Premature ejaculation

Premature ejaculation (PE) is a common male sexual dysfunction characterized by ejaculation that occurs sooner than desired during sexual activity, often with minimal stimulation and before the individual or their partner wishes. It can cause distress, frustration, and relationship difficulties.

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Causes and Contributing Factors

• Psychological factors: Anxiety, depression, stress, relationship problems, or performance pressure.

• Biological factors: Hormonal imbalances (low serotonin), hypersensitivity of the penile nerves, abnormal reflex activity, or thyroid disorders.

• Medical conditions: Prostatitis, erectile dysfunction, diabetes, hypertension, or neurological conditions.

• Substance-related causes: Excessive alcohol, drug use, or certain medications.

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Types

1. Lifelong (primary): Ejaculation has always occurred quickly since first sexual experiences.

2. Acquired (secondary): Develops later in life, often linked with psychological or medical conditions.

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Symptoms

• Ejaculation that always or nearly always occurs within one minute of penetration (for lifelong PE).

• Inability to delay ejaculation during intercourse.

• Negative personal consequences such as distress, frustration, or avoidance of intimacy.

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Treatment Options

1. Behavioral therapies

• Start–stop technique: Stopping stimulation before ejaculation and restarting after the urge subsides.

• Squeeze technique: Applying pressure to the penis before ejaculation to delay climax.

• Kegel exercises: Strengthening pelvic floor muscles to improve ejaculatory control.

• Psychosexual therapy: Addressing anxiety, relationship issues, or psychological triggers.

2. Medications

• Selective serotonin reuptake inhibitors (SSRIs):

  • Paroxetine, sertraline, fluoxetine (taken daily or before intercourse).

  • Delay ejaculation by increasing serotonin activity.

• Topical anesthetics:

  • Lidocaine or prilocaine cream/spray applied to the penis to reduce sensitivity.

• Phosphodiesterase-5 inhibitors (PDE5i):

  • Sildenafil (Viagra), tadalafil (Cialis) — sometimes used in men with both erectile dysfunction and PE.

• Dapoxetine (short-acting SSRI, not available in all countries): specifically developed for on-demand treatment of PE.

3. Counseling and psychotherapy

• Useful for individuals with anxiety, depression, or relationship issues contributing to PE.

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Lifestyle and Self-Help Measures

• Reducing alcohol and recreational drug use.

• Practicing relaxation techniques to reduce anxiety.

• Strengthening partner communication and intimacy.

• Regular physical exercise to improve circulation and reduce stress.

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When to Seek Medical Help

• If premature ejaculation is persistent and causes distress.

• If it occurs suddenly after years of normal function.

• If associated with other symptoms such as erectile dysfunction, pelvic pain, or urinary problems.