Your guide to Premature Ejaculation (PE)

Premature Ejaculation (PE) or the condition under which a man releases semen before or immediately after penetration is a sexual dysfunction having both physiological and psychological causes.

Earlier Premature Ejaculation (PE) was considered to have solely psychological roots, but, today it has been scientifically proved that a multifarious interface of biological and psychological factors lead to sexual dysfunction.

It is now globally accepted that serotonin or a natural substance produced by nerves, plays a critical role in Premature Ejaculation (PE). While greater levels of this element in the brain raise the time for ejaculation, lower levels diminish it and cause Premature Ejaculation (PE).

However, the precise cause of Premature Ejaculation (PE) is yet to be discovered.

Premature Ejaculation (PE) can be a lifelong condition or an acquired one. In the first case, Premature Ejaculation (PE) will happen right from the first time and will continue to recur in all subsequent sexual acts. In the latter, untimely or premature ejaculation occurs in a later phase, after experiencing normal and timely ejaculation for a certain period of time.

In both cases, a number of factors are instrumental, but psychological causes are particularly responsible for lifelong PE.

What causes lifelong premature ejaculation?

• Self-conditioning - During adolescence, guilt often makes boys ejaculate quickly to avoid embarrassment and getting caught by family members. This can lead to lifelong premature ejaculation syndrome.
• Trauma - Traumatic experiences, abuse or violence, during childhood can leave a man permanently anxiety-prone, which in turn can lead to lifelong PE.
• Socio-cultural causes - At times, cultural practises and beliefs also work behind lifelong PE. Societies where sex is considered inappropriate and shameful or is a taboo, makes men uncomfortable in the act. The indoctrinated mind withholds easy participation and can potentially lead to lifelong PE.
• Genetic causes - Sometimes, lifelong PE is genetically inherited.

What causes acquired premature ejaculation?

Both biological and emotional issues lead to acquired PE among men. The chief causes are -

• Biological causes - Underlying diseases including high blood pressure and sugar, thyroid issues and ailments of the prostrate are the most common biological causes of acquired PE. Besides, abnormal levels of hormone or neurotransmitters, inflammation and infection of the prostate or urethra also lead to PE. At times serious sicknesses like that of multiple sclerosis which damage the nerves can lead to acquired premature ejaculation.
• Emotional causes – Such causes include stress, depression, early sexual experiences or abuse, poor body image, performance anxiety, and guilt while involved in clandestine sex. Nervousness with a new partner, long periods of celibacy are other common causes of acquired PE.
• Relationship issues – Issues in couples like conflicts, resentment, different sexual needs, high expectations, and lack of communication or preparation for intercourse majorly contribute to PE.
• Addiction - Binge drinking and other addictions are also responsible for the condition.

Ejaculation or the release of semen from the penis during the sexual act is a process controlled by the central nervous system. Once aroused, the brain of a man sends signals to his genitals to release semen.

Though there isn’t any definite timing for ejaculation, one that happens before intercourse or within a minute of arousal, is largely known as Premature Ejaculation (PE).

Ejaculation happening before it is desired can get frustrating not only for the man but also for his partner as it takes away pleasure from the sexual act. With untimely ejaculation, the man loses his erection and the sexual act comes to an abrupt halt. This, when continues for long, gets bothersome and in turn, affects relationships.

Occasional or intermittent Premature Ejaculation (PE) is not a cause of concern as it happens to 30 to 40 per cent of men and gets cured automatically after some weeks or in a couple of months.

Only when Premature Ejaculation (PE) continues consistently for more than three months, that one needs medical attention. Premature Ejaculation (PE) or the inability to control semen release is primarily associated with intercourse, but the condition may occur in any sexual situation, including masturbation.

Premature Ejaculation (PE) - be it, lifelong (primary), i.e. occurring every time since the beginning, or Acquired (secondary) i.e. happening later in life after experiencing a period of normal ejaculation - exhibit almost similar kinds of symptoms.

Key symptoms of Premature Ejaculation (PE)

A lot of misconceptions exist regarding Premature Ejaculation (PE). Men at times wrongly consider certain signs as symptoms of this sexual dysfunction which in reality do not meet the medical criteria.

