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Premature Ejaculation

Premature ejaculation is when ejaculation occurs either before or shortly after sexual penetration, with minimal sexual stimulation and before the person wishes. This results in the sexual act being short and unsatisfactory for both partners. Stress and anxiety can enhance this problem. Premature ejaculation is one of the most common forms of male sexual dysfunction and can affect every man at some point in his life. If this happens very frequently it can have an effect on the sexual relationship of the couple.
Causes premature ejaculation
Most cases of premature ejaculation are idiopathic, ie no specific cause can be found. PSychological factors such as anxiety, guilt, or depression can cause premature ejaculation. Underlying medical conditions like hormonal problems, injury or a side effect of certain medications can lead to premature ejaculation. So, premature ejaculation is not always due to psychological causes, and it is now known that organic factors play an important role. Premature ejaculation may be related to erectile dysfunction.

Premature ejaculation is probably not as simple to understand and involves an interplay of both psychogenic and organic factors.
Psychological causes
  • Experience from early sexual encounters may lead to certain behaviour resulting in premature ejaculation - like hurrrying to reach orgasm because of fear of being discovered and due to inexperience. Anxiety about the sexual performance would enchance this. Young men may be conscious of their body and be over keen to please their partnere.

Biological causes
  • Hormonal imbalance
  • Abnormal reflex activity of the ejaculatory system
  • Certain thyroid problems
  • Inflammation and infection of the prostate or urethra
  • Inherited traits
  • Nervous system damage resulting from surgery or trauma
  • Withdrawal from narcotics or a drugs used to treat certain mental heath problems
Symptoms
The main symptom of premature ejaculation is that the ejaculation occurs before the man and his partner wishes. The man is not able to control the timing of his ejaculation and this leaves him and his partner unsatisfied with the act. Minimal sexual stimulation may bring about the ejaculation leaving no time for both partners being fully stimulated and satisfied. Premature ejaculation may occur with masturbation as well as with sexual encounter with your partner.
  • Primary premature ejaculation is if you have had this problem for as long as you've been sexually active.
  • Secondary premature ejaculation is if you had develop this problem later on and have a period of having satisfying sexual interactions.
Diagnosis
If you feel you have symptoms of premature ejaculation you should visit your andrologist. He will take a detailed medical history from you. He will also take a thorough sexual history from you and your partner. He willl then conduct a detailed physical examination on you.

Your doctor may order laboratory tests to rule out any underlying medical problem. Even though some of the questions asked may seem very personal and embarassing it is very important that you are completely frank and honest with your doctor, because what you tell your doctor will help him to tailor the investigations and treatment in the right direction.

Some of the questions that maybe asked are
  • How long have you been sexually active
  • How often do you have sex
  • Your sexual relationships, past and present
  • Your early sexual experiences
  • Any conflicts or concerns within your current relationship
  • How often you have premature ejaculation
  • Does the premature ejaculation leave you and your partner unsatisfied
  • Whether you have premature ejaculation only with a specific partner or partners
  • Whether you have premature ejaculation every time you have sex
  • Whether you also have trouble getting and maintaining an erection (erectile dysfunction)
  • Are you taking any medications or drugs
  • Your religious upbringing

Premature ejaculation may resolve on its own over time without the need for medical treatment. Your andologist may inform you about practicing relaxation techniques or using distraction methods to delay ejaculation. He will also advice you regarding a healthy lifestyle like , regular exercise, eating a balanced diet and cutting down on alcohol and cigarettes. This may also your ability to control ejaculation.

Treatment options for premature ejaculation include sexual therapy, medications and psychotherapy. For many men, a combination of these treatments works best.
Sexual therapy
Sexual therapy may involve simple steps such as masturbating an hour or two before intercourse so that you're able to delay ejaculation during sex. Your andrologist may also recommend avoiding intercourse for a period of time and focusing on other types of sexual play so that pressure is removed from your sexual encounters.

The squeeze technique
Your andrologist may instruct you and your partner in the use of a method called the squeeze technique. This method works as follows:
  • Start your sexual activity as usual until you feel almost ready to ejaculate.
  • Instruct your partner to squeeze the end of your penis, at the point where the head (glans) joins the shaft, and maintain the squeeze for several seconds, until the urge to ejaculate passes.
  • After the squeeze is released, wait for about 30 seconds, then go back to foreplay. You may notice that squeezing the penis causes it to become less erect, but when sexual stimulation is resumed, it soon regains full erection.
  • You can repeat the squeeze process several times drung the same sexual act and can therefore ensure penetration without ejaculation
Medications
Though certain antidepressants and topical anesthetic creams have been used to try a treat premature ejaculation, none of these drugs are specifically approved by the Food and Drug Administration to treat premature ejaculation.
Antidepressants
A side effect of certain antidepressants is to delay orgasm. So some men may take antidepressants to delay their ejaculation. Antidepressants have other side effects as well which may include nausea, dry mouth, drowsiness and decreased sex drive.
Topical anesthetic creams
Local anaesthetic creams are applied to the penis and then wiped after a while once the sensation has been dulled. This may help to delay ejaculation. Some men using topical anesthetic creams report reduced sexual pleasure because of lessened sensitivity. In some cases, female partners have also experienced reduced genital sensitivity and sexual pleasure, even though the cream is wiped off before starting actual intercourse. In very rare cases lthese creams can cause an allergic reaction.
Psychotherapy
Counseling or talk therapy, involves talking about your relationships and experiences with a mental health professional. These talk sessions can help you reduce performance anxiety or find effective ways of coping with stress and solving problems. For many couples affected by premature ejaculation, talking with a therapist together may produce the best results.