Premature Ejaculation

Premature Ejaculation

What Is It?

Published: February, 2020

This article is a repost which originally appeared on Harvard Health

Edited for content

Premature ejaculation occurs when a man reaches orgasm and ejaculates too quickly and without control. In other words, ejaculation occurs before a man wants it to happen. It may occur before or after beginning foreplay or intercourse. Some men experience a lot of personal distress because of this condition.

As many as one in five men experience difficulty with uncontrolled or early ejaculation at some point in life. When premature ejaculation happens so frequently that it interferes with the sexual pleasure of a man or his partner, it becomes a medical problem.

Several factors may contribute to premature ejaculation. Psychological problems such as stress, depression and other factors that affect mental and emotional health can aggravate this condition. However, there is growing evidence that biological factors can make some men more prone to experience premature ejaculation.

Rarely, premature ejaculation can be caused by a specific physical problem, such as inflammation of the prostate gland or a spinal cord problem.

Symptoms

The key symptoms of premature ejaculation include:

  • Ejaculation that routinely occurs with little sexual stimulation and with little control
  • Decreased sexual pleasure because of poor control over ejaculation
  • Feelings of guilt, embarrassment or frustration

Diagnosis

Premature ejaculation is diagnosed based on typical symptoms. To understand your problem, your doctor will need to discuss your sexual history with you. Be frank and open. The more your doctor knows, the better he or she can help you.

If your sexual history fails to reveal significant mental or emotional factors that may contribute to premature ejaculation, your doctor may want to examine you. Your doctor may examine your prostate or do neurological tests (tests of your nervous system) to determine if there is a physical problem that could be causing premature ejaculation.

Expected Duration

Sometimes, premature ejaculation goes away on its own over weeks or months. Working to relieve stress or other psychological issues may help the situation to improve.

Other men have lasting difficulties with premature ejaculation, and require professional help. Some men respond to treatment promptly, while others struggle with this problem over a prolonged period. Effective treatment is available.

Prevention

There is no known way to prevent premature ejaculation. However, you should consider the following advice:

  • Maintain a healthy attitude toward sex. If you experience feelings of anxiety, guilt or frustration about your sex life, consider seeking psychotherapy or sexual therapy.
  • Keep in mind that anyone can experience sexual problems. If you experience premature ejaculation, try not to blame yourself or feel inadequate. Try speaking openly with your partner to avoid miscommunication.

Treatment

Behavioral therapy is one possible approach for treating premature ejaculation. Most commonly, the “squeeze technique” is used. If a man senses that he is about to experience premature orgasm, he interrupts sexual relations. Then the man or his partner squeezes the shaft of his penis between a thumb and two fingers. The man or his partner applies light pressure just below the head of the penis for about 20 seconds, lets go, and then sexual relations can be resumed. The technique can be repeated as often as necessary. When this technique is successful, it enables the man to learn to delay ejaculation with the squeeze, and eventually, to gain control over ejaculation without the squeeze. Behavioral therapy helps 60% to 90% of men with premature ejaculation. However, it requires the cooperation of both partners. Also, premature ejaculation often returns, and additional behavioral therapy may be needed.

Another possible treatment is prescription medication that helps to delay ejaculation. Delayed orgasm is a common side effect of certain drugs, particularly those used to treat depression. This is true even for men who are not depressed. When this type of medication is given to men who experience premature ejaculation, it can help to postpone orgasm for up to several minutes. Drugs used for this type of treatment include selective serotonin reuptake inhibitors (SSRIs), such as fluoxetine (Prozac), paroxetine (Paxil) or sertraline (Zoloft); and tricyclic antidepressants, such as clomipramine (Anafranil).

Some men with premature ejaculation may benefit from drugs called phosphodiesterase inhibitors, such as sildenafil (Viagra), vardenafil (Levitra), and tadalafil (Cialis). A phosphodiesterase inhibitor can be used alone or in combination with an SSRI. One drug should be started at a time, preferably at a low dose.

Some men with premature ejaculation also benefit from reducing the stimulation they experience during sex. A number of creams are available that can partially anesthetize (numb) the penis and reduce the stimulation that leads to orgasm. Another option is to use one or more condoms. However, these techniques may interfere with the pleasure experienced during sex.

When To Call a Professional

Speak with your doctor if you consistently ejaculate before you want to. Remember, one instance of premature ejaculation does not mean that you have a condition that requires treatment. Your doctor may refer you to a sex therapist if premature ejaculation is causing major problems in your sex life or personal relationships or if you would like to consider behavioral therapy.

