Premature Ejaculation

Premature ejaculation is a very common problem experienced by some men, where a man ejaculates too quickly during sexual intercourse. Premature ejaculation can have many different causes including stress, depression, relationship problems, prostate or thyroid problems or drug use. Using condoms, trying new positions or taking breaks during intercourse may help slow down ejaculation. There are also medications available that can be used that may be effective.

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Advice for Premature Ejaculation

What is Premature Ejaculation and what causes it?

Premature ejaculation (PE) is a common problem for men during (or before) intercourse. It occurs when the male ejaculates (comes) too quickly during sex. There are no strict parameters regarding what is ‘too quickly’, though a recent survey looked at 500 couples and found that the average time between a man putting his penis into his partner’s vagina and ejaculation was approximately five-and-a-half minutes. This figure should only be treated as a guide as there is no official definition regarding how long intercourse should last. It should always be down to the individual and his partner to decide what amount of time is satisfactory for them. However, it is commonly agreed upon that an ejaculation that occurs in less than two minutes can be classed as premature ejaculation. Premature ejaculation most commonly affects men in their teenage years and 20’s, however 40% of men have experienced it at some stage.

The causes for premature ejaculation are varied and not always clear. It can be caused by physical or psychological problems or in some cases both. For example, if a man has had erectile problems in the past, this can lead to a feeling of anxiety when engaging in sexual intercourse. This anxiety could result in premature ejaculation.

Common physical causes of PE include:

  • High blood pressure
  • Recreational drug use
  • Excessive consumption of alcohol
  • Diabetes
  • Multiple sclerosis
  • Prostate disease
  • Overactive or underactive thyroid

Common psychological causes of premature ejaculation include:

  • Unresolved sexual or emotional issues within a relationship
  • Stress
  • Depression
  • Anxiety about sexual performance (this is usually a common cause at the start of a new relationship, or when a man has had previous problems with sexual performance).

What are the symptoms of PE?

Premature ejaculation is generally due to over-excitement or increased sensitivity of the penis meaning that an orgasm is reached faster than desired. The majority of men will experience some degree of premature ejaculation in their lifetime. The primary symptom is the inability for a man to control his ejaculation. This will usually result in him being unable to continue intercourse for a period long enough to satisfy both himself and his partner. There are two distinctively different types of premature ejaculation, these are; primary premature ejaculation and secondary premature ejaculation.

Primary premature ejaculation is a lifelong condition that can be caused by a number of different things. For example:

  • Genetic factors: Recent studies have suggested that a man is more likely to suffer from primary premature ejaculation if a first-degree male relative has also suffered with the condition.
  • Biological factors: If the nerve signals that travel from the brain to the penis have changed then it could result in the penis becoming more sensitive. This increased sensitivity will mean the penis will not require as much stimulation before ejaculation occurs.
  • Psychological conditioning: For example, if a teenager always rushes when masturbating (to avoid being caught), this early sexual experience can become habit-forming. Essentially, the mind has been conditioned to ejaculate very quickly.
  • Upbringing: If a man has suffered a strict or devoutly religious upbringing, they may come to view sex as inappropriate, wrong or sinful. These negative connotations may result in feelings of stress or unease when partaking in sexual activity. This may lead to being unable to relax during sex and can cause premature ejaculation.
  • Past sexual experiences: If a man has suffered an early traumatic sexual experience, such as sexual abuse or being caught masturbating. This can lead to lifelong feelings of stress or anxiety during sex, which can cause premature ejaculation.

Secondary premature ejaculation is a condition that is acquired by a man who has otherwise had a history of normal sexual performance. As with primary premature ejaculation, secondary can also be induced by both physical and psychological factors. For example:

  • Physical causes can include; prostate disease, high blood pressure, diabetes, thyroid problems, excessive consumption of alcohol or taking recreational drugs.
  • Common psychological causes include; stress, depression, anxiety about sex or unresolved sexual issues or conflicts.

Premature ejaculation often leads to self-esteem issues for the sufferers that can lead to anxiety, depression, and relationship problems due to their condition, it is therefore important not to suffer in silence.

How is Premature Ejaculation diagnosed?

If you feel you are suffering with premature ejaculation and it is making you or your partner unhappy, it is advised to take action. Premature Ejaculation can be self-diagnosed and treated, however it is advised to have a check-up with your GP to ensure there are no underlying health conditions that need to be addressed - you do not necessarily need to discuss your PE.

