Premature Ejaculation: Causes,Symptoms, Treatments

PREMATURE EJACULATION: FACTS & OVERVIEW

ejaculation guruPremature ejaculation (PE) is one of the most common types of sexual impairment and one of the most embarrassing male sexual problems. An estimated 30-70% of men in the general population suffer from premature ejaculation to some degree at one time or another, which can cause psychological consequences and relationship problems.

Even among healthy young males with an active sex life experience early ejaculation, also known as “rapid ejaculation“. Numerous studies have shown that premature ejaculation can have both biological and psychological triggers.

Because of the intimate nature of the problem, many men are too  embarrassed to seek medical help. And most of them are resorting to getting their premature ejaculation treatment at sex shop online such as delaying creams or anaesthetic sprays. This delaying method may work for some to numb the head of the penis, but as soon as you stop using them, the problem will return.

One of the biggest misconceptions surrounding PE is that by taking anti-depressant medications help reduce PE. However, taking anti-depressant drugs may lead to erectile dysfunction and other side effects.

So how can I cure my premature ejaculation? What is the best treatment for premature ejaculation? These are the questions that you might be asking for yourself. Just continue reading because as you go along you will have a better understanding about premature ejaculation and how you can control it. Do you want to last longer in bed tonight? Click here for more information.

HISTORY OF PREMATURE EJACULATION

The term premature ejaculation was mentioned as “ejaculatio ante portas” in the early Greek writings. It means ejaculation before the gate. It was in the late 19th century that rapid ejaculation was conceived as a disorder by the medical literature.

Major historical views on diagnosis, etiology and advocated treatment of Premature Ejaculation:

  • 1917-1950, Karl Abraham (German psychoanalyst) termed rapid ejaculation as “ejaculatio praecox“. PE then was considered neurosis linked to unconscious conflicts. And the treatment of premature ejaculation consisted of  classical psychoanalysis and psychoanalytic therapy.
  •  1943, Bernhard Schapiro (German endocrinologist) challenged the pure psychological view of Karl Abraham. Schapiro argued that PE is a  psychosomatic disturbance caused by the weak genital system. He advocated with the use of topical anaesthetic creams as the treatment for premature ejaculation.
  • 1950-1990, William Masters and Virginia Johnson (American sexologists), suggested that PE was the result of behavioural disorder. They argued that rapid ejaculation was linked to initial rapid intercourse that led to habituation and created performance anxiety. They recommended behavioural treatment (squeeze method) as the primary  treatment for premature ejaculation.
  •  1990-2005, Marcel Waldinger (Dutch neuropsychiatrist), postulated that lifelong PE is a neurobiological-genetic disorder,  which is related to a diminished central serotonin neurotransmission dysfunctions. He based his neurobiological theory of the disorder on the outcome data of a number of animals and psychopharmacological treatment studies on early ejaculation. He introduced selective serotonin reuptake inhibitors (SSRIs) in the treatment of premature ejaculation.
  • 2005-present, Pharmaceutical Industry & Genetics. A drug named dapoxetine has approved by the European Medicines Agency (EMEA) for the treatment of premature ejaculation.

HOW DOES EJACULATION WORK?

Premature Ejaculation - Mechanism of ejaculation

Physiology of ejaculation [Image via: min30min.com]

Ejaculation is the release of semen from the penis following sexual climax. When a man is sexually stimulated, the brain sends signals to the genital area through nerves in the spinal cord to contract the pelvic muscles.

Waves of muscle contractions transport the sperm, with a small amount of fluid, from the testes through to the vas deferens. The seminal vesicles and prostate contribute extra fluid to protect the sperm.

This mixture of fluid and sperm travels along the urethra to the tip of the penis where it is released (ejaculated) at the time of sexual climax (orgasm).

The mechanism of ejaculation has 3 phases: emission and expulsion, which is controlled by the central nervous system.Premature Ejaculation - Mechanism of ejaculation

When men are sexually aroused, signals are sent to the spinal cord and to the brain.  And when men come to a certain level of excitement, signals are then sent from the brain, spinal cord and  to  the reproductive organs (peripheral nerves). This causes seminal fluid to be ejected from the urethral meatus (penis), which is commonly accompanies sexual climax or orgasm.