Prognosis

Many men experience a brief period of premature ejaculation, then improve on their own. Even for men who require medical treatment, the outlook is usually good.

Speaking up about orgasms

Speaking up about orgasms

Men often don’t talk about delayed or absent orgasm. Still, these issues can have a profound impact on their sex life.

This article is a repost which originally appeared on Harvard Men’s Health Watch

Edited for content

Published: October, 2020

Erectile dysfunction continues to be the main sex-related issue among older men. Yet, two other problems also can arise with age: anorgasmia, the inability to achieve an orgasm during sex, and delayed orgasm, in which it takes longer than usual to reach orgasm and ejaculate despite proper stimulation. Men can experience either one or both.

While these conditions can cause stress for both men and their sexual partners, they don’t have to hinder a healthy, active sex life.

“Orgasms are pleasing and satisfying, but you often can achieve sexual satisfaction without one,” says urologist Dr. Michael O’Leary, director of Men’s Health at Harvard-affiliated Brigham and Women’s Hospital. “With the right approach, these conditions can have little, if any, impact on whether you can enjoy intimacy.”

Two similar conditions

With anorgasmia, you can get an erection and enjoy stimulation from intercourse even though you can’t reach orgasm. Research has defined delayed orgasm as taking longer than 30 minutes to achieve orgasm and ejaculate, although the time can vary per person. Some men with delayed orgasm can experience the sensation of orgasm but don’t ejaculate.

It’s not known how common these conditions are, as men are often reluctant to discuss them with their doctor or partner. Nor is it clear why they become more frequent with age.

However, a report in the November 2015 issue of Fertility and Sterility pointed to a combination of possible factors, like changes in penis sensitivity, lower testosterone levels, medication side effects, and lack of exercise.

The conditions also can occur when a man enters a new relationship. For instance, a man may feel under stress about pleasing his new partner. If he has not been sexually active for a while, he may struggle with performance anxiety. Men also may feel pressured to climax within a specific time frame, which can exacerbate the problem.

Treatment and options

Before rushing to your doctor for help with either of these conditions, Dr. O’Leary suggests that you first look at the larger picture of how it affects your overall sex life.

“It’s normal to want to maintain the sexual vigor of your youth, but men have to realize that their body changes with age. Sometimes, that means your sex life, too,” he says. “Even if you don’t always have an orgasm, you and your partner can still experience pleasure from the intimacy that accompanies any sexual encounter.”

Still, if an orgasm problem affects your sex life, certain strategies could help. The following are some options to discuss with your doctor.

Sexual therapy. Therapy with a sexual health expert can address the issues that may be causing orgasm trouble, especially if it’s related to a new relationship or some other psychological issue. “Many times, it’s not a physical problem, but the connection between the brain and body,” says Dr. O’Leary.

Testosterone. Since both anorgasmia and delayed orgasm can be related to low testosterone levels, a simple blood test can determine if you might benefit from supplementation.

Medication. There are no FDA-approved drugs to treat anorgasmia or delayed orgasm. Even so, one drug, called cabergoline (Dostinex), has received attention. Orgasm is associated with a surge in prolactin, a hormone made in the brain’s pituitary gland. If blood prolactin levels are always high, there is no surge. Cabergoline lowers levels to allow the surge normally experienced with orgasm.

A study in the March 2016 issue of Sexual Medicine found that men’s orgasm problems improved after they took 0.5 milligrams of cabergoline twice a week for about 10 months. About half of the group said their orgasms returned to normal. The drug tends to be well tolerated and it’s presumed safe, although its long-term effects are unknown. Consult with your doctor about whether this could be an option.

Some antidepressants, especially selective serotonin reuptake inhibitors like fluoxetine (Prozac) and sertraline (Zoloft), may cause anorgasmia or delayed orgasm. In fact, doctors will sometimes prescribe these drugs for men with the opposite problem, premature ejaculation. If you take an antidepressant, talk with your doctor about lowering your dosage or switching to a different one.

Change sexual positions. Modifying sexual positions or foreplay practices with your partner may increase arousal and help achieve orgasms, according to guidelines from the American Urological Association.

Penile vibratory stimulation. This clamplike device is placed around the penis and vibrates to stimulate the nerves in the base of the penis. It’s used before sex and can be incorporated into foreplay.