It is also possible to have variable ejaculatory patterns in which periods of fast or untimely ejaculation is followed by normal and timely ones. Such patterns are not symptoms of Premature Ejaculation (PE). Some key symptoms of PE include:

• Ejaculation or release of semen by the penis with very little sexual trigger
• Inability to control the release of semen during intercourse
• Diminished sexual pleasure both in the man and his partner because of untimely ejaculation
• Guilt, discomfiture or irritation due to incomplete or rushed sex

If the symptoms continue unabated for more than three months, medical care is a must. While talking to a doctor, the following things are important to consider -

• Talk openly about the exact symptoms, including the time of ejaculation, nature of erection and time taken to get one.
• The feeling of embarrassment only hampers treatment as it stops proper disclosure of the condition and its exact symptoms to the doctor. Without proper understanding, proper diagnosis becomes difficult.

If the identified symptoms are not convincing enough for the doctor, a medical examination of the prostate and neurological tests are prescribed in order to reach a definite conclusion about Premature Ejaculation (PE).

Premature Ejaculation (PE), a common and medically manageable disease, if not addressed timely, can involve a number of risks and complications. Outcomes of Premature Ejaculation (PE) not only affects the personal life of the man but also disrupts the life of his partner, and if married, that of the entire family.

Most common risks associated with Premature Ejaculation (PE) are:

Stress and relationship problems - Relationship stress is an inevitable consequence of long term Premature Ejaculation (PE). A number of factors resulting from Premature Ejaculation (PE) lead to relationship issues, including-

• Lack of Satisfaction in sex which affects the quality of sexual intimacy
• Frustration and distress experienced by both the man and the women
• Lack of confidence in the man’s sexual potency

All these have a negative effect on the overall quality of a man-woman relationship. Premature Ejaculation (PE) often takes a toll on the self-esteem of a man and causes marital conflicts. Men afflicted with this condition find it difficult to relax during the sexual act and tend to avoid discussing the issue with partners. This significantly decreases the frequency of sexual intimacy between couples. Severe and prolonged Premature Ejaculation (PE) can also result in constant conflict between partners, estrangement, separation or divorce.

Fertility problems - Premature Ejaculation (PE) can have more serious consequences as it thwarts intravaginal ejaculation without which fertilization and pregnancy become difficult if not impossible. Hence, couples planning a family can be greatly impacted if the man is afflicted with Premature Ejaculation (PE).

Risks associated with single men – Identifying Premature Ejaculation (PE) can create distress in the lives of single men and his parents; as such a man will be reluctant to take partners in his life or to get married. Existing social taboo often makes men hide such afflictions from family or doctors, which only aggravates the already distressing situation.

Side effects of treatment – Though Premature Ejaculation (PE) is not known to have caused direct morbidity or mortality, treatment of this condition can have side effects. Drug treatment of Premature Ejaculation (PE), even if prescribed by doctors, is often associated with adverse effects.

Dapoxetine, a commonly used drug for treating both primary and secondary PE, is known to have side-effects like headache, queasiness, diarrhoea, and giddiness. Also, treatment of Premature Ejaculation (PE) may be a very long term process just like lifelong therapies needed for depression, high blood pressure and diabetes.

Risks associated with Premature Ejaculation (PE) are not only limited to sexual health but also affects all aspects of life with both direct as well as collateral damage. Time has come to recognise sexual dysfunctions like Premature Ejaculation (PE) as serious public health issues.

Did you know that it is a myth that alcohol can control premature ejaculation?

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Treatments of Premature Ejaculation (PE) exist in many forms and are suggested by doctors either in a single way approach or through combined applications of two or more techniques.

The options available for Premature Ejaculation (PE) cure include sexual or behavioural techniques, topical anaesthetics, medications through prescribed drugs and psychological counselling.

Pharmacologic or drug therapy

Topical anaesthetics creams and sprays having numbing agents like benzocaine, lidocaine or prilocaine, are often prescribed for Premature Ejaculation (PE) cure. These are administered on the penis 15 minutes prior to having sex in order to diminish penile sensation, which helps in delaying ejaculation.

Prescribed oral drugs for treating Premature Ejaculation (PE), available both on-demand or daily use, include –

• Selective serotonin reuptake inhibitor (SSRI)s like - sertraline, paroxetine, fluoxetine, citalopram, or dapoxetine
• Phosphodiesterase type 5 (PDE5) inhibitors like- sildenafil, tadalafil, or possibly vardenafil
• Other agents like - pindolol or tramadol

Behavioural techniques to cure PE

Sexual or behavioural techniques are a very common remedy and involve some very simple measures like that of masturbating an hour or 45 minutes prior to any sexual encounter with a partner which apparently helps in delaying ejaculation during intercourse.

