Premature Ejaculation: Causes, Symptoms, and Treatment Options

 Premature ejaculation (PE) is a sexual dysfunction where a man ejaculates more quickly during sexual activity than he or his partner would like.

Early ejaculation and rapid ejaculations terms are also being used to define premature ejaculation more precisely.

PE is most commonly found in men below the age of 40 years and 30-70% of the males in USA.

Recent research defines PE using three key criteria:

1. Time to Ejaculation: Ejaculation typically occurs within about one minute of vaginal penetration.
2. Lack of Control: The man feels he has little to no control over delaying ejaculation.
3. Emotional Distress: The condition leads to distress, frustration, or avoidance of sexual intimacy due to the rapid ejaculation.

                                                 

Symptoms of the Premature Ejaculation: 

Here are the common symptoms  of premature ejaculation (PE) along with references from a recent research article:

1.Rapid Ejaculation

• Timing: Ejaculation occurs within about one minute of vaginal penetration in most cases of lifelong PE. For acquired PE, the time might be slightly longer but still considered too quick by the affected individual.
• Frequency: This rapid ejaculation happens persistently or recurrently, not just occasionally.

2. Inability to Delay Ejaculation

• Lack of Control: A significant hallmark of PE is the consistent inability to delay ejaculation during sexual activity. This lack of control can occur before or shortly after penetration and often with minimal sexual stimulation.

3. Distress and Frustration

• Emotional Impact: Men with PE frequently experience personal distress, frustration, or a sense of embarrassment due to their rapid ejaculation. This can lead to anxiety and a decrease in self-esteem.
• Relationship Strain: The condition can cause significant stress in sexual relationships, leading to tension between partners. It may result in avoidance of sexual intimacy due to the fear of repeated premature ejaculation.

4. Reduced Sexual Satisfaction

• Personal Satisfaction: Both the individual and their partner may experience reduced satisfaction from sexual activity due to the premature ejaculation. This can diminish the overall quality of the sexual experience.
• Partner's Experience: Partners may also feel unsatisfied and frustrated, which can further strain the relationship.

5. Occasional Secondary Symptoms

• Physical Symptoms: In some cases, men may experience other physical symptoms related to stress and anxiety, such as increased heart rate, sweating, or muscle tension during sexual activity.
• Psychological Symptoms: Chronic anxiety or depression can develop as a result of ongoing sexual dissatisfaction and relationship issues.

6. Varied Onset

• Lifelong PE (Primary PE) :It has been present since a man's first sexual experiences and found in approximately 30% of men with PE. 
• Acquired PE (Secondary PE) :It develops after a period of normal ejaculatory function and found in approximately 70% of men with PE. . 
• Natural Variable PE: In this type,  men who experience premature ejaculation inconsistently and unpredictably.

Causes of premature Ejaculation:

Biological Factors

• Abnormal levels of the brain neurotransmitter serotonin (low serotonin levels shorten the time to ejaculation)
• Abnormal hormonal levels, e.g., LH, prolactin, and TSH
• Hypogonadism
• Inflammation and/or infection of the prostate or urethra
• Erectile dysfunction (ED)
• Ejaculatory hyperreflexia
• Genetic predisposition
• Hyperthyroidism
• Neuropathy (such as multiple sclerosis)
• Alcoholism
• Diabetes
• Recreational drug use
• Sleep deprivation (leads to low serotonin levels)

Psychological Factors

• Depression
• Anxiety
• Stress
• Guilt
• Narcissism
• Distorted thinking
• Unrealistic expectations about sexual performance
• Performance anxiety
• History of sexual repression
• Overall lack of confidence/poor body image
• History of sexual abuse or prior bad experience
• Relationship problems
• Control issues with partner
• Feeling of self-loathing
• Unrealistic fear of harm from vaginal penetration
• Hostility against women
• Other underlying mental health issues

Diagnosis and When to See a Doctor:

• Premature ejaculation (PE) is typically diagnosed based on your sexual history and symptoms
• If you regularly ejaculate before you want to, or within about 1 minute of penetration, and it causes distress, you may have PE.
• See a doctor if PE occurs frequently or has occurred for an extended period of time, as it may require treatment.
• Occasional episodes of PE are common and usually aren't anything to worry about.

Self-Assessment: Describe how individuals can evaluate their symptoms

• Pay attention to how long you last during sex and whether it causes you or your partner distress.
• Consider keeping a log of your sexual activity to track patterns and duration.
• Reflect on whether PE is affecting your relationship or quality of life.
• Masturbate an hour or two before sex to see if you can delay ejaculation with your partner.

