Dr Nguyen Hoang Duc


About the condition
Many men sometimes ejaculate sooner than they or their partner would like. If it just happens occasionally, it's probably not something to worry about. However, if you regularly ejaculate sooner than you and your partner would like, such as before intercourse begins or soon afterward, you may have a condition known as premature ejaculation. Although the issue is often phrased in terms of time (i.e., I'm ejaculating within thirty seconds after starting intercourse), the issue is really about voluntary control of the ejaculatory process

What is the average time until ejaculation?
In assessing whether you have premature ejaculation, it can be important to ask whether your own or your partner's stamina expectation is realistic. Keep in mind that the average time from insertion to ejaculation is less than three minutes.

If your partner is a woman, remember that female orgasm doesn't occur automatically as a result of prolonged intercourse. Surveys tell us that only about one fourth to one half of women regularly orgasm during intercourse. Most women find it is easier to be orgasmic with manual or oral stimulation than through intercourse.

  • Ejaculating within 1 minute of vaginal penetration
  • An inability to delay or control ejaculation
  • The sufferer experiences distress, strained romantic ties or lowered self image

How common is it?
Premature ejaculation affects about one out of three men. It is the most common male sexual problem, particularly among younger men.

What are the causes?
Premature ejaculation can have both psychological and biological causes.
Psychological causes
Early sexual experiences may establish a pattern which is difficult to change. First experiences of sexual intercourse often involve excitement mixed with anxiety and a demand to perform quickly in order to avoid being discovered. Your focus might be on your performance rather than on the pleasurable and erotic aspects of the experience. Most males reach orgasm very quickly the first time they have intercourse. Although most men also learn to slow down, to enjoy their own and their partner's pleasure, and become comfortable and confident with sexual intercourse, early ejaculation continues to be a problem for about 30 percent of men.

Many men with premature ejaculation also have problems with anxiety — either specifically about sexual performance, or anxiety caused by other issues. In general, linking sex and performance, rather than sex and pleasure, can be problematic. In developing ejaculatory control, you might find that it is best to focus on what would bring pleasure to you and to your partner. It can also help to think of ejaculatory control as a skill that you and your partner develop together to enhance mutual satisfaction.

Premature ejaculation can also be related to erectile dysfunction. Men who are anxious about obtaining or maintaining their erection during sexual intercourse may form a pattern of rushing to ejaculate and have difficulty changing that pattern.

Biological causes
A number of biological factors may contribute to premature ejaculation, including:
  • Abnormal hormone levels
  • Insufficient concentration of the neurotransmitter serotonin
  • Abnormal reflex activity of the ejaculatory system
  • Certain thyroid problems
  • Inflammation and infection of the prostate or urethra
  • Inherited traits

Rarely, premature ejaculation is caused by:
  • Nervous system damage resulting from surgery or trauma
  • Withdrawal from narcotics or a drug called trifluoperazine (Stelazine), used to treat anxiety and other mental health problems
Whether the cause is psychological or biological, treatments including medications, counseling and learning sexual techniques to delay ejaculation can improve sex for you and your partner(s)

What are the treatment options?
Treatment for premature ejaculation can include behavioral therapy (including learning specific sexual techniques), certain medications and counseling or psychotherapy. Often, a combination approach works best. 80-90% of men are able to learn better control through treatment.

In some cases, behavioral therapy may involve simple steps such as masturbating an hour or two before intercourse to help you delay ejaculation during sex or stimulating your partner to a state of high arousal before you have your genitals touched, so that your orgasms can be achieved closer to the same time.

Another approach that may help is to avoid intercourse for a period of time and instead focus on other types of sexual play so that pressure is removed from your sexual encounters. Connecting in this way can help you re-establish a satisfying physical bond with your partner(s).

In addition to the approaches above, there are two specific behavioral methods which can help you develop ejaculatory control:
  • The stop and start method helps you learn to recognize when climax is imminent and to slow down or reduce stimulation in order to extend the time until ejaculation. If you find yourself nearing climax, withdraw your penis from your partner or otherwise reduce stimulation and allow yourself to relax enough to prevent ejaculation. By starting and stopping sexual stimulation and learning to notice when climax is imminent, you can learn to prolong the sex act.
  • A second method known as the squeeze technique also helps you gain control over the timing of your ejaculation. To use the squeeze technique, you begin sexual activity as usual, including stimulation of the penis, until you feel almost ready to ejaculate. Have your partner squeeze the end of your penis, at the point where the head joins the shaft, and maintain the squeeze for several seconds, until the urge to ejaculate passes. After the squeeze is released, wait for about 30 seconds, then go back to sex play. (You may notice that squeezing the penis causes it to become less erect, but when sexual stimulation is resumed, the full erection returns.) If you again feel you're about to ejaculate, have your partner repeat the squeeze process. By repeating this as many times as necessary, you can reach the point of entering your partner without ejaculating. You can also use this technique without a partner by masturbating and then applying the squeeze yourself as described above. After a few practice sessions, the feeling of knowing how to delay ejaculation may become a habit that no longer requires the squeeze technique.

Medication is another option for treatment and generally most effective when used in combination with behavioral methods.
  • Certain antidepressants and topical anesthetics can be used to treat premature ejaculation. You may need to try different medications or doses before you and your doctor find a treatment that works for you.
  • A side effect of certain antidepressants is delayed orgasm. Doctors sometimes suggest men who have premature ejaculation can take antidepressants to benefit from this specific side effect. You may not need to take these medications every day to prevent premature ejaculation. Taking a low dose several hours before you plan to have sexual intercourse may be enough to improve your symptoms. Other side effects of these antidepressants can include nausea, dry mouth, drowsiness and decreased libido.

Desensitizing lubricants can also be used to treat premature ejaculation. They contain a mild anesthetic (7.5 percent benzocaine) that causes a temporary numbing sensation after being applied to the skin. The purpose of this desensitization is to help men to keep their erections and to postpone ejaculation. Since the penis has less sensation, sexual pleasure could be reduced. Wearing a condom when you use these products can help so that the lube can't rub off onto your partner's body, diminishing sensation and pleasure for him or her as well. Desensitizing lubes are water-soluble, not oil-based, and so they can be used with latex condoms. They are available over the counter. Durex Play Longer is one of the most commonly available desensitizing lubes.

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