Premature ejaculation is a condition of sexual dysfunction where a man releases sooner than anticipated or desired during sexual intercourse. It is among the most common sexual dysfunctions in men, with up to one-third of men reporting instances of premature ejaculation at some point in their life.
Infrequent and irregular instances of premature ejaculation are common and present little cause for concern. However, if it occurs regularly, it could be caused by various physical and psychological factors. When it does become a problem, patients can experience significant distress and frustration and avoid sexual intimacy.
Psychological causes are contributing factors in many cases. These can include a history of sexual abuse, early sexual experiences, anxiety, depression, and poor self-image. Men experiencing erectile dysfunction are also prone to premature ejaculation. Biological causes can also contribute to abnormal hormone or neurotransmitter levels and prostate or urethra inflammation or infections.
The primary symptom of premature ejaculation is the inability to delay ejaculation past one minute into sexual intercourse. The problem can also occur during other sexual activities. Symptoms are generally divided into the following categories:
- Lifelong: Where problems have occurred frequently since the first sexual encounter
- Acquired: Where problems develop after previous sexual intercourse without issue
A physician will first ask the patient about the extent of their premature ejaculation and their other medical history. That can reveal potential underlying causes. In cases where erectile dysfunction is also an issue, the physician will order blood tests to check for testosterone levels, a deficiency of which can cause many sexual problems.
In many cases, the physician will recommend the patient to a psychiatrist or other mental health professional specializing in sexual dysfunction. Premature ejaculation is typically the result of psychological factors—at least in part.
Further testing could include a physical examination for inflammation of the prostate and a urine test to check for urinary tract infection. A general practitioner will often refer patients to a urologist for specialized diagnosis and treatment.
There are many different approaches to the treatment of premature ejaculation. A physician can choose to prescribe a combination of these various treatments, including behavioral techniques, pelvic floor exercises, counseling, medications, and the use of condoms designed to delay ejaculation.
Among the first recommendations for most patients are some simple behavioral adjustments that can provide results. A patient may be advised to masturbate several hours before sexual intercourse to delay ejaculation. Engaging in sexual activities other than intercourse can also reduce the anxiety that can come with premature ejaculation.
Several topical anesthetics can numb the penis, reducing sensation and delaying ejaculation. These products are available in both creams and sprays. Some oral medications are also available to delay ejaculation, although none are FDA-approved for that use.
Due to the many psychological factors involved in premature ejaculation, counseling for the patient alone or with their partner can help resolve the issue.