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Premature Ejaculation(Rapid Ejaculation)
Definition

Ejaculation occurs when a man reaches sexual climax and semen is ejected from his penis. Premature ejaculation is when:

  • Ejaculation occurs before the man wishes it to occur.
  • Ejaculation occurs too quickly to sexually satisfy his partner.
Causes

Many men experience premature ejaculation at one time or another. For example, some men experience it after not having had sex for a long period of time. Premature ejaculation is only a problem when it becomes a persistent condition.

Ejaculation occurs automatically after a certain degree of sexual stimulation. Persistent premature ejaculation usually results from a man's inability to recognize that he is about to ejaculate. This inability prevents him from taking steps to delay the process.

Psychological factors may contribute to premature ejaculation. This may include difficulty in the relationship with a partner, guilt about sex, or fears related to sex.

In rare cases, premature ejaculation can be caused by:

  • Prostate problems, such as prostatitis
  • A problem with the nerves
  • Medications that increase sexual stimulation
  • Certain medical conditions (such as thyroid problems)

Prostate

Anatomy of the Prostate Gland

© 2011 Nucleus Medical Media, Inc.

Risk Factors

Factors that increase your risk for premature ejaculation include:

  • Lack of sexual experience
  • Lack of knowledge of male and female sexual responses
  • Fear of:
    • Causing pregnancy
    • Contracting a sexually transmitted disease
    • Poor sexual performance
  • Guilt about sex
  • Interpersonal problems between sexual partners
  • Early sexual experiences that precondition a man to rapid ejaculation, usually from fear of being caught
Symptoms

The primary symptom is persistent episodes of premature ejaculation during sex.

Diagnosis

Most men experiencing premature ejaculation will notice the condition themselves. The doctor will ask about your symptoms and medical history. A physical exam will be done.

The doctor may search for an underlying medical cause if:

  • You suddenly developed persistent premature ejaculation and have never experienced it before.
  • You have other neurological symptoms.
  • You are taking medication that may cause premature ejaculation.
  • The condition is getting much worse or causing severe problems for you.
Treatment

Treatments may include:

Behavior Therapy

This aims to improve your ability to:

  • Recognize when you are about to ejaculate
  • Take steps to delay it

It may include:

  • Biofeedback—electrical feedback that helps you learn to control the muscles that cause ejaculation
  • Start and stop method—stopping sexual stimulation for 30 seconds when nearing climax, then resuming
  • Squeeze method—same as start and stop method, but includes gently squeezing the base of penis before the 30-second stop period
  • Sexual positions—trying different sexual positions that may allow greater control over the muscles that cause ejaculation
Psychological Counseling

Counseling may be offered for an individual or for a couple. It is aimed at identifying and treating:

  • Fears or guilt
  • Interpersonal problems with your partner that may contribute to the condition
Medication

In some cases, a doctor may prescribe a desensitizing cream. It can be applied to the penis to lessen sexual stimulation.

In other cases, a doctor may prescribe an antidepressant medication such as Zoloft, Prozac, or Clomipramine. Such antidepressants have been found to prolong the interval from intromission to ejaculation. However, these drugs do not cure the underlying cause of premature ejaculation.

Prevention

To help prevent premature ejaculation:

  • Learn how male and female sexual responses work.
  • Improve communication with your partner before engaging in sexual activity.
  • Have sex in situations that are private and relaxed.

RESOURCES:

Urology Care Foundation
http://www.urologyhealth.org

FamilyDoctor.org - American Academy of Family Physicians
http://familydoctor.org

CANADIAN RESOURCES:

Health Canada
http://www.hc-sc.gc.ca

Sex Information and Education Council of Canada
http://www.sieccan.org

References:

Montague DK, Jarow J, et al. AUA guideline on the pharmacologic management of premature ejaculation. J Urol 2004; 172:290-294.

Premature ejaculation. American Academy of Family Physicians website. Available at: http://familydoctor.org/familydoctor/en/diseases-conditions/premature-ejaculation.html. Updated February 2011. Accessed September 14, 2012.

Premature ejaculation. American Urological Association website. Available at: http://www.urologyhealth.org/urology/index.cfm?article=122. Updated January 2011. Accessed September 14, 2012.

Premature ejaculation. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what.php. Updated August 28, 2012. Accessed September 14, 2012.

Pryor JL, Althof SE, et al. Efficacy and tolerability of dapoxetine in treatment of premature ejaculation: an integrated analysis of two double-blind, randomised controlled trials. Lancet 2006; 368:929-927.



Last reviewed September 2013 by Adrienne Carmack, MD

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.

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