Premature Ejaculation

Premature ejaculation arises when a man
experiences orgasm and ejaculates sooner
during intercourse than desired by either partner.

What is Premature Ejaculation?

Premature ejaculation (PE) occurs when ejaculation occurs sooner than desired by either the man or his partner during sexual activity, typically within a short timeframe, often less than 2 to 3 minutes.

Also referred to as rapid ejaculation, premature climax, or early ejaculation, occasional instances of PE may not raise significant concern. However, persistent occurrences can diminish sexual pleasure and strain relationships. Seeking guidance from our healthcare professional can offer effective solutions if PE becomes a recurring issue impacting intimacy and satisfaction.

How Common is Premature Ejaculation?

Approximately 30% to 40% of men encounter premature ejaculation at various stages of their lives, making it the most prevalent form of sexual dysfunction among men. It's noteworthy that around one in five men, aged 18 to 59, report instances of premature ejaculation.

Symptoms and Causes

Causes of Premature Ejaculation

Premature ejaculation can stem from various physical, chemical, and emotional factors:

Physical and Chemical Factors:

1. Underlying Erectile Dysfunction: Individuals may experience premature ejaculation alongside erectile dysfunction.
2. Hormonal Imbalances: Disruptions in oxytocin, luteinizing hormone (LH), prolactin, or thyroid stimulating hormone (TSH) levels can affect sexual function.
3. Neurotransmitter Levels: Low serotonin or dopamine levels in the brain, crucial for sexual desire and arousal, may contribute.
4. Penile Sensitivity: Some individuals may have a heightened sensitivity in the penis, leading to premature ejaculation.

Emotional or Psychological Causes:

1. Performance Anxiety: Nervousness or apprehension about sexual performance, especially with a new partner or after a period of abstinence, can trigger premature ejaculation.
2. Stress: High stress levels, whether related to work, relationships, or other life factors, may contribute to premature ejaculation.
3. Relationship Issues: Strain or conflicts within a relationship can impact sexual performance and contribute to premature ejaculation.
4. Depression: Mental health conditions such as depression can affect sexual function and contribute to premature ejaculation.

Medical & Surgical Management

Premature ejaculation (PE) is a common sexual dysfunction in men, characterized by ejaculation that occurs sooner than desired, either before or shortly after penetration, causing distress to one or both partners. Management of PE can involve a combination of behavioral techniques, medications, and, in some cases, surgical interventions. Here’s an overview of the current medical and surgical management options:

Medical Management

1. Behavioral Therapies:

Pause-Squeeze Technique: This involves the partner squeezing the penis just below the head when ejaculation is imminent, pausing until the urge subsides, and then resuming activity.
Start-Stop Technique: This involves stopping sexual stimulation before ejaculation and then starting again once the urge has passed.

2. Pharmacotherapy:

Topical Anesthetics: Creams or sprays containing lidocaine or prilocaine can be applied to the penis to reduce sensitivity and delay ejaculation.
Selective Serotonin Reuptake Inhibitors (SSRIs): Antidepressants such as paroxetine, sertraline, and fluoxetine are commonly used off-label for PE. These medications can delay ejaculation by increasing serotonin levels.
Tricyclic Antidepressants: Clomipramine, a tricyclic antidepressant, is also effective in delaying ejaculation.
Phosphodiesterase-5 Inhibitors: Drugs like sildenafil (Viagra), tadalafil (Cialis), and vardenafil (Levitra) can help, particularly in men who also have erectile dysfunction.
Dapoxetine: A short-acting SSRI specifically approved for the treatment of PE in many countries, taken 1-3 hours before sexual activity.

3. Counseling and Psychotherapy:

Cognitive Behavioral Therapy (CBT): This can help address the psychological factors contributing to PE.
Sex Therapy: Working with a therapist can help improve communication between partners and address any underlying relationship issues.

Surgical Management

Surgical interventions for PE are considered less commonly and typically as a last resort after other treatments have failed. These include:

1. Selective Dorsal Neurectomy:

This procedure involves the surgical cutting of certain nerves on the dorsal (upper) side of the penis to reduce sensitivity. This can help delay ejaculation in some men but comes with risks such as reduced penile sensitivity and potential for other complications.

2. Penile Augmentation Procedures:

In some cases, procedures to increase the girth of the penis (e.g., fat injections, dermal fillers) may be considered to reduce penile sensitivity, although these are not standard treatments for PE and carry their own risks.

Combining Treatments

Often, the best approach to managing PE involves combining multiple therapies. For instance, a combination of behavioral techniques and pharmacotherapy can be more effective than either approach alone. Couples counseling can also be beneficial when combined with other treatments.

