What is Premature Ejaculation?
Premature ejaculation is ejaculation prior to the desired time in sexual intercourse. Premature ejaculation comes in two forms: life-long and acquired. In the first, the patient has never been able to delay ejaculation more than two minutes since their first sexual encounter. In the second, there has been a significant worsening of the time to ejaculation.
What Causes Premature Ejaculation?
Lifelong premature ejaculation is often idiopathic, meaning a specific cause can rarely be identified. This means that men with this condition usually start treatment immediately without evaluation of possible causes.
Acquired premature ejaculation can be related to numerous medical conditions, medications, new partners, or other changes in your life. Your doctor can work with you to help identify what might be contributing to your premature ejaculation. Identification of a cause can help to avoid need to ongoing medical therapies.
Diagnosis
All men with premature ejaculation should have a thorough discussion with their doctor about what premature ejaculation means to them. Many men feel that they are unable to delay ejaculation for a long enough period, but in fact have a normal time to ejaculation. Studies have shown normal ejaculatory latency time (the time it takes from penetration to ejaculation) is around 4-5 minutes, although there is a wide range of normal.
Your doctor will review your medications and other medical conditions, as well as your surgical history to help find causes of premature ejaculation.
You may also have blood tests done to evaluate hormonal function, blood sugar, and electrolytes, which can provide clues into conditions that may affect your time to ejaculation.
Some men experience premature ejaculation as a response to erectile dysfunction. They feel that they will lose their erection if they have intercourse for too long, and as a result, rush to completion. Identification of erectile dysfunction and treatment to restore confidence is a satisfactory erection can be very effective for this type of problem.
Treatment
Behavioral therapy: Behavioral therapy consists of practicing techniques to delay ejaculation. More than just “thinking of baseball”, physical maneuvers and sensate focus techniques can extend the time to ejaculation without need for medications.
Topical Therapy: Medications can be applied directly to the penis to reduce pleasurable sensation and extend time to ejaculation. Use of condoms is usually recommended with these therapies to prevent your partner from experiencing the effect as well.
SSRIs: A class of medications called “Selective Serotonin Reuptake Inhibitors” are commonly used to treat depression and anxiety, but at low doses have a very strong effect on ejaculation time. Men taking a low dose of these medications can expect to see an increase in their time to ejaculation by 6-7 times. These medications cannot be stopped suddenly and have some interactions with other medications. Your doctor will discuss the risks and benefits of these medications with you.
Other medications: Other medications have been shown to have an effect on time to ejaculation. If you are not a good candidate for other therapies or they haven’t worked for you, your doctor can recommend alternative options.
Surgery: No surgery has been shown to be effective for the treatment of premature ejaculation.