Premature ejaculation

About 33 percent of men experienced premature ejaculation at one time or another. If it occurs rarely or occasionally, it is not a permanent issue to be seriously concerned about. If persistent, this condition could be devastating to the couple.

What is premature ejaculation?

The most satisfying love-making is when orgasm of the partners occurs exactly at the same time. Normally, the timing does not have to be perfect for a couple to have an enjoyable sex, but if the male ejaculates before penetration or just one minute or less after penetration, it is called premature ejaculation. In some cases, premature ejaculation could also happen during masturbation. When male climax occurs too soon, the man feels inadequate and the woman, unfulfilled and disappointed. But there is hope.

How long should intercourse last?

There is no set rule for this. In a survey of 4,400 heterosexual partners, the act lasts for an average of 19 minutes, 10 minutes of foreplay, and 9 minutes of actual penetrating intercourse. Other studies show the average vaginal sex lasts about 5 minutes. Some women want longer foreplay before orgasm is possible. Certain positions make some men ejaculate later or sooner. Being candid with each other and exploring various techniques will help the couple find the best strategy.

What causes prejaculation?

The exact cause is not known. It was previously thought to be psychological, but science now knows the cause is a complex interaction between psychological and biological factors. The psychological role includes sexual abuse, early sexual experiences, depression, poor body image and self-esteem, the guilt of rushing through sexual encounters, and the actual worry about premature ejaculation itself. The other factors are: stress, anxiety, problem in the relationship; and erectile dysfunction. The biological factors are inherited traits, abnormal levels of the hormones, infection of the prostate or urethra, abnormal levels of brain chemicals, the neurotransmitters.

When should a physician be consulted?

If premature ejaculation happens most of the time, it is time to see a physician, no matter how embarrassing. In some cases, talking to a physician could be so reassuring it could help. Some men think ejaculation after 5 minutes of sex is premature. Actually, as we stated above, 5 minutes is, on average, is normal for most people, and that occasional prejaculation is not a problem.  Ejaculation outside the vagina, results in no pregnancy.

How is prejaculation diagnosed?

Premature ejaculation is confirmed if the man always or nearly always discharges his semen within 60 seconds of penetration; unable to delay ejaculation during the sex act all the time or most of the time; when he feels frustrated and depressed over it and usually avoids sex because of it. The two types of pre-jaculation are: Primary (life-long), when the man experiences premature ejaculation his whole life, from the very first sexual encounter; Secondary (Acquired), when it develops after having no ejaculatory problems in the past. Besides asking about the details of your sexual life, the physician will also ask about your personal, medical, and family history, and some info about your partner. This is followed by a complete physical examination. If erectile dysfunction is also present, a male hormone (testosterone) level and other tests might be ordered. A referral to a urologist might be needed.

What is the treatment for prejaculation?

The management for this condition includes behavioral modification, medications, topical anesthetics, and counseling. Each man varies in response to the treatment. Behavioral therapy combined with drug could be a most effective option. Masturbation an hour or two before sexual intercourse to delay ejaculation sometimes helps. Another is abstinence from intercourse for a period of time and perform other modes of sexual play with the woman to reduce anxiety and pressure before the actual intercourse.  Doing Kegel pelvic floor exercise to strengthen weak pelvic floor muscles that can cause prejaculation helps. When one holds back on passing gas (sort of puckering, tightening the anus), the muscles involved are the pelvic muscles. To do the Kegel exercise, hold the contraction for 3 seconds and then relax for 3 seconds, repeating this same cycle (3 sets of ten) a day. This can be done while sitting, standing, or even walking.

What is the pause-squeeze technic?

This is another maneuver that can help treat prejaculation. Start the sexual encounter the usual way until the urge to ejaculate starts. Have the woman squeeze the end of the penis at the area between the head of the penis and the shaft, maintaining the vaginal squeeze for several seconds, until the urge to ejaculate wanes or stops. Repeat as often as needed. Make this your routine strategy with your sex partner. After repeated use, the man eventually feels he is in control of his ejaculation better. Another option is to stop sexual stimulation or withdraw the penis out of the vagina, and wait until the arousal has declined, and then start again, a technic called start-stop-start. Available in the drug stores are special condom that could help delay ejaculation, with benzocaine or lidocaine numnbing anesthetic agent in them. Some of them are: Lifestyles Everlast Intense, Trojan Extended, and Durex Performax Instense. The anesthetic agent (like EMLA, a prescription drug, or Licdocaine spray) could be applied to theT penis 10 minutes before sex to minimize sensitivity and aid in delaying ejaculation. Sometimes these could reduce arousal in either partner.

How about pills?

Although these drugs have not been approved by the FDA specifically for premature ejaculation, the following have been tried by physicians: antidepressants (Paroxitine), analgesics (tramadol), clomipramine, phosphodiesterase-5 inhibitors (Viagra, Cialis, Levitra), and the following which are still being tested: modafinil, dapoxetine, and silodosin. Counseling combined with medication has also been found effective among many patients. The most important first step is to openly acknowledge the problem, and then seeking medical consultation. Premature ejaculation is treatable. The more candid, positive, and open-minded the man is, the more effective the therapy is.

Philip S. Chua, MD, FACS, FPCS, a Cardiac Surgeon Emeritus based in Northwest Indiana and Las Vegas, Nevada, is an international medical lecturer/author, and Chairman of the Filipino United Network-USA, a 501(c)3 humanitarian foundation in the United States. Websites:   philipSchua.com and FUN8888.com    Email: [email protected]