Your GP, or our Online Pharmacy team, will then ask a number of questions to try and understand the nature and cause of your problem. This may include quesions about:

  • Your sexual and emotional health.
  • Lifestyle, diet, exercise, alcohol etc.
  • Your medical history (to try and identify any underlying medical cause).
  • Whether you’ve sustained any pelvic injury or undergone any surgery in the pelvic region.

If the doctor can’t determine the cause through these questions then additional tests may be required. They can include a rectal examination to check for any abnormalities with the prostate gland. Blood and urine samples may also be taken. These samples can then be analysed to check the body’s hormone and cholesterol levels.

If you feel that there may be psychological problems that relate you your PE, it is advised you speak to your partner to resolve these. It may be appropriate to seek advice from a sex and relationships therapist who can help to resolve any underlying issues that may be causing your problem.

What treatments are available for PE?

Treating premature ejaculation can prove challenging but most men who opt for treatment and persevere will end up having successful outcomes.

There are a variety of treatments and techniques used to help treat premature ejaculation, such as topical anaesthetics containing lidocaine or prilocaine. These will reduce sensitivity in the penis, allowing for longer sex. A topical preparation containing both these anaesthetics is Emla Cream. Emla can be applied directly to the tip for the penis 30 minutes before sex to help numb sensation and prolong the time to ejaculation. Emla is a popular and effective treatment, however it can be inconvenient to apply.

Dapoxetine (Priligy) is another popular treatment for premature ejaculation. It belongs to a group of medicines called selective serotonin reuptake inhibitors (SSRIs); unlike other medicines belonging to this group, Dapoxetine has been specifically formulated to treat premature ejaculation. Priligy is the first medication to be licensed to treat premature ejaculation in the UK. It is usually taken one to three hours before having sex. It is only advised to take one Priligy tablet per day. Priligy has the advantage that it is more discreet to use compared to Emla Cream. It is recommended that men wishing to try Priligy should begin treatment on the lower 30mg strength. The strength can then be increased next time if necessary depending on the response.

It is important to note that Emla cream and Priligy tablets only treat the symptoms of premature ejaculation and do not address the cause. It is important to try to understand the cause of your premature ejaculation and tackle any issues that you have control over.

Behavioural techniques, sex therapy or psychological counseling can help some men gain control over ejaculation and prevent the problem. Another non-medicinal treatment for premature ejaculation is couples therapy. Here any couple engaged in a long-term relationship will be able to discuss and hopefully resolve any emotional conflict or sexual issues that may be responsible for the premature ejaculation.

Can I prevent Premature Ejaculation?

There are a number of self-help techniques that can be used to help prevent premature ejaculation. Before seeking medical advice you should try the following:

  • Masturbate an hour before sex.
  • Use a thicker or numbing condom, such as Durex Extended Pleasure or Pasante Delay condoms.
  • Remember to breathe deeply and regularly during sex - do not hold your breath.
  • Take breaks during sex and try focusing on something boring and unsexy during these pauses.
  • Letting your partner go on top. This will allow them to pull away when you are close to ejaculating.

These techniques should also be used in conjunction with any medical or psychological treatments.

Alternatives

Non-Medicinal Alternatives for Premature Ejaculation

There are a few techniques that can be used as non-medicinal alternatives, these include:

  • Behavioural Techniques- This is usually taught by sexual therapists. Techniques such as stopping stimulation just before ejaculation to allow arousal to subside, or squeezing the head of the penis to reduce arousal. How ever the draw back of this is that it can take months to be effective and sexual therapists can be costly if not referred on the NHS.
  • Psychological Techniques- Counselling can often help men to gain control, as well as helping with the anxiety and depression linked with premature ejaculation. Although counselling can be costly.
  • Reduce Penis Sensitivity- Use a thicker or numbing condom, such as Durex Extended Pleasure or Pasante Delay condoms, or try masturbating an hour before sex.

Premature Ejaculation FAQs

  • Premature ejaculation is ejaculation that occurs uncontrollably before or shortly after the start of sexual intercourse/penetration, without much stimulation and before you want it to happen. Premature ejaculation describes the condition where a man achieves orgasm very soon after penetrating his partner or even before penetration.

    Doctors use three criteria to establish whether a person has premature ejaculation:

    1. Ejaculation frequently occurs within a minute of penetration.
    2. You find it difficult to delay ejaculation.
    3. Sex has become problematic, frustrating or distressing.

