Premature Ejaculation Causes And Treatments

Premature Ejaculation Causes And Treatments

How long should it take for a man to ejaculate? That a tough question to answer. Like so much in life, it's subjective.

If you are distressed, however, because you think you climax too quickly and you have other specific symptoms, then you may meet the criteria for the medical diagnosis premature ejaculation (PE).

But even if you don't "officially" have PE, either you or your partner or both of you may want to extend your physically-intimate moments.

With that stated, let's look at options to treat PE and prolong sexual pleasure.  

What Is Premature Ejaculation?

If you reach orgasm shortly after sexual foreplay or during intercourse without control, you may be ejaculating prematurely. "Premature" is generally cited as within one minute of sexual activity, before you want it to occur and if it causes you and/or your partner distress.

The average time for male ejaculation is 5 - 7 minutes.1

Reaching orgasm "too early" occurs in about 1 in 51,2 men at some point in their life. It may not be a problem if it is temporary and easily attributed to transient situations−among them stress, anxiety or fatigue−and they are resolved within a period that is acceptable to you.

As many as one-third of men experience repeated premature ejaculation.3

 

However, research shows that up to 30% of men persistently ejaculate early, also called Rapid Ejaculation (RE), and less that 10% speak to their doctor about it.3

Meanwhile, there are a variety of treatments for premature ejaculation and in most cases PE is treatable.1,4

How Do I Know If I Have Premature Ejaculation?

If you consult with a physician, your doctor will likely ask you a series of questions. if any of the below apply to you, then you may have PE.

  • Ejaculation almost always occurs unintentionally within one minute of penetration.1
  • The issue has been occurring for more than six months.1
  • Premature ejaculations are very distressing.1
  • No other medical problem is identified as a cause.1

What Causes Premature Ejaculation?

Emotional disturbances that may cause or are related to premature ejaculation include:

  • Guilt1
  • Stress1
  • Lack of confidence in sex or in general1
  • Feelings of inadequacy about the relationship1
  • Performance pressure from yourself or actual or perceived pressure from your partner1

Conditions like Benign Prostatic Hyperplasia (BPH) and thyroid disease can cause premature ejaculation. 

Erectile dysfunction (ED) medication may inadvertently lead to premature ejaculation. 

 

Despite all of the possible causes for premature ejaculation, the use of medication or practice of behavioral modification techniques can be successful for up to 95% of men.4

 

How Is Premature Ejaculation Treated?

You medical provider can diagnose and help you resolve premature ejaculation. 

Treatments include

  • Individual or couples counseling.
  • Topical application of lidocaine to the penis is one of the oldest 4 and most successful treatments.5 It is available in 5% strength as an over-the-counter remedy. Not needing a prescription to obtain 5% lidocaine to treat premature ejaculation can make it easier to extend your sexual activity even if you don't meet the diagnostic criteria for PE or seek a first-line remedy. Keep in mind, this statement is not meant to provide diagnosis, treatment or medical advice. You should always seek consultation from a physician or medical professional for any medical or health-related diagnoses or treatments. 
  • Off-label use of Selective Serotonin Reuptake Inhibitors (SSRIs), a class of prescription antidepressants.
  • Exercises and behavioral modification techniques.

Some men choose to use a combination of treatments.

couple in bed

Lidocaine Topical To Treat Premature Ejaculation

Lidocaine 5% applied to the penis 20-30 minutes before sex may be one of the least invasive and easiest treatments. Low-dose lidocaine can slightly reduce sensation to help you control when you ejaculate.

You may ejaculate too quickly because you are extremely sensitive. If that is the case, dulling sensation slightly but not so much that it interferes with your pleasure could be all that is needed.

Techniques To Control Ejaculation

Start and stop technique: This involves stimulating the penis almost to the point of orgasm and then stopping to regain control and resist the urge. You may do this several times during each sexual encounter. Over time, some men learn how to control their ejaculation and feel that they no longer have PE.

Squeeze technique: Similar to the start and stop technique, allow yourself to reach the point of near orgasm and then place some pressure on the head of the penis to decrease the level of arousal. You may find that it is easiest to do by placing your index finger on the back side of the penis (where the head joins the shaft) and placing your thumb on the other side. Next, gently squeeze the area and then wait 30 seconds. Repeat this several times in a row.

Distract yourself: Take your mind off your present situation to turn your excitement down a notch. This is also similar to the start and stop technique. Some men find distraction useful while others state that they lose some firmness or their erection completely.  If this is the case, you may want to practice or just try something else. 

Pelvic floor exercises: The pelvic floor is a muscle that supports the sphincter and urethra. Controlling the urethra helps delay ejaculation. 

What Medications Treat Premature Ejaculation?

In addition to topical desensitizing products like lidocaine, SSRIs may be prescribed off-label.

They include fluoxetine (Prozac), paroxetine (Paxil), sertraline (Zoloft) and clomipramine (Anafranil). They may be taken on demand 2-6 hours before sex or on a regular basis. 

Priligy (dapoxetine), a quick-acting SSRI that the body eliminates within a short period, was developed specifically to treat premature ejaculation. 

