Premature ejaculation (PE) is a common sexual dysfunction in men, characterized by ejaculation that occurs sooner than desired, either before or shortly after sexual penetration, causing distress to either one or both partners. It can occur during all types of sexual activity, including masturbation. PE can be classified into two main types: lifelong (primary) PE, which has been present since a man’s first sexual experience, and acquired (secondary) PE, which develops later in life after previous normal sexual function. The exact causes are multifactorial and may include psychological factors like anxiety and stress, as well as biological factors such as hormone levels and neurotransmitter imbalances. Treatments vary and can include behavioral techniques, counseling, medications, and topical anesthetics.

What is premature ejaculation?

Premature ejaculation (PE) is defined as a condition in which a man ejaculates sooner during sexual intercourse than he or his partner would like. It typically involves ejaculation that occurs within one minute of vaginal penetration, though it can also be characterized by the inability to delay ejaculation on all or nearly all penetrative encounters, leading to negative personal consequences, such as distress, frustration, and avoidance of sexual intimacy. This condition can significantly impact a man’s sexual satisfaction and emotional well-being, as well as affect his partner and overall relationship.

Types of PE

Premature ejaculation (PE) is typically classified into two main types: lifelong (primary) PE and acquired (secondary) PE. Each type has distinct characteristics and underlying causes.

Lifelong (Primary) Premature Ejaculation

Definition: Lifelong PE refers to a condition where premature ejaculation has been present since a man’s first sexual experience.

Characteristics:

Consistent and persistent early ejaculation, usually within one minute of penetration.

Difficulty or inability to control ejaculation during almost all sexual encounters.

Causes:

• Often believed to have a strong biological component, such as genetic factors or neurobiological issues.
• May also involve psychological factors, including anxiety or conditioned responses from early sexual experiences

Acquired (Secondary) Premature Ejaculation

Definition: Acquired PE occurs after a period of normal sexual function. It develops later in life and is not present from the beginning of a man’s sexual activity.

Characteristics:

Sudden onset of early ejaculation, which is a change from previous sexual performance.

Can happen within a few minutes of penetration or even before penetration in severe cases.

Causes:

• Psychological factors such as stress, anxiety, or relationship issues.
• Physical or medical conditions like erectile dysfunction, prostatitis, thyroid problems, or changes in hormone levels.
• Certain medications or substance use can also contribute to the development of acquired PE.

Other Considerations

• Situational PE: Some experts also refer to situational PE, where premature ejaculation occurs only in specific situations or with certain partners. This is often related to psychological factors such as performance anxiety or relationship dynamics.
• Generalized PE: This term can be used to describe PE that occurs in all sexual situations, regardless of the partner or context. It can be lifelong or acquired.

Causes

Premature ejaculation (PE) can have a variety of causes, which are generally categorized into psychological and biological factors. Here are some of the key causes:

Psychological Causes

• Anxiety: Performance anxiety or general anxiety can contribute to PE.
• Stress: High levels of stress in daily life can affect sexual performance.
• Depression: Psychological conditions like depression can impact sexual function.
• Relationship Issues: Problems in a relationship can lead to sexual dysfunction, including PE.
• Previous Sexual Trauma: Traumatic sexual experiences can lead to anxiety around sex and result in PE.
• Lack of Sexual Experience: Inexperience or lack of confidence in sexual skills can lead to premature ejaculation.

Biological Causes

• Hormonal Imbalances: Abnormal levels of hormones, particularly testosterone, can affect ejaculation.
• Neurotransmitter Imbalances: Abnormal levels of brain chemicals called neurotransmitters, such as serotonin, can play a role.
• Genetics: Some men may be genetically predisposed to PE.
• Thyroid Issues: Hyperthyroidism has been linked to PE.
• Prostatitis: Inflammation or infection of the prostate gland can lead to PE.
• Erectile Dysfunction (ED): Men with ED may develop a pattern of rushing to ejaculate before losing their erection.
• Certain Medications: Some medications can affect sexual function and lead to PE.

Mixed Causes

• Combination of Factors: Often, PE is caused by a combination of psychological and biological factors. For example, a man might have a slight hormonal imbalance that, combined with anxiety about sexual performance, results in PE.

Other Factors

• Lifestyle Choices: Poor physical health, including obesity, lack of exercise, and substance abuse (alcohol, drugs), can contribute to PE.
• Sexual Habits: Some men may develop a pattern of rapid ejaculation during masturbation, which can carry over into sexual intercourse.