  • Phase 1: Emission – During this phase, the sperm begins to travel from the testes through the vas deferens to the urethra. Fluid secretions are also released by the prostate gland and seminal vesicles to make semen laden with acid phosphatase, citric acid, and zinc  with spermatozoa-rich fluid from the vas deferens in the prostatic urethra. The emission phase also includes excretion of fluid from both Cowper’s glands and periurethral glands.
  • Phase 2: Expulsion or Ejaculatory -In this phase, sperm and semen travel through the urethra and are ejaculated out of the penis.

WHAT IS PREMATURE EJACULATION

Masters and Johnson defined premature ejaculation as the man’s inability to control ejaculation long enough to satisfy his partner. PE happens with minimal sexual stimulation and before a man wants it to happen.

Another definition of PE from a psychological point of view is by using quantitative measures such as the duration of ejaculatory latency, or the number of thrusts prior to ejaculation. The length of time is varied from 1-7 minutes after vaginal intromission. Men who ejaculated within seconds are qualified as serious cases.

WHAT ARE THE DIFFERENT TYPES OF PREMATURE EJACULATION?

Premature ejaculation can be classified as lifelong (primary) or acquired (secondary).

1. Lifelong Premature Ejaculation means that the problem has always existed since the first sexual experience and remains a problem  for the rest of his life.

2. Acquired  Premature Ejaculation means that he had previously successful sexual experience, but developed suffering from premature ejaculation at some point later in his life.

SIGNS & SYMPTOMS OF PREMATURE EJACULATION

The main symptom of premature ejaculation is the inability to delay ejaculation either before or shortly after intercourse begins.

With lifelong premature ejaculation the symptoms can include the following:

  • Psychological difficulties
  • Deep anxiety about sex that relates to  past traumatic experiences encountered during development, such as sexual assault, incest, conflict with parents)

With regard to acquired premature ejaculation early signs can include the following:

  • Erectile dysfunction
  • Fear of failure to satisfy the partner or performance anxiety
  • Psychotropic or street drug use

WHAT ARE THE CAUSES OF PREMATURE EJACULATION?

In most cases, premature ejaculation can be a side effect of an erectile dysfunction. However, when a man is able to have a normal erections,  psychological factors such as anxiety, guilt or depression can often lead to a habit of an early ejaculation especially. While it was once thought to be only psychological cause, but new studies concluded that premature ejaculation  can be physiological (biological), psychological or a combination of both.

Physiological or Biological Causes

A number of possible physiological causes of premature ejaculation may include:

  • Highly responsive nervous system – If your sympathetic nervous system is highly responsive, it can lead to an early triggering of an orgasm and eventually early ejaculation.
  • Low testosterone levels in the body have always been associated with lack of climax control.
  • Abnormal levels of brain chemicals called neurotransmitters have been found in men with premature ejaculation.
  • Abnormal reflex activity of the ejaculatory system due to an autonomous reflex.
  • Diabetes
  • Excessive alcohol consumption
  • Hypertension or high blood pressure
  • Inflammation and infection of the prostate or urethra
  • Nerve damage from injury, surgery or trauma
  • Thyroid disorders (overactive or under active thyroid gland)
  • Psychotropic drug withdrawal (SSRI: Paxil and Zoloft)
  • Weak pelvic muscle

Psychological Causes

Most cases of premature ejaculation are due to psychological factors such as:

  • Anxiety – performance pressure like fear of failure to satisfy the partner can cause premature ejaculation psychologically.
  • Early sexual experiences that rushed you to orgasm may result in premature ejaculation in later life.
  • Depression
  • Guilt
  • Relationship problems
  • Stress

 

RISK FACTORS

Various factors that can play major risk of premature ejaculation include:

  • Erectile dysfunction
  • Health problems
  • Anxiety
  • Relationship problems

 

POSSIBLE COMPLICATIONS

If a man ejaculates rapidly before sexual intercourse, it may interfere with conception or may prevent a couple from getting pregnant, who are trying to have a baby. Failure to respond to treatment for uncontrolled ejaculation and the complications may lead to sexual dissatisfaction for both partners. It may also become a source of stress and relationship problems, and eventual break ups or separation.

TEST & DIAGNSOSIS

In males who have troubled to last longer in bed or have premature ejaculation, your doctor will ask about your medical and sexual history. Because premature ejaculation can have many causes, your doctor may order some laboratory tests to rule out any other medical issues. If you are suffering both premature ejaculation and impotence problem, your doctor may check your levels of serum testosterone and prolactin levels in your blood. If depression or other conditions coexist, your doctor may refer you to go to a psychiatrist who specializes this condition.