If are hesitant to take an SSRI, you are not alone. One study on the use of paroxetine, generic Paxil, showed a high degree of nonacceptance.6 One-third of participants chose not to take the medication, with 42.9% of that group citing fear of using an antidepressant as their reason.6

Out of the 30.8% who began treatment but later discontinued it, the majority said the results did not meet their expectations.6 The others said they stopped because they lost interest in the sexual relationship or the side effects of the medication deterred further usage.6

Tramadol is another Rx medication that some physicians prescribe off-label. Physicians may decline to prescribe it, however, due to lack of quality Randomized Clinical Trials and/or the potential for addiction.7 Tramadol is an analgesic with opiate-like qualities.7

Can Antidepressants Cause ED?

Yes, ED is a common side effect of antidepressants, but choosing whether to begin or stop taking an antidepressant is a serious decision that requires medical guidance. 

ED that stems from the use of antidepressants is commonly treated with ED medications like tadalafil, the active ingredient in (Cialis) and sildenafil, the active ingredient in Viagra

Ironically, some ED treatments can actually trigger PE. The reason? You may feel pressured to rush because you fear you will lose your erection.

Everyone's situation is unique and that's why options are so important.

ED And BPH Tied To Premature Ejaculation

Two common comorbidities of BPH are premature ejaculation and ED. Up to 20 mg of tadalafil may be prescribed to treat erectile dysfunction, while 5 mg has demonstrated success in the treatment of BPH with lower urinary tract symptoms (LUTS).8

A 5 mg dose of tadalafil each day could be the sweet spot for treating both ED and BPH. When used to treat ED, "Cialis Daily" or tadalafil daily, maintains a steady low-dose of the drug in the body. Many men find that they can keep sex spontaneous and don't need to plan ahead to take their ED prescription when using a daily 5 mg dose of tadalafil.

Tadalafil works by relaxing smooth muscle in the penis. This increases blood circulation to the penis to enable an erection and treats BPH by relieving pressure on the prostate which allows urine flow.

Thyroid Problems Linked To Male Sexual Dysfunction

A number of studies have found a connection between hyperthyroidism and premature ejaculation. At least one link may be hormonal imbalance caused by the primary condition of an overactive thyroid.9

Symptoms and effects of hypothyroidism may cause PE. They include fatigue, depression and elevated levels of the hormone prolactin (hyperprolactinemia). Hyperprolactinemia may interfere with the function of the testes, which subsequently contributes to low testosterone,9 and then possibly ED or other sexual dysfunction.

Restoring thyroid balance may resolve related premature ejaculation.9

References

1 InformedHealth.org [Internet]. Cologne, Germany: Institute for Quality and Efficiency in Health Care (IQWiG); 2006. Premature ejaculation: Overview. 2019 Sep 12. https://www.ncbi.nlm.nih.gov/books/NBK547548/

2 Mens Health | Premature Ejaculation. What is it? Mens Health | Harvard Health Publishing. February 20, 2020. https://www.health.harvard.edu/mens-health/premature-ejaculation-a-to-z

3 Porst H, Montorsi F, Rosen RC, et al. The Premature Ejaculation Prevalence and Attitudes (PEPA) survey: prevalence, comorbidities, and professional help-seeking. Eur Urol. 2007;51(3):816-824. doi:10.1016/j.eururo.2006.07.004

4 Premature Ejaculation: Causes & Treatment - Urology Care Foundation. Urologyhealth.org. https://www.urologyhealth.org/urologic-conditions/premature-ejaculation#Causes Published 2020. Accessed September 8, 2020.

5 Abu El-Hamd, M. Effectiveness and tolerability of lidocaine 5% spray in the treatment of lifelong premature ejaculation patients: a randomized single-blind placebo-controlled clinical trial. Int J Impot Res (2020). https://doi.org/10.1038/s41443-019-0225-9

6 Salonia A, Rocchini L, Sacca' A, et al. Acceptance of and discontinuation rate from paroxetine treatment in patients with lifelong premature ejaculation. J Sex Med. 2009;6(10):2868-2877. doi:10.1111/j.1743-6109.2009.01404.x

7 Martyn-St James M, Cooper K, Kaltenthaler E, et al. Tramadol for premature ejaculation: a systematic review and meta-analysis. BMC Urol. 2015;15:6. Published 2015 Jan 30. https://doi.org/10.1186/1471-2490-15-6

8 Hatzimouratidis K. A review of the use of tadalafil in the treatment of benign prostatic hyperplasia in men with and without erectile dysfunction. Ther Adv Urol. 2014;6(4):135-147. https://doi.org/10.1177/1756287214531639

9 Grine S, Charfi N, Kamoun M, Mnif F, Naceur BB, Rekik N, Mnif M, Abid M. Hyperthyroidism: A rare cause of pulmonary embolism: Report of two cases. Indian J Endocr Metab [serial online] 2013 [cited 2020 Sep 8];17:1104-7. Available from: http://www.ijem.in/text.asp?2013/17/6/1104/122640

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