Last modified on May 26th, 2020
Causes of Premature EjaculationThe causes of premature ejaculation are still unknown. There were earlier beliefs that premature ejaculation was as a result of psychological issues rather than biological causes. However there are new indications that the causes of premature ejaculation are more complicated, and involve a complex interaction of both psychological and biological factors.There are basically two types of premature ejaculation which are the primary and secondary types. Primary premature ejaculation is a condition where the man has been suffering from premature ejaculation throughout his entire sexual life. On the other hand, secondary premature ejaculation is where the man develops premature ejaculation later in life due to one or several possible causes. The majority of men suffering from premature ejaculation fall into the secondary category.Ejaculation is a reflex action that is triggered when a certain level of stimulation is attained. Therefore the ability to control this reflex action depends mostly on the capability of the man to recognize and regulate the amount of stimulation he is receiving so that he does not reach the point of triggering off his ejaculatory reflexes before he wants to.Premature ejaculation can have both psychological and biological causes as hereunder listed.
Psychological CausesSome of the psychological causes of premature ejaculation include the following:
Early Sexual ExperiencesThough premature ejaculation is a problem that occurs in men of all ages, younger men are more prone to suffering from this disorder. A reason for this might be as a result of established patterns of events that occurred in their earlier sexual experiences. A lot of first experiences of sexual intercourse often involve excitement mixed anxiety and a demand to perform quickly to avoid being caught.In such first experiences, performance – the desire to “get it right”, is often the focus rather than the pleasurable and erotic aspect of the experience. As a result, a good percentage of young men reach orgasm too quickly. This might be considered a problem by such young men, and next time there might be fear of a repeat which increases the chances of a premature ejaculation happening and thus a pattern is formed. This might continue well into adulthood if not treatment is undertaken.
Anxiety and StressAnxiety related to a man’s sexual performance or caused by other issues can also be a cause for premature ejaculation. When sex is linked with performance rather than with pleasure, developing ejaculatory control might become a difficult proposition. It is therefore better for a man to focus on what will bring pleasure to him and his partner.
Erectile Dysfunction FearsMen suffering from erectile dysfunction could also develop premature ejaculation as they may be anxious of obtaining and maintaining an erection during sexual intercourse and thus rushing to ejaculate quickly. Once a pattern of rushing to ejaculate is formed, it may become difficult changing it.
Biological causesThe biological factors that may contribute to premature ejaculation include the following: –
- Abnormal hormone levels
- Insufficient concentration of the neurotransmitter serotonin
- Abnormal reflex activity of the ejaculatory system
- Certain thyroid problems
- Inflammation and infection of the prostate or urethra
- Inherited traits
Treatment of premature ejaculationDespite the fact that premature ejaculation exists as a clinical diagnosis, it cannot be classified as a disease or an illness.Irrespective of whether the cause is psychological or biological, treatments for premature ejaculation include behavioral therapy, psychological counselling, and medications. There could also be a combination of any of these methods of treatment.
Behavioral TherapyBehavioral therapy helps about 60% to 90% of men with premature ejaculation. In general, practice and relaxation will help in dealing with the problem. However it should be noted that premature ejaculation often returns and additional behavioral therapy may be needed.Below are some examples of behavioral therapy methods that can be used for the treatment of premature ejaculation.
The “Squeeze” TechniqueThis method was developed by Masters and Johnson some decades ago. If a man senses that he is about to ejaculate, he simply withdraws from his partner, then him or his partner squeezes the shaft of his penis between a thumb and two fingers. The squeeze should be light and for about 20 seconds, then let go and resume sexual activity. The technique is repeated as often as necessary during intercourse. With practice, a man can gain good control over ejaculation without the squeeze.
The “Stop and Start” MethodThis second method which was developed by Dr. Helen Kaplan helps men with premature ejaculation to recognize when they are about to climax and then to slow down or reduce stimulation in order to extend the time until ejaculation. By starting and stopping sexual stimulation you can learn to prolong the sex act.
Abstaining from IntercourseCouples may be instructed to avoid sexual relations for a period of time to help reduce anxiety. This is beneficial as while avoiding intercourse they can spend time to focus on other types of sexual plays that eliminate pressure from the sexual encounters. This can help the man to connect and re-establish a satisfying physical bond with his partner.
More ForeplayBy engaging in more foreplay, couples can help each other achieve a state of high arousal by stimulating each other through kissing, cuddling, hugging, petting, stimulating the breasts, genitals, and other erogenous zones before copulating. This way, ejaculation and orgasm can be achieved almost at the same time by the couples.
MasturbationIn some cases, behavioral therapy may involve simple steps such as masturbating an hour or two before intercourse to help in the delay of ejaculation or stimulation of the partner to a state of arousal before copulating. Also since an ejaculation has already occurred, the man will now take a longer time to ejaculate when having sex with his partner.
Routine Kegel ExercisesResearchers have noted that some men who suffer from premature ejaculation have a faster neurological response in the pelvic muscles. Men with premature ejaculation caused by neurological factors can undertake certain exercises like Kegel to help them gain voluntary control over the PC muscle and thus give them more control over ejaculation. The added benefit of this is that it can also give men stronger erections and can therefore help to alleviate erectile dysfunction.
Counselling or PsychotherapyThis can help patients and their partners resolve conflicts and personal issues that might include anxiety, stress and resentment that can be contributing to premature ejaculation. In most cases this is more effective when couples attend sessions together.Current approaches to psychotherapy enables men amongst other things to learn techniques to control and/or delay ejaculation, increase confidence in sexual performance, reduce performance anxiety, modify rigid sexual patterns, overcome intimacy issues, resolve feelings and thoughts that interfere with sexual functions and to increase communication between him and his partner.
MedicationsThere are two classes of medications that can be used in the treatment of premature ejaculation and these include the use of (a) certain antidepressants and (b) topical anaesthetic creams.
Antidepressant DrugsThe 1990s ushered in a new era in the treatment of premature ejaculation when physicians discovered certain antidepressant drugs that had a side effect of delaying ejaculation. This type of medication can be helpful as they have a common side effect of prolonging the time it takes to achieve orgasm.However, antidepressants are not approved by the Food and Drug Administration (FDA) to treat premature ejaculation. Nonetheless, studies have shown that they are safe and effective. These medications include selective serotonin reuptake inhibitors (SSRIs) such as fluoxetine (Prozac), paroxetine (Paxil) or sertraline (Zoloft); and tricyclic antidepressants, such as clomipramine (Anafranil).
Topical Anaesthetics/Desensitizing CreamsLocal anaesthetic creams may be applied to the penis to decrease stimulation. The decreased feeling in the penis may help in prolonging the time before ejaculation.Topical creams are applied to the glans penis 10-30 minutes before intercourse and a condom is often used to enhance absorption. The condom can either be removed before intercourse or used during intercourse. Either method prevents possible genital numbness in the partner. Topical anaesthetics include the combination product lidocaine-prilocaine (EMLA) and an herbal Korean product (SS Cream).To determine whether one is suffering from premature ejaculation, it is important to ask whether you or your partner’s expectations about stamina are realistic considering the fact that the average time from insertion to ejaculation is less than three minutes. Also it would be helpful to note that female orgasm doesn’t occur automatically as a result of prolonged intercourse. Equally of note is the fact that majority of women find it easier achieving orgasm through manual or oral stimulation than through intercourse.
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