Professional Diagnosis: Outline what to expect during a medical consultation

• Your doctor will ask about your sexual history and health.
• They may do a physical exam to rule out any underlying medical conditions.
• Blood tests to check hormone levels may be ordered if you have both PE and erectile dysfunction.
• You may be referred to a urologist or mental health provider who specializes in sexual problems.

Importance of Diagnosis: Explain the benefits of getting a professional diagnosis

• A proper diagnosis can help determine the underlying cause of your PE, whether psychological or biological.
• Treatment can then be tailored to your specific needs, which may include behavioral techniques, medications, counseling, or a combination.
• Diagnosing and treating PE can improve your sexual function, relationship satisfaction, and overall quality of life.
• Untreated PE can lead to relationship issues, depression, and other problems.

Treatment 

Behavioral Techniques:

• Stop-Start Technique
  • Partner stimulates penis until feeling of ejaculatory inevitability
  • Stop stimulation, relax, then restart stimulation process
  • Helps improve control over ejaculatory reflex
• Squeeze Technique
  • Partner squeezes the end of the penis where the head meets the shaft
  • Maintain squeeze for several seconds until urge to ejaculate passes
  • Allows to resume sexual activity with better control
• Masturbation Before Intercourse
  • Ejaculate 1-2 hours before sexual intercourse through masturbation
  • Can help delay ejaculation during partnered sexual activity

Counseling and Therapy:

• Sex Therapy
  • Addresses psychological factors like anxiety, guilt, or poor body image
  • Incorporates behavioral techniques and communication exercises
• Cognitive Behavioral Therapy (CBT)
  • Challenges negative thoughts and unrealistic expectations
  • Develops better coping strategies for managing anxiety/stress

Topical Anesthetic Agents:

• Lidocaine or Prilocaine Creams/Sprays
  • Reduces penile sensitivity by temporary numbing
  • Applied 10-15 minutes before intercourse, wipe off excess
  • Can cause numbness for the partner or loss of erection

Oral Medications:

• Dapoxetine (SSRI)
  • Short-acting selective serotonin reuptake inhibitor
  • Taken 1-3 hours before sexual activity as needed
  • Possible side effects like nausea, dizziness, headaches
• Off-label use of SSRI Antidepressants
  • Paroxetine, Sertraline, Fluoxetine taken daily
  • Delay ejaculation by blocking serotonin reuptake
  • May cause side effects like low libido, fatigue.

Natural Remedies and Lifestyle Changes

Pelvic Floor Exercises:

• Technique: Kegel exercises strengthen the pelvic floor muscles, which can help in controlling ejaculation.
• Practice: Regularly contract and relax the pelvic muscles multiple times a day.

Healthy Diet:

• Impact: A balanced diet can improve overall health, including sexual function. Foods rich in zinc and magnesium are particularly beneficial.
• Examples: Nuts, seeds, whole grains, and leafy greens.

Regular Exercise:

• Benefits: Improves cardiovascular health, reduces stress, and enhances sexual stamina.
• Activities: Include aerobic exercises like running, swimming, and cycling.

Mindfulness and Relaxation Techniques:

• Practice: Techniques such as deep breathing, meditation, and yoga can reduce anxiety and improve sexual control.
• Effect: Helps in managing stress and enhancing mental focus during sexual activity.

Avoiding Alcohol and Smoking:

• Impact: Reducing or eliminating alcohol and smoking can improve overall sexual health and reduce instances of premature ejaculation.

Latest Research and Future Directions

Recent Studies: Summarize key findings from recent research on PE.

• Brain imaging studies have identified regions associated with ejaculation control
• Genetic and epigenetic factors may influence susceptibility to PE
• Prevalence rates and subtypes of PE vary across different cultures/ethnicities
• Perceived intravaginal latency time correlates poorly with stopwatch measures
• Partner's perception and interpersonal factors impact treatment outcomes

Innovative Treatments: Introduce new and emerging treatments being explored.

• Oxytocin nasal spray to delay ejaculation by reducing arousal
• Transcranial magnetic stimulation to modulate brain activity
• Stem cell therapy to restore nerve function and ejaculatory reflex
• Wearable devices/apps to track and improve ejaculation timing
• New topical formulations with improved absorption and lesser transfers

Future Outlook: Discuss ongoing research and what it means for the future of PE treatment.

• Personalized medicine approach based on genetic/phenotypic profiles
• Combination multi-modal treatments targeting different pathways
• Exploring PE as a potential symptom of other underlying conditions
• Larger scale prevalence studies across different populations
• Qualitative research on impact of PE on relationships and quality of life
• Development of on-demand fast-acting oral treatments with minimal side effects

The emerging research shows promise in better understanding the complex biological and psychosocial factors involved in PE. This could pave the way for more effective, personalized and well-tolerated treatment strategies in the future. However, more extensive, high-quality research is still needed to fully optimize the management of this common sexual dysfunction.