Symptoms. How often do you ejaculate before you or your partner would wish? How long after you begin having intercourse do you typically ejaculate?
- Sexual history. Think back on your relationships and sexual encounters since you became sexually active. Have you had problems with premature ejaculation before? With whom, and under what circumstances?
- Medical history. Write down any other medical conditions with which you've been diagnosed, including mental health conditions. Also note the names and strengths of all medications you're currently taking or have recently taken, including prescription and over-the-counter drugs.
- Questions to ask your doctor. Creating a list of questions in advance can help you make the most of your time with your doctor.
Basic questions to ask your doctor
The list below suggests questions to ask your doctor about premature ejaculation. Don't hesitate to ask more questions during your appointment.
- What may be causing my premature ejaculation?
- What tests do you recommend?
- What treatment approach do you recommend?
- How soon after I begin treatment can I expect improvement?
- How much improvement can I reasonably expect?
- Am I at risk of this problem recurring?
- Is there a generic alternative to the medicine you're prescribing?
- Are there any brochures or other printed material that I can take home with me? What websites do you recommend visiting?
What to expect from your doctor
Your doctor may ask a number of very personal questions and may want to include your partner in the interview. To help your doctor determine the cause of your problem and the best course of treatment, be ready to answer questions such as:
- How often do you have premature ejaculation?
- Has this problem developed gradually or suddenly?
- Do you have premature ejaculation only with a specific partner or partners?
- Do you experience premature ejaculation when you masturbate?
- Do you have premature ejaculation every time you have sex?
- How often do you have sex?
- How much are you bothered by premature ejaculation?
- How much is your partner bothered by premature ejaculation?
- How satisfied are you with your current relationship?
- What were your first sexual experiences?
- Are you also having trouble getting and maintaining an erection (erectile dysfunction)?
- What medications have you recently started or stopped taking?
- Do you use recreational drugs?
What you can do in the meantime
While you wait for your appointment, consider focusing on other ways of enjoying and connecting with your partner. Premature ejaculation can cause considerable strain and anxiety in a relationship, but it is a treatable condition. Deciding to talk with your doctor is the most important step you can take. In the meantime, enjoy the many other ways in which you and your partner bring each other pleasure.
Tests and diagnosis
In addition to a detailed interview about your sex life, your doctor will want to know about your health history and may perform a general physical exam. He or she may refer you to a urologist who specializes in sexual dysfunction or to a mental health professional to help make the diagnosis.
If 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.
Treatments and drugs
Treatment options 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 sexual encounters.
The squeeze technique
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 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.
Certain antidepressants and topical anesthetic creams are used to treat premature ejaculation. Although none of these drugs is specifically approved by the Food and Drug Administration to treat premature ejaculation, some are used 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. Your doctor may suggest that you take an antidepressant to benefit from this specific side effect. Other side effects of these antidepressants can include nausea, dry mouth, drowsiness and decreased libido.
- Your doctor may prescribe one of several selective serotonin reuptake inhibitors (SSRIs), such as sertraline (Zoloft), paroxetine (Paxil) or fluoxetine (Prozac), to help delay ejaculation. It may take up to 10 days for these drugs to take effect.
- 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 symptoms.
Antidepressants are not approved in the treatment of premature ejaculation. They work by taking advantage of a side effect common to these medications. Talk with your doctor about whether the risk and benefits are worth it in your case.
Topical anesthetic creams
Topical 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 ejaculation. A lidocaine-prilocaine spray is currently being studied.
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.
Cognitive behavioral therapy
This approach, also known as counseling or talk therapy, involves talking with a mental health provider about your relationships and experiences. These talk sessions can help you reduce performance anxiety or find effective ways of coping with stress and solving problems. Counseling is most likely to help when it's used in combination with drug therapy.
Some people have tried yoga as one possible alternative treatment for premature ejaculation. More research is needed to evaluate how well it, or other alternative treatments, might work.
Coping and support
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 relationship problems for you or your partner.
While you explore treatment options, consider lifting 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 sexual relationship.
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 premature ejaculation.
Open communication between sexual partners, as well as a willingness to try a variety of approaches to help both partners feel satisfied, 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.
- Mehta A, et al. Ejaculation disorders. In: Ferri FF. Ferri's Clinical Advisor 2011: Instant Diagnosis and Treatment. Philadelphia, Pa.: Mosby Elsevier; 2011. http://www.mdconsult.com/das/book/body/120705265-3/804926975/1701/189.html#4-u1.0-B978-0-323-04134-8..50008-2--subchapter5_3989. Accessed Nov. 13, 2010.
- Diaz VA, et al. Male sexual dysfunction. Primary Care Clinics in Office Practice. 2010;37:473.
- Lue TF, et al. Evaluation and nonsurgical management of erectile dysfunction and premature ejaculation. In: Wein AJ, et al. Campbell-Walsh Urology. 9th ed. Philadelphia, Pa.: Saunders Elsevier; 2007. http://www.mdconsult.com/books/page.do?eid=4-u1.0-B978-0-7216-0798-6..50024-8--cesec104&isbn=978-0-7216-0798-6&sid=1082841620&type=bookPage§ionEid=4-u1.0-B978-0-7216-0798-6..50024-8--cesec104&uniqId=226471491-7#4-u1.0-B978-0-7216-0798-6..50024-8--cesec104. Accessed Nov. 13, 2010.
- Althof SE, et al. International Society for Sexual Medicine's Guidelines for the Diagnosis and Treatment of Premature Ejaculation. Journal of Sexual Medicine. 2010;7:2947.
- Brotto LA, et al. Yoga and sexual functioning: A review. Journal of Sex & Marital Therapy. 2009;35:378.
- Nippoldt TB (expert opinion). Mayo Clinic, Rochester, Minn. Nov. 16, 2010.