Doctors often recommend a break from sexual activities and suggest engagement in different sorts of playful sexual acts which remove performance anxiety in men.

Frail or infirm pelvic floor muscles thwart the ability to delay ejaculation; hence exercises like pelvic floor exercises and pause-squeeze technique are prescribed to build these muscles

Do condoms help in managing PE?

Condoms, especially the Climax control variety, are known to diminish the sensitivity of the penis, which helps in delaying ejaculation. Climax control condoms come with numbing agents like benzocaine or lidocaine or are manufactured with thicker latex in order to delay ejaculation.

How does sex therapy or counselling help in managing PE?

Psychological counselling sessions with therapists are also very effective in Premature Ejaculation (PE) cure. The disorder often leads to distress, anxiety, and even emotional distance from the partner.

Sharing the symptoms, anxieties and exact nature of the disorder helps immensely in curbing performance anxiety and finding solutions for managing stress. Counselling is often used alongside drug therapy.

Does Ayurveda cure PE?

Various other remedies like Ayurveda, yoga, meditation and acupuncture are available for treating Premature Ejaculation (PE). The efficacy of these treatments is yet to be scientifically established.

How can your partner help in curing PE?

The available treatments work best when the partner is equally involved in the process, including being present in the counselling sessions.

The effort is taken by the partner in relieving underlying performance anxiety from the man also goes a long way in improving the condition.

Additionally, a second attempt at coitus –after an initial experience of premature ejaculation, is generally better as the ejaculatory control improves subsequently.

All-natural actions of the human body are scientific and occur in a thoroughly logical and coordinated manner, primarily controlled by the brain. Ejaculation is no different.

In order to understand the science behind ejaculation, it is important to understand the anatomy of the penis and the science behind erection.

The penis has a very complex structure and is made of -

• Corpora cavernosa, which is a twin-chamber running along the entire length of the penis and consisting of a network of blood vessels having a sponge-like texture.
• The urethra, or the conduit for urine and sperm, runs alongside the base of corpora cavernosa
• Erectile tissues enclosing the urethra, both the primary arteries and a number of nerves and veins
• The shaft, which is the longest component of the male sex organ
• The glans located at the head of the shaft
• The meatus, or cavity at the tip of the glans from which urine/semen are discharged or ejaculated

How does an erection happen?

Erection is initiated from stimulation, either mental or sensory, which then leads to arousal. Once aroused, nerve messages start exciting the male sex organ or penis, whereas signals from the brain make the muscles of the corpora cavernosa relax and open up.

This helps in rapid blood flow into the opened up spaces. The blood fills up the cavernous arteries and exerts pressure on the corpora cavernosa, which inflates the penis and makes it erect.

The membrane surrounding the corpora cavernosa, known as tunica albuginea, locks in the blood in the corpora cavernosa and helps in sustaining an erection. Once the muscles in the penis contract, the blood flows into the corpora cavernosa stops, outflow channels open up, which in its process reverses the erection.

How does ejaculation happen?

Sexual excitement or act on reaching its optimum level through stimulation and friction triggers ejaculation - a reflex action controlled by the central nervous system. The shaft and the glans have a skin covering which is stuffed with nerve endings highly responsive to pressure and pulsation.

Fondling the skin creates impulses which are sent to the brain by the nerves. On receiving the message from the skin as well as from other body parts of an aroused man, the brain reacts by making the skin further sensitive to stimulation.

With enough stimulation, arousal culminates into orgasm through ejaculation of semen. Here too, a flurry of activities are involved in order to coordinate the discharge of sperm from testes, production of semen, and the last few contractions that eject semen out through orgasm.

What are the stages of ejaculation?

To start with, the sperms are taken out from their storage space and are aptly positioned for movement. The muscles in the walls of the penis contact and create a conveyor-belt like a process which move the thick masses of sperm away from the epididymis, or the place of their growth.

Peristaltic wave-like contractions of the pipe-like structures storing and transporting sperms from testes (vas deferens), keeps squeezing and pushing the sperms towards the tip of the penis.