Investigations

Premature ejaculation (PE) is a common sexual dysfunction in men, characterized by ejaculation that occurs sooner than desired, either before or shortly after penetration, causing distress to either partner. To diagnose PE and identify its underlying causes, a thorough evaluation is necessary. Here are the steps typically involved in the investigation and diagnosis of premature ejaculation:

1. Detailed Medical and Sexual History

Onset and Duration: Determine if PE is lifelong (primary) or acquired (secondary). Lifelong PE starts with the first sexual experiences, while acquired PE develops after a period of normal sexual function.
Frequency and Context: Assess how often PE occurs and in what situations. Understanding if it happens in all sexual encounters or only specific ones can provide clues.
Impact on Life: Evaluate the emotional and psychological impact on the patient and his partner.
Other Sexual Issue: Identify if there are any other sexual problems, such as erectile dysfunction, which can be associated with PE.
Relationship Factors: Consider relationship dynamics and any stressors that might contribute to PE.

2. Physical Examination

Genital Examination: Check for any physical abnormalities or conditions (e.g., inflammation, infection, Peyronie’s disease).
Neurological Examination: Assess the nervous system, especially focusing on genital reflexes and any signs of neuropathy.
Prostate Examination: Conduct a digital rectal exam to evaluate prostate health, which can impact ejaculatory function.

3. Psychological Evaluation

Mental Health Assessment: Screen for anxiety, depression, or other psychological conditions that might contribute to or result from PE.
Stress and Lifestyle Factors: Explore stress levels, lifestyle habits (e.g., alcohol, drugs), and overall mental health.

4. Laboratory Tests

Hormonal Profile: Test for hormonal imbalances by measuring levels of testosterone, thyroid hormones, and prolactin.
Blood Tests: General health markers to rule out conditions like diabetes or hyperlipidemia that might impact sexual function.
Urine Tests: To check for infections or other urological conditions.

5. Specialized Tests (if needed)

Intravaginal Ejaculatory Latency Time (IELT): Measure the time from vaginal penetration to ejaculation. An IELT of less than one minute is often used as a diagnostic criterion for PE.
Penile Sensitivity Tests: To determine if hypersensitivity contributes to PE.
Erectile Function Tests: If erectile dysfunction is suspected, tests like nocturnal penile tumescence (NPT) can help evaluate erectile function.

6. Partner’s Input

Partner’s Perspective: Understanding the partner’s view can provide additional insights and help in formulating a treatment plan that addresses both partners' concerns.

7. Questionnaires and Self-Report Tools

PE Diagnostic Tools: Tools like the Premature Ejaculation Diagnostic Tool (PEDT) or the International Index of Erectile Function (IIEF) can help quantify the severity and impact of PE.

Diagnosis

Premature ejaculation (PE) is a common sexual dysfunction in men characterized by ejaculation that occurs sooner than desired, either before or shortly after penetration, causing distress to one or both partners. Here is a comprehensive guide for diagnosing PE:

Diagnostic Criteria

1. Symptom Duration: Persistent or recurrent pattern over a period of at least six months.
2. Time to Ejaculation: Intravaginal ejaculatory latency time (IELT) of less than one to two minutes.
3. Lack of Control: Inability to delay ejaculation on nearly all or all vaginal penetrations.
4. Psychological Distress: Marked personal distress or interpersonal difficulty due to the condition.

Types of PE

1. Lifelong (Primary) PE:

Present from the first sexual experience.
Persistent throughout the individual's life.

2. Acquired (Secondary) PE:

Develops after a period of normal sexual function.

Diagnostic Evaluation

1. Medical and Sexual History:

Duration and onset of symptoms.
Impact on the relationship and psychological distress.
Sexual habits and frequency of intercourse.
Presence of any associated conditions (e.g., erectile dysfunction, anxiety).

2. Physical Examination:

Genital examination to rule out any anatomical abnormalities.
Assessment for any underlying medical conditions (e.g., prostatitis, thyroid disorders).

3. Psychological Evaluation:

Screening for mental health conditions like depression and anxiety.
Evaluation of relationship dynamics and sexual expectations.

4. Laboratory Tests (if indicated):

Hormonal profile (testosterone levels).
Screening for diabetes or other metabolic conditions.

Differential Diagnosis

Erectile Dysfunction (ED): Sometimes men with ED may ejaculate quickly to avoid losing an erection.
Ejaculatory Duct Obstruction: Causes pain and premature ejaculation.
Hyperthyroidism: Can lead to symptoms of PE.

Management and Treatment

1. Behavioral Techniques:

Start-stop technique.
Squeeze technique.

2. Pharmacological Treatment:

Topical anesthetics (e.g., lidocaine-prilocaine cream).
Selective serotonin reuptake inhibitors (SSRIs) like paroxetine, sertraline, or fluoxetine.
Tricyclic antidepressants like clomipramine.

3. Counseling and Therapy:

Cognitive-behavioral therapy (CBT).
Sex therapy for couples to improve communication and reduce performance anxiety.

4. Lifestyle Modifications:

Regular physical exercise.
Reduction in alcohol consumption and cessation of smoking.

Follow-up

Regular follow-up appointments to assess the effectiveness of the treatment plan and make necessary adjustments are essential. Addressing any side effects of medications and ensuring adherence to behavioral strategies is important for long-term management.

