What is Premature Ejaculation (PE)?
Premature ejaculation, also referred to as early or rapid ejaculation, is defined by the International Society for Sexual Medicine (ISSM) as a male sexual dysfunction characterized by ejaculation which always or nearly always occurs prior to or within about one minute of penetration, and the inability to delay ejaculation on all or nearly all penetrations.
It often causes significant anxiety and frustration for the couple and can lead to avoidance of sexual intimacy.
Premature ejaculation (PE) is one of the most common forms of sexual dysfunction, affecting as many as 1 in 4 adult men, according to a survey conducted by Canadian Male Sexual Health Council.
Many experts believe that PE is probably under-diagnosed as many men find it difficult to openly discuss it with their care providers.
Two Types of Premature Ejaculation
Premature ejaculation is categorized into either Lifelong PE or Acquired PE.
Patients with lifelong PE could never achieve a normal ejaculatory experience, often ejaculating in less than 1 minute.
In the case of acquired PE, there is usually a contributory factor such as performance anxiety that causes rapid ejaculation in otherwise healthy individuals. Patients with acquired PE may experience an ejaculatory time of less than 3 minutes.
While premature ejaculation is more common in younger men, it can happen at any age.
Diagnosis of Premature Ejaculation
Having an orgasm too soon is not always cause for concern. However, clinical diagnosis is made when a man exhibits the following symptoms:
- Ejaculation occurs too quickly, often in the first few minutes of intercourse, or in other sexual situations, even during masturbation.
- Inability to delay ejaculation most of the time.
- Feelings of anxiety, or avoidance of sexual intimacy as a result.
Both psychological and biological factors can play a role in premature ejaculation. Although many men feel embarrassed talking about it, premature ejaculation is a common and treatable condition.
Consequences of Premature Ejaculation
Premature ejaculation can cause problems in a man’s personal life, including:
- Stress and relationship problems – A common complication of premature ejaculation is relationship stress.
- Fertility problems – Premature ejaculation can occasionally make fertilization difficult for couples who are trying to have a baby if ejaculation doesn’t occur intravaginally.
- Erectile Dysfunction – studies have also shown that up to 30% of men with premature ejaculation also have difficulties getting or maintaining an erection.
Premature ejaculation treatment explained by Dr. Pollock
Causes of Premature Ejaculation
The exact cause of premature ejaculation is still uncertain however, many believe that Lifelong PE is believed to be a result of penile hypersensitivity, while acquired PE is often caused by a complex neurochemical and psychological disturbance.
In addition, there are some speculations that PE may also be affected by genetic, ethnic, and cultural factors for which further scientific evidence is required.
Premature ejaculation involves a complex interaction of psychological and biological factors.
Psychological Causes of PE
Psychological factors that might play a role include:
- Early sexual experiences.
- Sexual abuse.
- Poor body image.
- Worrying about premature ejaculation.
- Guilty feelings that increase your tendency to rush through sexual encounters.
- Relationship problems between you and your current partner.
- Anxiety related to sexual performance or other issues.
Biological Causes of Premature Ejaculation
A number of biological factors might contribute to premature ejaculation, including:
- Frenulum Breve – a tight band of tissue connecting the glans (head of the penis) to the shaft of the penis on its underside. When the frenulum is tight or short this is called a frenulum breve.
- Abnormal hormone levels.
- Abnormal levels of brain chemicals called neurotransmitters.
- Inflammation and infection of the prostate or urethra.
- Inherited traits.
- Erectile dysfunction.
Kelowna PE Treatment Options
An individualized treatment plan will be determined for each patient after a thorough medical examination and consultation and with consideration of the patient’s goals, values and preferences. Options include:
In addition to the above there are a variety of other pharmacological and non-pharmacological treatment options for premature ejaculation.
Traditionally, a topical anesthetic combination applied to penis can be used to treat PE by reducing penile sensitivity; however, the side effects such as genital numbness and irritation for the patient and his partner can be quite bothersome if the topical medication is not applied and administered properly.
Oral medications such as Selective Serotonin Reuptake Inhibitors (SSRIs) which are used to treat depression and anxiety have been shown effective in prolonging the ejaculatory time. Some experts also suggest a trial of Phosphodiesterase-5 inhibitors to help with PE especially in men who also suffer from erectile dysfunction. Other medications have also been suggested but may in some people be associated with a more significant side effect profile.