Symptoms

The primary symptom of premature ejaculation (PE) is ejaculation that occurs sooner than desired, often with minimal sexual stimulation and before, during, or shortly after penetration. Specific symptoms include:

Quick Ejaculation: Ejaculation that typically occurs within one minute of penetration in most cases.

Inability to Delay Ejaculation: Difficulty or inability to delay ejaculation during sexual intercourse, consistently or almost all the time.

Distress and Frustration: Personal distress, frustration, or avoidance of sexual intimacy due to concerns about premature ejaculation.

Negative Impact on Relationship: Problems in sexual relationships caused by the inability to control ejaculation, leading to dissatisfaction for both partners.

PE can manifest as either lifelong (primary) or acquired (secondary):

Lifelong (Primary) PE: Present from the first sexual encounter and persists throughout life.

Acquired (Secondary) PE: Develops after a period of normal sexual function and may be due to various factors such as stress, new relationship dynamics, or health issues.

These symptoms should be persistent over a period of at least six months for a diagnosis of PE, and they must cause significant distress to the individual or the couple. If you suspect you have PE, consulting a healthcare provider can help determine the underlying cause and appropriate treatment.

Treatment

Treatment for premature ejaculation (PE) can involve a combination of behavioral techniques, counseling, medications, and other therapies. The appropriate treatment depends on the underlying causes and the severity of the condition. Here are some common treatment options:

Behavioral Techniques

• Stop-Start Technique: This involves stimulating the penis until the urge to ejaculate is strong, then stopping until the urge decreases. This cycle is repeated several times before ejaculation is allowed.
• Squeeze Technique: The penis is stimulated until the urge to ejaculate is strong, then pressure is applied to the head of the penis to reduce the urge. This technique is repeated several times before ejaculation is allowed.
• Pelvic Floor Exercises: Strengthening the pelvic floor muscles through exercises like Kegels can help improve control over ejaculation.

Counseling and Therapy

• Cognitive Behavioral Therapy (CBT): This form of therapy helps address the psychological factors contributing to PE, such as anxiety, depression, or relationship issues.
• Sex Therapy: A sex therapist can work with both partners to improve communication, reduce performance anxiety, and enhance sexual satisfaction.

Medications

Topical Anesthetics:

• Creams or sprays containing numbing agents like lidocaine or prilocaine can reduce sensation and help delay ejaculation.

Oral Medications:

• Selective Serotonin Reuptake Inhibitors (SSRIs): Medications like sertraline, paroxetine, and fluoxetine, commonly used to treat depression, can delay ejaculation.
• Tricyclic Antidepressants: Clomipramine, another type of antidepressant, can also be effective.
• Phosphodiesterase-5 Inhibitors: Medications like sildenafil (Viagra), tadalafil (Cialis), and vardenafil (Levitra) can be used, especially if PE is associated with erectile dysfunction.

Alternative Therapies

• Herbal Supplements: Some herbal remedies claim to help with PE, but their efficacy and safety are not always well-established. It’s important to consult a healthcare provider before using them.
• Acupuncture: This traditional Chinese medicine technique has been used to treat various sexual dysfunctions, including PE, but more research is needed to confirm its effectiveness.

Lifestyle Changes

• Exercise: Regular physical activity can improve overall health and reduce stress, which may help with PE.
• Healthy Diet: A balanced diet can improve overall well-being and sexual health.
• Avoiding Alcohol and Drugs: Reducing or eliminating alcohol and drug use can improve sexual performance.

Combination Approaches

• Often, a combination of treatments is the most effective approach. For example, behavioral techniques can be combined with medications or counseling to achieve better results.

Consulting with a urologist is essential to determine the most appropriate treatment based on individual needs and the specific causes of PE.

Summary

Premature ejaculation (PE) is a common male sexual dysfunction characterized by ejaculation occurring sooner than desired, often within one minute of penetration, leading to distress and frustration for one or both partners. PE is classified into two main types: lifelong (primary) PE, present from the first sexual experience, and acquired (secondary) PE, which develops after a period of normal sexual function. Causes can be psychological (e.g., anxiety, stress) or biological (e.g., hormonal imbalances, genetics).

Treatment options include behavioral techniques, counseling, medications, and lifestyle changes, often tailored to the specific type and underlying causes of PE.

Prof. Dr. Emin ÖZBEK

Urologist

Istanbul- TURKIYE