What is premature ejaculation?

Premature ejaculation is a common occurrence that affects almost all sexually active men at some point in their life. Premature ejaculation occurs when a man is unable to control the timing of the ejection of semen (ejaculation) during sexual activities. This means that the ejaculation occurs sooner than expected, which can lead to reduced satisfaction for either one or both partners.

Causes

The causes of premature ejaculation can be divided into two main types:

Lifelong premature ejaculation

Lifelong premature ejaculation occurs from the first time a person has sex and is ongoing throughout their life whenever they have sex. This can be caused by:  

  • A learnt behaviour to ejaculate quickly;
  • Increased sensitivity to sexual arousal, and;
  • Anxiety with sex, particularly if related to sexual abuse during childhood.

Acquired premature ejaculation

Acquired premature ejaculation is when there has been a period of normal sexual activity prior to developing premature ejaculation. This can occur as a result of psychological problems such as anxiety. This can be related to a new relationship, past sexual performance, expectation of failure, stress and religious beliefs. It can also be due to medical conditions, such as diabetes, erectile dysfunction and hyperthyroidism.

Anxiety

A feeling of tension, nervousness and dread about future events. It can trigger physical symptoms such as a rapid pulse or breathing difficulties.

Diabetes

A metabolic disorder that is caused by problems with insulin secretion and regulation and which is characterised by high blood sugar levels. Also known as diabetes mellitus.

Psychological

Relating to, arising in, or affecting the mind.

Risk factors

Some risk factors for premature ejaculation are:

  • Stress;
  • Relationship difficulties;
  • A history of sexual abuse, and;
  • Recreational drug use.

Signs and symptoms

The signs and symptoms of premature ejaculation include:

  • Ejaculation during foreplay;
  • Ejaculation while starting sex, and;
  • Ejaculation soon after starting sex.

Premature ejaculation can cause relationship stress. 

Methods for diagnosis

Diagnosis of premature ejaculation is based on questions by your doctor that relate to your sexual, medical and psychological history. This can include questions about the time taken to ejaculate, how often premature ejaculation occurs, previous sexual relationships and the impact of premature ejaculation on you and your partner.

Psychological

Relating to, arising in, or affecting the mind.

Types of treatment

There are multiple treatments for premature ejaculation. These can involve behavioural techniques, medications and counselling.

Behavioural techniques

Behavioural techniques are methods that can help prolong the time taken to ejaculate. These include:

Stop-start technique

The stop-start technique is also known as the Semans' technique after Dr James Seman who is credited with developing the treatment. It involves practising bringing yourself near to ejaculation and stopping the stimulation before ejaculation occurs. This can help you to recognise and control the sensations when you are close to ejaculation.

Squeeze technique

Also known as the Masters and Johnson technique, it involves you or your partner squeezing the middle of your penis when you feel that you are about to ejaculate. This can help delay the urge to ejaculate and can be repeated as required.

Pelvic floor exercises

Pelvic floor exercises, also known as Kegel exercises, are used to strengthen the pelvic floor muscles. These are the muscles that are used to stop urination midstream and are involved in supporting ejaculation. These muscles can be exercised by contracting them and releasing them after 10 seconds. Over time they can better help control the timing of ejaculation.

Medications

Medications to treat premature ejaculation can include antidepressants such as clomipramine, fluoxetine, sertraline, dapoxetine and paroxetine. These may be required to be taken daily or some may be taken shortly prior to sex. Side effects of some medications may include dry mouth and eyes, blurred vision, dizziness and reduced libido.

Topical anaesthetics are creams that are applied to the penis about 10-20 minutes before sex. They contain numbing agents including lignocaine. It is important to wash off excess cream or wear a condom, to prevent causing numbness in your partner.

Counselling

When the cause of premature ejaculation is psychological, some people can benefit from seeing a counsellor or psychologist. This can help to confront and overcome relationship difficulties, anxiety or stress.

Anxiety

A feeling of tension, nervousness and dread about future events. It can trigger physical symptoms such as a rapid pulse or breathing difficulties.

Psychological

Relating to, arising in, or affecting the mind.

Potential complications

Complications associated with premature ejaculation can include relationship stress and an inability to conceive a baby. Your doctor can provide support to help with both of these situations.

Prognosis

If premature ejaculation is persistent and troubling you or your partner, behavioural techniques, medication or topical anaesthetic creams can be used to effectively treat the condition.

Prevention

To help prevent premature ejaculation there are a number of simple techniques that can be used. These include the stop-start technique, the squeeze technique and pelvic floor exercises. Building and maintaining a healthy relationship with your partner can also help to prevent premature ejaculation.