Premature Ejaculation

Premature ejaculation occurs when male sexual climax (orgasm) occurs before a man wishes it or too quickly during intercourse to satisfy his partner.

Description

Premature ejaculation is the most commonly reported sexual complaint of men and couples. The highest number of complaints is among teenage, young adult, and sexually inexperienced males. Increased risk is associated with sexual inexperience and lack of knowledge of normal male sexual responses.

Causes and symptoms

There are several reasons why a man may ejaculate prematurely. For some men, the cause is due to an innate reflex or psychological predisposition of the nervous system. Sometimes it can be caused by certain drugs, such as non-prescription cold medications. Psychological factors, such as stress, fear, or guilt can also play a role. Examples of psychological factors include guilt that the sexual activity is wrong or sinful, fear of getting caught, or stress from problems at work or home.

In general, symptoms are when a male reaches climax in less than two minutes or when it occurs before the male or couple want it to occur.

Diagnosis

There are no tests used to diagnose premature ejaculation. It is usually determined by the male involved based on his belief that he reached orgasm too quickly. General guidelines for premature ejaculation is if it occurs in two minutes or less, or prior to about 15 thrusts during sexual intercourse.

Treatment

In 1966, William H. Masters and Virginia E. Johnson published Human Sexual Response, in which they broke the first ground in approaching this topic from a new perspective. Their method was devised by Dr. James Seman and has been modified subsequently by Dr. Helen Singer Kaplan and others.

A competent and orthodox sex therapist will spend much more time focusing on the personal than the sexual relationship between the two people who come for treatment. Without emotional intimacy, sexual relations are superficial and sexual problems such as premature ejaculation are not always overcome.

With that foremost in mind, a careful plan is outlined that requires dedication, patience, and commitment by both partners. It necessarily begins by prohibiting intercourse for an extended period of time—at least a week, often a month. This is very important to the man because "performance anxiety" is the greatest enemy of performance. If he knows he cannot have intercourse he is able to relax and focus on the exercises. The first stage is called "sensate focus" and involves his concentration on the process of sexual arousal and climax. He should learn to recognize each step in the process, most particularly the moment just before the "point of no return." Ideally, ally, this stage of treatment requires the man's partner to be devoted to his sensations. In order to regain equality, he should in turn spend separate time stimulating and pleasing his mate, without intercourse.

At this point the techniques diverge. The original "squeeze technique" requires that the partner become expert at squeezing the head of the penis at intervals to prevent orgasm. The modified procedure, described by Dr. Ruth Westheimer, calls upon the man to instruct the partner when to stop stimulating him to give him a chance to draw back. A series of stages follows, each offering greater stimulation as the couple gains greater control over his arousal. This whole process has been called "outercourse." After a period of weeks, they will have together retrained his response and gained satisfactory control over it. In addition, they will each have learned much about the other's unique sexuality and ways to increase each other's pleasure.

With either technique, the emphasis is on the mutual goal of satisfactory sexual relations for both partners.

However, the 1990s ushered in a new era in the treatment of premature ejaculation when physicians discovered that certain antidepression drugs had a side effect of delaying ejaculation. Clinical studies have shown that a class of antidepressants called selective seratonin reup-take inhibitors (SSRIs) can be very effective in prolonging the time to ejaculation. The individual drugs and the average amount of time they delay ejaculation are fluoxetine (Prozac), one to two minutes with doses of 20-40 milligrams per day (mg/day) and eight minutes with 60 mg/day; paroxetine (Paxil), three to 10 minutes with doses of 20–40 mg/day; and sertraline (Zoloft), two to five minutes with doses of 50–200 mg/day.

Alternative treatment

There are several alternative products, usually found in health food and nutrition stores, designed to be sprayed or rubbed on the penis to delay ejaculation. Although the products promise results, there are no valid clinical studies to support the claims. A device called a testicular restraint, sold through erotic mail-order magazines, sometimes helps men delay ejaculation. The Velcro-like device restrains the testicles from their natural tendency to move during sex. Testicular movement can cause premature ejaculation.

Prognosis

The "squeeze technique" has elicited a 95% success rate, whereby the patient is able to control ejaculation. Treatment with SSRIs is effective in 85–90% of cases. However, the effectiveness begins to decrease after five weeks of daily administration. Although more studies are needed, this suggests the SSRIs are more effective when used on an as-needed basis.

Prevention

The best prevention is obtaining adequate information on normal sexual responses of males before having sex. It is also helpful to have sex in a comfortable, relaxed, private setting, free of guilt, stress, and fear.