Meanwhile, the prostate gland and seminal vesicles discharge secretions to produce the semen which is a complex mix of sperm and secretions. Further contraction forces the semen into the urethra.

The urethral bulb swells up with the inflow of semen and gets inflated up to 2 to3 times of its normal size. Ejaculation is now inescapable.

The muscles that encircle the urethral bulb together with the muscles surround the urethra proper create a muscular pump like force. As a result of this, muscle contractions at the tip of the penis occur every 0.8 seconds which toss semen out with an astounding amount of force.

This propelling can happen in about five spurts. In the initial spurts, semen can dash through 1-2 feet in the air or more. After the first few strong contractions, the muscles continue to contract with lesser vigour for many more seconds, ejecting 2 to 5 millilitres of semen out of the male body.

Meanwhile, muscles located at the bladder constrict and shut the bladder opening, preventing not only the backward flow of semen but also stooping urination during orgasm. The entire process of ejaculation takes nearly three seconds and is accompanied by a sense of inevitability and pleasure called orgasm.

Did you know that the STOP-START method helps in managing PE?

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The first evidence‐based definition for Premature Ejaculation (PE) was developed by The International Society for Sexual Medicine (ISSM) Ad Hoc Committee, in 2007.

Dr Serefoglu and his colleagues, who were members of the Committee, provided an integrated definition of Premature Ejaculation (PE) both lifelong and acquired. The society was established in 1978 for the purpose of promoting research and exchange of knowledge for the clinical entity “impotence” throughout the international scientific community.

According to the committee, Premature Ejaculation (PE) is a male sexual dysfunction characterized by -

1. Ejaculation that always or nearly always occurs prior to or within about 1 minute of vaginal penetration from the first sexual experience (lifelong) or a clinically significant and bothersome reduction in latency time, often to about 3 minutes or less (acquired);
2. The inability to delay ejaculation on all or nearly all vaginal penetrations; and
3. Negative personal consequences, such as distress, frustration, and/or the avoidance of sexual intimacy.

Ejaculation is a reflex action monitored by the central nervous system of the human body. Only aroused or sensually stimulated messages from the male sex organs are sent to the spinal cord and brain.

When the level of excitement reaches its climactic stage, instructions are sent back by the brain to the male genitals, making ejaculation, or tossing out of semen from the penis, possible. Any disruption in the process can lead to untimely messages to the reproductive organs and cause early ejaculation or what is known as, Premature Ejaculation (PE).

Earlier, Premature Ejaculation (PE) was considered to have solely psychological causes like stress, depression and relationship issues. However, today medical science has established that factors pertaining to both the body and the mind can cause Premature Ejaculation (PE).

If premature ejaculation becomes a recurrent phenomenon and constantly interferes with pleasure, it should be considered as a medical problem, and it is important to talk to an expert and find the root cause.

A number of body constituents and parts play important roles in causing Premature Ejaculation (PE). Here are the most important ones -

Serotonin

The constituency of the human brain is believed to have a role in Premature Ejaculation (PE). Men with relatively lower levels of serotonin, a chemical substance, are likely to take less time to ejaculate.

Serotonin, when less active between nerves located in that part of the brain which controls ejaculation, causes early ejaculation and can lead to the medical condition of primary Premature Ejaculation (PE).

Serotonin also plays a critical role in the entire sexual activity and also in desire for sex. It also enables the passage of signals from one neuron to another. Lack of active serotonin hampers the signal transfer process in men during the sexual act.

The level of serotonin along with its state of activeness is determined by a gene, named 5-HTTLPR (serotonin-transporter-linked polymorphic region, or- the gene that codes for the serotonin transporter).

Of the three types of Carriers present in HTTLPR - LL, SL and SS - LL results in fast ejaculation. Hence, men with LL will ejaculate twice as faster than those with SS or SL genes.

According to medical science, Premature Ejaculation (PE) can occur in men having problems with erection, i.e. those with Erectile Dysfunction (ED). When a man is afflicted with Erectile Dysfunction (ED) the penis will not be able to achieve or hold on to erection firm enough for sex.

This results in the anxiety of losing an erection too soon and leads to a pattern of rushing to ejaculate, thereby causing Premature Ejaculation (PE), eventually. It often becomes a deeply rooted habit, extremely hard to give up.