 

HOW IS PREMATURE EJACULATION TREATED? 

Most common possible treatment for premature ejaculation may include behavioural therapy, counselling, topical anaesthetics and oral medications. A combination of these approaches along with behavioural techniques and counselling is highly recommended.

A. Behavioural Techniques

Behavioural Therapy can help you delay ejaculation by 60%-90%.  These include the “squeeze techniques” and  the “start-stop method”. It may take a little time to get used to it, but once you have mastered this method you are on your way to last longer whenever you want.  In a nutshell, the sooner in life you learn to master these techniques the better you’ll get positive results

What is the “squeeze” technique?

This technique requires you to gently squeeze the base of the penis for several seconds, just before you are about to ejaculate. After the squeeze is released, you have to stop sexual stimulation for about 30-45 seconds before resuming sexual stimulation. The idea is to reduce your erection through squeezing and recognize the “point of no return”. This way, you may be able to delay future ejaculations.

You may repeat this technique for at least 4-6 times until you decide not to delay ejaculation anymore. This technique may be frustrating  as it can disrupt sexual activity and may also affect your erection.

What is the “Start-Stop” technique?

This technique involves by stimulating the penis and stopping just before you feel the urge to reach orgasm. Stop the stimulation for about 30-45 seconds and then start again once you feel that you have regained control. You may repeat this process 4-6 times until you wish to ejaculate. By doing this several times without distraction will help you learn where your “point of no return” is. This technique can be done alone or with a partner.

What are the other  techniques to stop premature ejaculation?

The  “squeeze” and “start-stop” technique prove more effective when combined with these techniques:

  • Triangular breathing technique if you’re getting too close to ejaculation. This type of deep breathing technique brings about a deep level of calmness and increases level serotonin production. Deep breathing helps control the arousal and relieves performance anxiety that leads to an early ejaculation. To do the triangle breathing:
  • 1. Inhale for 3 seconds
  • 2. Pause and hold for 3 seconds
  • 3. Exhale for 3 seconds
  • 4. Repeat the process
  • Kegel Exercises. Also known as the “pelvic floor exercise”, is the action of repetitive contraction of the pelvic region in order to create strong pubococcygeus muscle (PC muscle). The easiest way to find this muscle is to see if you can stop yourself urinating midstream. That’s your PC muscle. This exercise can be done wherever you want because all you need is to flex that muscle. To do the Kegel exercises, you will quickly clench and release the PC muscle repeatedly for 10 seconds. Once you get the hang of it, you can increase it by 30 seconds to 5 minutes. By strengthening your pelvic region, you’ll be able to hold your ejaculation for as long as you want.
  • Wearing thick condoms can help decrease penis sensitivity, thereby decreasing the level of arousal and early ejaculation incident.
  • Mental distraction: think something about nonsexual, some guys imagining they’re counting from 1 to 1000 which may also help to delay orgasm.

B. Topical Anaesthetics

Topical anaesthetic creams and sprays containing lidocaine or prilocaine are used before sex to treat premature ejaculation by reducing the sensitivity of the penis and thus help prolong ejaculation. But be wary of these numbing agents because you may experience temporary loss of sensitivity and decrease pleasure as a potential side effects. Dr. Goldstein has a warning about this, though: “If you are going to use a numbing agent, you should wear a condom or its numbing effects will transfer to your partner.” It is recommended, as well, that one wipe off the numbing agent before beginning intercourse.

C. Counselling

Man’s issues with premature ejaculation is usually psychological in nature. It is a given for a man to feel frustrated, disappointed, embarrassed and ashamed if premature ejaculation left untreated. Therefore, counselling is a crucial part of premature ejaculation treatment. The counselling involves talking with a  mental health professional or psychiatrist detailing your past relationships and experiences.

D. Oral Medications

Antidepressants such as Zoloft, Paxil, Prozac or Sarafem are often prescribed to help delay ejaculation. However, these prescription drugs not only can cause nausea, dry mouth and decreased libido but also erectile dysfunction.

Natural Cure for Premature Ejaculation

 

SOURCES & HELP

Urology Care Foundation (U.S.)

REFERENCES

Masters WH, Johnson VE (1970) Premature ejaculation. In: Masters WH, Johnson VE (eds)

Human sexual inadequacy. Little, Brown and Co, Boston

http://www.medicalnewstoday.com/articles/188527.php

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3697283/

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