Premature ejaculation (PE) is when a man reaches climax (ejaculates semen during orgasm) sooner than wanted during sex.e60dc2a1-f33c-4a05-9b50-8e3e8e59762967e75ffb-563f-4cf4-b657-a47cd5767d28 If you or your partner are experiencing premature ejaculation, there are several medications and lifestyle changes that can help.
Types of Premature Ejaculation Types Some research suggests that ejaculation that occurs less than one minute into intercourse is premature, while other research says less than four minutes.e60dc2a1-f33c-4a05-9b50-8e3e8e5976297677eb27-1efd-4fd3-95a4-dcd13376077a Premature ejaculation can be lifelong or acquired. Lifelong PE occurs if a man climaxes earlier than wanted, starting with the first time he has intercourse, while acquired PE develops over time.e60dc2a1-f33c-4a05-9b50-8e3e8e597629cb0f1de7-db38-444b-a996-ac4c5799944b
Causes and Risk Factors for Premature Ejaculation Causes and Risk Factors There are several possible reasons for early sexual climax, and they may overlap. Reasons include: e60dc2a1-f33c-4a05-9b50-8e3e8e597629dec696ce-c6c1-49c5-852b-a06d26fe7de5 Low Serotonin Levels Serotonin , a brain chemical known as a neurotransmitter, plays a significant role in premature ejaculation. Low levels in the brain increase the chances of premature ejaculation.e60dc2a1-f33c-4a05-9b50-8e3e8e5976291e48ab7d-b1dd-47fc-bf34-2a9daf4fa81a Psychological Issues Emotional and mental strain can take its toll on sexual activity. Stress can inhibit the ability to relax and focus during sex. If a man feels pressure to maintain a long-lasting erection, this could cause an early orgasm in some cases. “Guys with erectile dysfunction are worried about losing their erection, so they may try to ejaculate quicker,” says Justin Dubin, MD, a urologist and men’s health specialist with Memorial Healthcare System in Aventura, Florida. Feeling nervous with a new partner can also set off premature ejaculation.e60dc2a1-f33c-4a05-9b50-8e3e8e597629401574ce-7c66-4b48-ba54-97ecdab871f7 Anxiety , depression , and lack of confidence may also disrupt normal ejaculation. A man with deep-rooted psychological issues—such as sexual repression—might feel a lack of control tied to bottled-up sexual thoughts and feelings.e60dc2a1-f33c-4a05-9b50-8e3e8e597629b7b6263d-8a18-4d20-9872-f9d389e8abf4 Age While premature ejaculation is most often reported in men ages 18 to 30, older men can also experience this disorder.e60dc2a1-f33c-4a05-9b50-8e3e8e597629df1b31c9-075d-4c03-9431-57a8a2c1bbda For some older men, low testosterone can lead to erections that may not be as firm as they used to be. This can make it difficult to differentiate a premature ejaculation issue from erectile dysfunction.e60dc2a1-f33c-4a05-9b50-8e3e8e5976298b84748a-768d-45b8-b6cc-5e16420cef75 Other Factors Additional factors contributing to premature ejaculation may include:e60dc2a1-f33c-4a05-9b50-8e3e8e597629548fbecd-40a3-40d0-b262-b26551ed8f88 Hormonal imbalance Hyperthyroidism Inflammation or infection of the prostate or urethra Neuropathy, such as multiple sclerosis Substance abuse, including alcohol and drugs
How is Premature Ejaculation Diagnosed? Diagnosis While many men may recognize that they have premature ejaculation without a doctor’s consultation, a healthcare provider can help determine the possible cause and recommend possible treatments. During diagnosis, a doctor will ask you about your sex life and health history. They may perform a physical exam, concentrating on the genitals and looking for any abnormalities in the penis, testicles, or surrounding areas. They may also consider any other physical, mental, or emotional issues that could be contributing to premature ejaculation.e60dc2a1-f33c-4a05-9b50-8e3e8e59762939a261f8-a600-43c8-bd19-37371472faf5 In some cases, a doctor will refer you to a mental health provider or a urologist, a specialist who treats the urinary tract and the reproductive system. For some men, getting help for a sexual challenge can be difficult. Some men may feel embarrassed, says Dr. Dubin, but he notes that premature ejaculation is only a problem if it interferes with your life. “The issue has to cause distress for you or your partner,” he says. “Some people come in and say, ‘Listen, I last a minute and 30 seconds. I feel good, and my wife’s happy.’ If no one’s complaining, I’m not going to treat that.” Knowing you’re not the only one with PE may help. “One key that I start with in my practice to reduce the stigma about PE is to discuss the prevalence,” says Michael Eisenberg, MD, professor of urology at Stanford Medicine. “Knowledge of the disorder and how common this is can help.” Premature ejaculation is the most frequently experienced type of sexual dysfunction worldwide and may affect as many as 1 in 3 adult men.e60dc2a1-f33c-4a05-9b50-8e3e8e5976296282261c-3abb-4a7e-8a67-30fbe4ee48e8