    If these apply to you then you are likely to suffer from the condition, which is thought to affect around 20% of men at some point in their lives. It is important to get help as premature ejaculation can have a bearing on the well-being of a relationship as well as the sufferer’s happiness and self-esteem.

    It can often lead to both partners having an unsatisfactory sexual experience. This then can increase the anxiety that in some ways contributes to the problem. If you suffer from premature ejaculation, you should bear in mind that it is probably the most common form of male sexual dysfunction and will undoubtedly have affected most men at some point in their lives.

  • With most cases, there is not a clear cause of premature ejaculation. Men often learn how to delay orgasms and ejaculation as they gain more experience and get older. Premature ejaculation is sometimes caused by there being a long period of time between orgasms or with a new partner.

    Psychological problems like depression, nerves or anxiety can sometimes be the culprit, while in other cases it could be related to a medical condition such as a side effect to a particular medicine, an injury or hormonal problems.

    It can be a more common occurrence for young men in a new relationship, and it usually improves over time. In addition, inflammation of the prostate, nervous system disorders or the side-effects of certain medicines or even illegal drugs like cocaine can cause premature ejaculation. It is important that if any other physical or mental symptoms accompany premature ejaculation that you consult your GP.

  • In the majority of cases, premature ejaculation is often resolved over time on its own without medical treatment. Using distraction methods and relaxation techniques could help you delay ejaculation. Other men have successfully treated their premature ejaculation by cutting down or completely stopping their use of recreational drugs, tobacco or alcohol.

    Premature ejaculation can sometimes be temporary and simply get better on its own. In certain instances, having sex more often can help to address the problem, as can wearing a condom to reduce the sensitivity of the penis.

    It can be helped by adopting certain positions and techniques during sex. Premature ejaculation is less likely to occur if you have sex with your partner on top. There is also the 'squeeze technique'. Your partner masturbates you then gently but firmly squeezes the head when you signal that you are about to orgasm. After about 10-20 seconds start again, repeating the process several times.

    Your doctor or GP may recommend specific methods for you and your partner to practice to delay ejaculation. This could involve identifying the sensations that lead up to ejaculation and controlling them by communicating with each other to slow down or stop stimulation.

    Other helpful options could be trying sexual intercourse in a different position or by using a delay condom (if you don’t already) to reduce the sensation to your penis. Behavioural therapy and counselling is also thought to be beneficial in reducing anxiety that could be causing your premature ejaculation.

    Priligy (Dapoxetine) has been successfully used to prevent premature ejaculation and can prolong time to orgasm by 200 – 300%. Priligy comes in tablet form and is taken 1 – 3 hours before sex to give the desired effect. Up to 80% of those who take Priligy experience a longer ejaculation time.

    There are also a variety of topical sprays, gels and creams – such as Emla – that are used to reduce sensation by being applied before intercourse. A downside to these particular medicinal treatments is that they, in addition to affecting your own sensation, can sometimes affect your partner’s too. Instructions with these treatments should be followed carefully to avoid this.

    EMLA is an anaesthetic cream that is applied to the penis approximately 30 minutes before sex. It delays ejaculation in the majority men and is a popular treatment with minimal side effects.

  • Premature ejaculation occurs when a man ejaculates earlier than desired during penetrative sex. Because the concept of ‘normal’ sex is subjective, it is sometimes difficult to tell whether ejaculation is premature or not. As a guideline, studies have shown that the average time that a man takes to ejaculate during penetrative sex is between five and six minutes.

    Almost all men will experience premature ejaculation from time to time; this is normal. If you notice that it occurs in the majority of your attempts at intercourse, you might consider your options for treatment.

  • There is a multitude of factors that can contribute to problems with ejaculation. Many causes are psychological, including depression, stress (either from the relationship or otherwise) and a history of traumatic sexual experiences. Men can also have anxiety problems during sex, whereby they hurry through sex for fear of erectile dysfunction.

    Certain medical conditions and medications can delay or accelerate ejaculation as a side effect. Some men may also be physically predisposed to premature ejaculation, for example, those with an abnormally sensitive penis.

  • Premature ejaculation is the most prevalent sexual problem amongst men. Studies have shown that one in three men are affected. Because many men might be embarrassed to admit to this dysfunction, the true rate is likely significantly higher.

