Premature ejaculation- causes, diagnosis and treatment

What is premature ejaculation ?

Premature ejaculation is defined when a man ejaculates sooner during sexual intercourse than he would like to. Nearly one third male experience this problem at some point of time. Premature ejaculation is diagnosed by a doctor when a male presents with complaints such as –

  • Always or nearly always ejaculate within one minute of penetration
  • Are unable to delay ejaculation during intercourse all or nearly all of the time
  • Feel distressed and frustrated, and tendency to avoid sexual intimacy therefore

What is the presentation of premature ejaculation ?

Premature ejaculation can be either of two types – Primary (Lifelong) and Secondary (Acquired). When a male presents with history of premature ejaculation nearly all of the times during sexual acts since the start of his first sexual encounter, it is called as primary type. Secondary type or acquired premature ejaculation is the one where a man who did not had ejaculation problems to begin with, start having early ejaculation now.

What are the causes of premature ejaculation ?

Premature ejaculation can be broadly divided into – Psychological causes and organic causes.

Psychological causes – Various factors such as poor body image, depression, previous sexual experiences, sexual abuse etc can lead on to the premature ejaculation.

Organic causes – Erectile dysfunction, anxiety disorder, hypogonadism (Testosterone and Testosterone deficiency syndrome), abnormal hormone levels etc.

How the diagnosis of premature ejaculation made ?

The diagnosis of premature ejaculation is made on the patient’s history. Repeated or very often episodes of very early ejaculation which cannot be delayed or postpone by the person, points towards premature ejaculation. There is high chances of patient with premature ejaculation who is also suffering from erectile dysfunction and hence the evaluation of such disorder is also done.

What is the treatment for premature ejaculation ?

There are various methods to treat premature ejaculation, and often either one or combination of these used for the any patient.

  • Pelvic floor muscle exercises – Kegal exercises where the pelvic floor muscles are tightened and to hold it in contraction for three seconds, and then relax for three seconds. This is tried a few times in a sequence. Kegel exercises can be done while sitting, standing or walking.
  • Squeeze technique – In this method, the sexual activity is started as usual till the level of stimulation and at the peak of stimulation before the ejaculation, the sexual activity is stopped and either partner or male himself squeeze the penis till the urge to ejaculate goes off and then subsequently sexual activity can be resumed. This process can then be repeated again.
  • Use of condoms – Condom application leads to decrease in sensation and helps delaying ejaculation therefore.
  • Topical anesthetics – Anesthetic creams and sprays that contain a numbing agent, such as benzocaine, lidocaine or prilocaine, are sometimes used to treat premature ejaculation. These products are applied to the penis 10 to 15 minutes before sex to reduce sensation and help delay ejaculation. Side effect include that some men report temporary loss of sensitivity and decreased sexual pleasure.
  • Medications – Many oral medications are used to delay the ejaculations. These medicines include SSRI (escitalopram, paroxetine, fluoxetine, dapoxetine), Tricyclic antidepressant (Clomipramine), tramadol, phosphodiesterase inhibitors (sildenafil, tadalafil). Use of SSRI and clomipramine may take few days to show its effect completely.

Whom to consult if someone suffering from premature ejaculation ?

You should consult your nearby andrologist if you or your partner suffering from premature ejaculation.

Published by Dr Varinder Attri

MS MCh (PGI Chandigarh), Urologist and Andrologist

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