Treatment and Medication Options for Premature Ejaculation Treatments Over-the-counter and prescription medications are available for premature ejaculation. Always discuss any treatment with a doctor before starting it. Erectile Dysfunction Medications For people who have PE related to their erectile dysfunction , doctors may prescribe erectile dysfunction meds, such as: sildenafil (Viagra) tadalafil (Cialis) vardenafil (Levitra) dapoxetine (Priligy) avanafil (Stendra) If erectile dysfunction is not an issue, these medications could still be prescribed to address PE when other treatments have failed.e60dc2a1-f33c-4a05-9b50-8e3e8e5976294a573241-1477-4ca2-8044-7d4de1c13724 Anesthetic numbing agents Topical anesthetics such as lidocaine and prilocaine in the form of a cream, a gel, or a spray are moderately effective in delaying ejaculation by diminishing sensitivity in the head of the penis, or glans.e60dc2a1-f33c-4a05-9b50-8e3e8e597629a52818bd-28d8-4538-b1b6-5d4773ddf16b Antidepressant medications Antidepressants called selective serotonin reuptake inhibitors (SSRIs) may be prescribed even if a patient is not depressed.e60dc2a1-f33c-4a05-9b50-8e3e8e597629f8bbfb2f-5dd7-4bc5-aa14-459440a41b47 “A lot of these medicines have a side effect of causing delayed ejaculation,” says Kian Asanad, MD , urologist with Keck Medicine of USC and director of the USC Fertility and Men’s Sexual Health Center. SSRIs include: paroxetine (Paxil, Pexeva, Brisdelle) escitalopram (Lexapro) citalopram (Celexa) sertraline (Zoloft) fluoxetine (Prozac) Research suggests that paroxetine is the most effective for premature ejaculation.e60dc2a1-f33c-4a05-9b50-8e3e8e597629bf566e91-cc92-4c0a-a72c-0021a9aa3803 Opioids The pain reliever tramadol (Ultram, Conzip, Qdolo) has been shown to be effective against PE when used sporadically. The drug is in a class of medications called opiate (narcotic) analgesics and can be habit-forming with prolonged use.e60dc2a1-f33c-4a05-9b50-8e3e8e59762971765bc2-62c7-4ebf-8725-fd8dae4671f4
Lifestyle Changes for Premature Ejaculation Lifestyle Changes Men with PE issues may improve their condition by changing their exercise habits and diet and by exploring techniques that can directly address the problem. Exercise Exercise benefits almost all aspects of health, including sex and ejaculation. Research consistently shows that men who work out regularly are less likely to experience premature ejaculation compared to those who are sedentary.e60dc2a1-f33c-4a05-9b50-8e3e8e59762981693dd8-05cc-4094-886c-c5bc80561991 Some scientists say that as regular exercise boosts the metabolism, it also improves the nervous system involved in ejaculatory control. In addition, physical activity enhances cardiovascular health, which may improve blood flow to the penis and decrease the likelihood of early climaxes.e60dc2a1-f33c-4a05-9b50-8e3e8e59762939b39cf3-7fd7-45d5-9cd3-cf6bac6bc18d Regular exercise also helps with weight loss , and excess belly fat has been linked to imbalances in testosterone and estrogen levels, which can affect male sexual performance. Pelvic and Behavioral Therapy Pelvic floor exercises: Research suggests that exercises to strengthen pelvic floor muscles, or Kegel exercises , may extend time until ejaculation.e60dc2a1-f33c-4a05-9b50-8e3e8e59762927a67f07-9a4f-4b8d-baa4-5b79ab0bab69 The “pause-squeeze” technique : With this, your partner repeatedly squeezes your penis during sex until the urge to ejaculate passes.e60dc2a1-f33c-4a05-9b50-8e3e8e597629d53e071e-7ef1-4bbb-bd57-75d8bc164eb4 The “stop and start” method: This requires repeatedly stimulating