Premature ejaculation (PE) is the most common sexual dysfunction in men. It is a condition when a man is unable to delay ejaculation for a sufficient period of time to guarantee his partner gets an adequate satisfaction. Although the definition of premature ejaculation varies, the American Urological Association defines ejaculation as 'premature' if it occurs sooner than desired, either before or shortly after penetration and causing distress to either one or both partners.
Some couple may define sex as the time period between penetration and ejaculation (also known as intravaginal ejaculation latency time, IELT) and if it last just a few minutes, then it is possible that there is an issue of premature ejaculation. However, if the individual or his partner are satisfied with the duration of vaginal penetrative sex, even if it lasts for just over a few minutes, then the couple does not have this issue. But if one or both partners are unsatisfied, bothered and negatively affected by this, then this can be classified as premature ejaculation. It is helpful to have realistic expectations which typically, the normal time from penetration to ejaculation is between 5 to 7 mins.
There are two types of premature ejaculation, primary and secondary. Patients with primary PE experience rapid ejaculation right from their very first sexual experience, with every one of their sexual partners, and in virtually all their sexual encounters. Secondary or acquired premature ejaculation occured in men who initially had normal ejaculatory times but developed premature ejaculation over time commonly cause by psychological isssue like performance anxiety and erectile dysfunction (ED). Around 30-50% of men with ED will develop PE, and specifically in the Asia-Pacific region, the chances of an ED patient developing PE is 6.9 times higher than someone without ED.
There are several ways to treat premature ejaculation. Behavioural treatment can play a key part to develop tolerance to stimulation and in turn delaying ejaculation. This includes start-stop technique. This method involves stimulating the penis until just before orgasm and then stopping until the urge to ejaculate goes away. This is repeated several times so the man can learn to recognize the 'point of no return' or the maximal point before orgasm occured. Another technique is the squeeze method. This involves either you or your partner squeeze the point where the head (glans) joins the shaft when you feel the sensation to ejaculate and maintain the squeeze for several seconds, until the urge to ejaculate passes. It is very important to communicate openly with your partner about this. Other methods such as masturbation before sexual intercourse, using condom and pelvic floor exercises can also help to treat premature ejaculation.
Medication that can be used to treat premature ejaculation are topical numbing agent and short-acting SSRIs such as Dapoxetine. Dapoxetine, now commonly branded as Priligy, was actually initially manufactured as an antidepressant. Men with premature ejaculation can now use this medication 1 to 3 hours prior to sexual activity. Side-effects include dizziness and faint, nausea, vomiting and headache. In patient with both premature ejaculation and erectile dysfunction, several investigation need to be done to rule out causes of erectile dysfunction such as poor lifestyle, smoking, diabetes, heart disease and low testosterone level. Use of PDE5-i such as Cialis and Viagra can also help with erectile dysfunction.
Premature ejaculation is a common sexual issue for men but very few men seek treatment and continue to suffer in silence. It can impact negatively both to patient and their sexual partner. It can also delay successful conception for couple planning to start a family. Patient often reported feeling ashamed and embarrassed at not being able to satisfy his partner leading to poor self -esteem and sexual confidence. It can also be disruptive and create conflict in the relationship. If you and your partner suffer from premature ejaculation or any other sexual dysfunction, talk to our doctor for discussion and treatment available to help with your symptom.