Pelvic floor muscles

Pelvic floor muscles can also contribute to Premature Ejaculation (PE). Strong pelvic floor muscles increase penile strength and hardness and help in penetration and thrust.

Hence Pelvic floor muscle dysfunction can cause a weak erection and in the long run, Premature Ejaculation (PE).

Age

Premature ejaculation is mostly age agnostic. However, age does affect erections and the pattern of ejaculation. Erection in aged men is not as firm or as long as that of the young. Age also increases the apprehension of rapid ejaculation.

All these can lead to a Premature Ejaculation (PE) syndrome.

Did you know women can also have premature ejaculation?

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An array of cure exists for treating Premature Ejaculation (PE) including behavioural and sexual techniques, topical anaesthetics, medications and psychological therapy. While a single pronged treatment works for some men, others need a combined approach.

Medical science has not yet found a medication dedicated solely for Premature Ejaculation (PE) cure. Doctors mostly suggest medication used in treating other syndromes but having the potential to cure Premature Ejaculation (PE).

Prescription medication has always been a very effective procedure in Premature Ejaculation (PE) cure. These drugs delay orgasm up to several minutes as a common side effect and work well for treating Premature Ejaculation (PE).

The commonly prescribed drugs used for the treatment of Premature Ejaculation (PE) are –

Selective serotonin reuptake inhibitors (SSRI)s

• Fluoxetine (Prozac),
• Paroxetine (Paxil) or sertraline (Zoloft);
• Tricyclic antidepressants, like clomipramine (Anafranil).

Phosphodiesterase inhibitors

These drugs also work extremely well for men with premature ejaculation and can be taken alone or with an SSRI. Prescribed A mixture in this category include –

• Sildenafil (Viagra)
• Vardenafil (Levitra)
• Tadalafil (Cialis)

Topical anaesthetics

The numbing agents of anaesthetic creams and sprays are very effective in Premature Ejaculation (PE) cure. Drugs in this category are –

• Benzocaine
• Lidocaine or prilocaine

** Advice given here should not be considered as medical advice, and the reader should always take doctor's opinion.

Did you know PE was a 'strength' in the evolution of Homo sapiens?

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A number of factors, both emotional and biological, lead to Premature Ejaculation (PE). Addressing the root causes of these factors can help prevent Premature Ejaculation (PE) to a large extent.

Here are some of the effective ways to prevent Premature Ejaculation (PE):

Dealing with social taboos - Socio-cultural practises and taboo often lead adolescent boys towards self-conditioning for quick ejaculation. This, in turn, can lead to Premature Ejaculation (PE) in future.

Care should be taken to provide an open and healthy atmosphere in the family, so that young boys are not forced into such unhealthy self-conditioning.

The pervasive misconception about sex in Indian society, which considers sex a shameful act also needs to be addressed to prevent Premature Ejaculation (PE).

Many indoctrinated adult men feel uncomfortable in the sexual act as they consider it inappropriate; this also leads to Premature Ejaculation (PE).

Trauma – Any childhood trauma can have ramifications in adulthood in the form of Premature Ejaculation (PE). Timely treatment of such traumas through counselling and medication is essential to in order to prevent the disorder.

Health issues - Diseases like high blood pressure and sugar, thyroid issues, ailments of the prostrate, hormonal imbalance, inflammation and infection of the urethra can cause Premature Ejaculation (PE). Addressing health issues on time can prevent the disorder.

Stress management – Depression, early sexual experiences or abuse, poor body image, performance anxiety, and guilt greatly contribute to Premature Ejaculation (PE). Proper management of these issues through communication and counselling helps in preventing the affliction considerably.

Relationship management – Tackling relationships with effective communication, understanding, empathy and love, keeps away conflicts, resentment and dissatisfaction – all of which lead to relationship issues and can cause Premature Ejaculation (PE).

Sex education - Sex education is extremely important as it prepares a man for intercourse, in the absence of which, he can face anxiety and stress, which might lead to Premature Ejaculation (PE).

≈Addiction - Binge drinking and other addictions often result in Premature Ejaculation (PE). Staying away from both can prevent the disorder.

Erectile Dysfunction cure - Most men having erectile dysfunction or ED get afflicted with Premature Ejaculation (PE) eventually. Treating ED is a prerequisite for prevention of Premature Ejaculation (PE).