the penis to the point of orgasm but then stopping.e60dc2a1-f33c-4a05-9b50-8e3e8e5976294417c7dc-2569-45fc-88e7-c1e3b91552e8 Other Methods A few other possible approaches for delaying orgasm during sex include:e60dc2a1-f33c-4a05-9b50-8e3e8e597629b521d2e8-788d-427c-a8d1-93bd2105ab5a Masturbating an hour or two before intercourse Wearing a condom to reduce sensitivity of the penis Focusing your mind on nonsexual distractionse60dc2a1-f33c-4a05-9b50-8e3e8e5976293394b4f2-dce4-4796-8307-f1268ed35dc0 Stress Reduction Practicing relaxation techniques such as deep breathing, mindfulness , or yoga can also help to manage anxiety and to exert more control over ejaculation.e60dc2a1-f33c-4a05-9b50-8e3e8e59762952f7012b-5c36-4fe6-899b-0c14717fec12 Intimacy-Building Premature ejaculation can cause partners to feel less connected or hurt. Talking about the issue openly can help you and your partner explore the problem together and find a solution. This can also reduce stress, which tends to make PE worse. “You might be surprised to find that most partners are accepting and open to learning how to get past it together,” says Raevti Bole, MD , a urologist at Cleveland Clinic. “In addition to your PE treatment, experts may recommend focusing on your partner and learning other ways to enhance intimacy together.”
Mental Health Treatment for Premature Ejaculation Mental Health Treatments Your healthcare provider can help you understand if a mental health professional can help address psychological, emotional, or relationship problems that may be related to your PE.e60dc2a1-f33c-4a05-9b50-8e3e8e5976298a7043e6-08cd-487f-9882-c61a3b37fd5a Psychological causes of premature ejaculation can include early sexual experiences, sexual abuse, poor body image, depression , worrying about PE, and guilty feelings that cause you to rush through sex. General anxiety and relationship problems can also cause PE. Mental health treatment may be an option. Therapy A therapist can work with you to identify problems in your sex life or personal relationship that may be influencing ejaculation, such as performance anxiety, depression, and stress. There are several types of psychotherapy that might work for you:e60dc2a1-f33c-4a05-9b50-8e3e8e5976292e8c9a83-5b2f-4855-b00e-41ab07472a20 Cognitive-behavioral therapy identifies and changes negative thoughts and beliefs about sexual performance. Sex therapy will help you better understand the physiology of sexual anatomy and arousal. Couples therapy can improve communication and understanding with a partner. General counseling to deal with depression, anxiety, or a past trauma may also help.
Related Conditions Related Conditions In addition to erectile dysfunction, other physical health issues may be connected with premature ejaculation, including:e60dc2a1-f33c-4a05-9b50-8e3e8e597629dd62e178-34e3-4563-bb75-d9c1b048a57b Chronic pelvic pain: Aching in the pelvis area directly affects the nerves and muscles involved in sexual function, leading to issues with ejaculatory control.e60dc2a1-f33c-4a05-9b50-8e3e8e5976294bad4582-de07-44dc-b340-e99f5c4a1c1b Thyroid disorders: An imbalance in thyroid hormones may contribute to sexual dysfunction and early orgasm.e60dc2a1-f33c-4a05-9b50-8e3e8e59762944a565ea-657b-461d-9770-b82092bcfad6 Substance-use disorders: Drug use may be linked to low testosterone levels, erectile dysfunction, and changes in mood that can trigger PE.e60dc2a1-f33c-4a05-9b50-8e3e8e5976298c555776-20b7-4cfb-a876-bb0bc6b2ae01
The Takeaway Premature ejaculation affects 1 in 3 adult men, according to research. Medical treatments can help delay orgasm, but men may first want to explore at-home techniques and lifestyle changes that could be just as effective. Although premature ejaculation may be considered a physical problem, it can be related to psychological and emotional issues that counseling or therapy can help resolve.
Resources We Trust Cleveland Clinic: Premature EjaculationInternational Society for Sexual Medicine: What Is the Connection Between Mental Health and Sexual Health?Mayo Clinic: Premature EjaculationMedlinePlus: Sexual Problems in MenUrology Care Foundation: What Is Premature Ejaculation?
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