Premature ejaculation

Premature ejaculation is a common complaint. It is only rarely caused by a physical or structural problem.

Premature ejaculation early in a relationship is most often caused by anxiety and overstimulation. Other psychological factors such as guilt may also be relevant. The condition usually improves without formal treatment.

Ejaculation happens before the individual or couple would like (prematurely). This may range from before penetration to a point just after penetration, and may leave the couple feeling unsatisfied.

Abnormal findings are unlikely to be associated with the condition. Useful information is more likely to be obtained from interviewing the person or the couple.

In general, practice and relaxation will help you deal with the problem. Some men try to distract themselves by thinking non-sexual thoughts (such as naming baseball players and records) to avoid becoming excited too fast.

Some helpful techniques include the following:

The "stop and start" method:

• This technique involves sexual stimulation until the man recognizes that he is about to ejaculate. The stimulation is then removed for about thirty seconds and then may be resumed. The sequence is repeated until ejaculation is desired, the final time allowing the stimulation to continue until ejaculation occurs.

• This technique involves sexual stimulation until the man recognizes that he is about to ejaculate. At that point, the man or his partner gently squeezes the end of the penis (where the glans meets the shaft) for several seconds, withholding further sexual stimulation for about 30 seconds, and then resuming stimulation. The sequence may be repeated by the person or couple until ejaculation is desired, the final time allowing the stimulation to continue until ejaculation occurs.

Antidepressants such as Prozac and other selective serotonin reuptake inhibitors (SSRIs) may be helpful because they have a common side effect of prolonging the time it takes to achieve ejaculation.

Local anesthetic creams may be applied to the penis to decrease stimulation. Decreased feeling in the penis may prolong the time before ejaculation. Condom use may also have this effect for some men.

Evaluation by a sex therapist, psychologist, or psychiatrist may be helpful for some couples.

In most cases, the man is able to learn ejaculatory control through education and practice of the simple techniques outlined. Chronic premature ejaculation may be a sign of anxiety or depression, both of which could be helped by psychiatric intervention.

• Very early ejaculation, occurring prior to entry into the vagina, may prohibit a desired pregnancy.
• A continued lack of ejaculatory control may lead to sexual dissatisfaction on the part of either or both partners and may be a factor in sexual tension or discord in the relationship.

Call for an appointment with your health care provider if premature ejaculation is causing a problem and does not respond to techniques such as those described above.

There is no prevention for this disorder, though relaxation can reduce the likelihood of its occurrence.