  • You may be able to delay your ejaculation on your own. Here are two techniques that you can try:

    The ‘stop/start’ technique involves training yourself to recognise the point just before you ejaculate. Gradually stimulate the penis until you think you have reached this point, then stop stimulation until you no longer feel the need to ejaculate. This should take 30 to 60 seconds. Resume stimulation until you reach the same point, then rest for another 30 to 60 seconds. After repeating this process at least four times, allow yourself to ejaculate normally. Do this routine regularly for a few weeks – you should notice much more control over your ejaculation during sex.

    The ’squeeze’ technique is a similar routine that will include your partner. While they are stimulating your penis, alert them when you are about to ejaculate. Have them squeeze the shaft just below the glans or head. You should notice the need to ejaculate go away. As with the first technique, repeat this routine a few times before allowing yourself to ejaculate normally. This is a difficult technique which will require commitment from both partners.

  • A delay spray is a local anaesthetic which can reduce the sensitivity of the penis. For men with lifelong premature ejaculation have been shown to last up to six times longer during sex with the use of anaesthetic sprays. Your GP can prescribe delay sprays, most of which contain the anaesthetic lidocaine.

    There are no serious side effects of delay sprays, though they may reduce sensitivity to the point of which you do not actually feel yourself ejaculating. The anaesthetic can also be transferred to your partner – consider using a condom so that her sensitivity is not also affected.

  • Some types of antidepressant have been shown to delay ejaculation. However, most of these are not approved in the UK for treating premature ejaculation. If you are prescribed an antidepressant for your premature ejaculation, it will likely be a selective serotonin-reuptake inhibitor, known as a SSRI. You will be required to take one pill each night for one month. If this is shown to be effective at delaying your ejaculation, you will then simply take a SSRI one hour before sex. Side effects can include drowsiness, blurred vision and dry mouth. Because of the nature of these side effects, it should be taken only at night; you should also be careful when driving or operating machinery the following day.

    One particular SSRI approved in the UK for treating premature ejaculation is dapoxetine. It is taken one to three hours before intercourse and has been shown to substantially delay ejaculation. Dapoxetine must be prescribed by a GP, as complications can arise when mixed with other medications. For example, the combination of dapoxetine and phosphodiesterase inhibitors such as Viagara can cause a decrease in blood pressure. Furthermore, it should not be combined with alcohol or other recreational drugs. Dapoxetine can cause nausea, headache and dizziness. Other side effects include insomnia, anxiety, blurred vision, tinnitus, reduced libido and erectile dysfunction.

    If SSRIs are not appropriate with your current medication, or if you also experience erection problems, your GP may prescribe other available drug treatments. In some cases, the benefits of these drugs might not outweigh potential risks.

  • There are a number of self-help techniques that you can try to delay your ejaculation. These may not always be successful, and may not deal with the root cause of the problem.

    It is important to discuss your problem with your partner. Many of the problems men face during sex come from pressure and anxiety; being completely open with your partner may relieve some of this. Similarly, you may feel less pressure if you place less emphasis on penetration during sex with your partner.

    Some men find that they will last longer during sex if they ejaculate more often. So, for example, masturbating more frequently might help with premature ejaculation. This can be combined with the ‘stop/start’ technique, mentioned above, which can help you develop some control over your orgasms.

    You can also deliberately reduce the sensitivity of the head of the penis by using condoms and/or anaesthetic sprays.

    If you think your premature ejaculation may be due to stress, consider trying exercises that will relax tension in your muscles. Focus on a group of muscles, contract them for several seconds, then relax. Start from your feet, and repeat the process with each muscle group until you reach your head.

  • Anxiety and stress can prevent you from relaxing or concentrating during sex, which can contribute to premature ejaculation. This can come from any area of your life, including your sex life itself. For example, men who occasionally suffer from erectile dysfunction may rush through sex for fear of losing an erection. Other medical conditions can bring about anxiety during sex as well, including heart disease.

  • Dapoxetine can cause complications when used concurrently with erectile dysfunction medication. The combination can decrease blood pressure, making you feel light headed and possibly faint when standing. As such, the two should be used only with care and only if you have told your doctor. In case you do feel faint, start off by only combining these medications in a safe environment in which you will be able to sit and lie down comfortably.

    If you are taking Levitra or Viagra, you must wait 24 hours between your dapoxetine and your ED medication to reduce your risk of fainting. If you are taking Cialis, you should must wait 48 hours.

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