Tests

Premature ejaculation (PE) is a common sexual dysfunction in men, and diagnosing it involves a combination of patient history, physical examinations, and sometimes questionnaires or tests. Here are some common tests and evaluations used to diagnose premature ejaculation:

Patient History and Interview
A detailed patient history is crucial for diagnosing PE. The physician will ask about:

The duration of the issue (whether it's lifelong or acquired).
The frequency and consistency of the problem.
The specific circumstances under which PE occurs.
Any psychological factors such as stress, anxiety, or relationship issues.
Other sexual dysfunctions (e.g., erectile dysfunction).
Overall sexual satisfaction.
Medical history, including any medications or conditions that might contribute to PE.

Physical Examination
A physical examination can help rule out any underlying health issues that might contribute to PE, such as:

Hormonal imbalances.
Urological problems.
Prostate issues.

Intravaginal Ejaculatory Latency Time (IELT)
This is a more objective measure where the time from vaginal penetration to ejaculation is measured. Typically, an IELT of less than one minute is considered indicative of PE. This can be measured by the patient using a stopwatch or estimated based on multiple instances.

Questionnaires and Self-Report Scales
Several standardized questionnaires can help assess the severity and impact of PE:

Premature Ejaculation Diagnostic Tool (PEDT): A validated questionnaire that helps diagnose PE and differentiate it from other conditions.
International Index of Erectile Function (IIEF): While primarily used for erectile dysfunction, it includes questions relevant to PE.
Male Sexual Health Questionnaire (MSHQ): This assesses various aspects of male sexual health, including ejaculation control.

Partner's Input
Getting input from the sexual partner can provide additional insights into the frequency and impact of PE on the relationship and sexual satisfaction.

Psychological Assessment
Since psychological factors like anxiety, depression, and relationship issues can contribute to PE, a psychological assessment may be recommended. This can involve:

Counseling sessions.
Psychological questionnaires.

Specialized Tests
In rare cases, specialized tests may be recommended to rule out other conditions:

Neurological tests: To check for nerve damage or dysfunction.
Hormonal tests: To assess levels of testosterone or other hormones.

Ruling Out Other Conditions
It's important to rule out other conditions that can mimic PE symptoms, such as:

Erectile dysfunction.
Prostatitis or other prostate conditions.
Thyroid disorders.

These evaluations collectively help in diagnosing premature ejaculation accurately and formulating an appropriate treatment plan. If you suspect you have PE, it's best to consult our healthcare professional for a comprehensive evaluation and personalized advice.

Getting Ready for Your Appointment

For your specific health needs, you may choose to consult with our healthcare professionals, such as a specialized urologist for male genital issues or an endocrinologist focusing on hormonal systems.

As appointments may be brief with a wide range of topics to discuss, adequate preparation is key. Here are some guidelines to help you prepare and understand what to anticipate during your consultation with our doctors.

Being prepared to discuss premature ejaculation can ensure you receive the necessary treatment to restore your sexual satisfaction. The details provided below will assist you in preparing to maximize the effectiveness of your appointment.

Pre-Appointment Preparation Checklist

Before your visit, it's helpful to gather the following information:

1. Symptoms: Note the frequency of premature ejaculation and the duration of intercourse before ejaculation occurs.
2. Sexual History: Reflect on past relationships and sexual experiences. Have there been previous instances of premature ejaculation, and if so, with whom and in what circumstances?
3. Medical History: Document any diagnosed medical conditions, including mental health issues. Make a list of current and recent medications, both prescription and over-the-counter, including their names and strengths.
4. Questions for Your Healthcare Professional: Prepare any questions you have in advance to ensure you make the most of your consultation with our healthcare professional.

Essential Questions to Discuss with Our Doctor

Here are essential questions to discuss with our doctor regarding premature ejaculation. Feel free to ask additional questions during your appointment.

1. What factors could be contributing to my premature ejaculation?
2. Which diagnostic tests do you advise?
3. What treatment options do you suggest?
4. When can I anticipate seeing improvements after starting treatment?

What to Anticipate During Your Consultation

During your appointment, the doctor may inquire about intimate details and may also wish to converse with your partner. To aid in diagnosing your condition accurately and devising the most suitable treatment plan, it's important to be prepared to address inquiries such as:

How frequently do you experience premature ejaculation?
When did you first notice premature ejaculation?
Does premature ejaculation occur during masturbation?
Is premature ejaculation a consistent occurrence during sexual activity?
What is the frequency of your sexual activity?
To what extent does premature ejaculation distress you?
How does premature ejaculation affect your partner?
How satisfied are you with your current relationship?
Are you experiencing difficulties in achieving or maintaining an erection (erectile dysfunction)?
Are you currently taking any prescription medications? If so, what medications have you recently started or ceased taking?

A Note from Kamakhya Andro-Uro Care & Fertility Clinic:

Our dedicated urologists and healthcare professionals are committed to formulating an effective treatment plan tailored to address your premature ejaculation concerns. With targeted interventions, premature ejaculation can often be resolved through straightforward measures. If you're experiencing premature ejaculation, it's crucial to consult with our urologists for personalized care. We understand that discussing sexual issues may feel uncomfortable, but rest assured, our team is here to provide professional support, aiming to ensure you and your partner enjoy a fulfilling sexual relationship. Remember, you're not alone in facing this common challenge!