Premature ejaculation occurs when a man ejaculates sooner during sexual intercourse than he or his partner would like. Premature ejaculation is a common sexual complaint. Estimates vary, but as many as 1 out of 3 men say they experience this problem at some time. As long as it happens infrequently, it's not cause for concern.
However, you may meet the diagnostic criteria for premature ejaculation if you:
* Always or nearly always ejaculate within one minute of penetration.
* Are unable to delay ejaculation during intercourse all or nearly all of the time.
* Feel distressed and frustrated, and tend to avoid sexual intimacy as a result.
Symptom
The primary symptom of premature ejaculation is the inability to delay ejaculation for more than one minute after penetration. However, the problem may occur in all sexual situations.
Factors that can play a role in causing premature ejaculation include:
* Erectile dysfunction:
Men who are anxious about obtaining or maintaining an erection during sexual intercourse may form a pattern of rushing to ejaculate, which can be difficult to change.
* Anxiety:
Many men with premature ejaculation also have problems with anxiety — either specifically about sexual performance or related to other issues.
* Relationship problems:
If you have had satisfying sexual relationships with other partners in which premature ejaculation happened infrequently or not at all, it's possible that interpersonal issues between you and your current partner are contributing to the problem.
While premature ejaculation alone doesn't increase your risk of health problems, it can cause significant problems in your personal life, including:
* Stress and relationship problems: A common complication of premature ejaculation is relationship stress.
* Fertility problems: Premature ejaculation can occasionally make fertilization difficult or impossible for couples who are trying to have a baby.
Common treatment options for premature ejaculation include:
* 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 (glans) joins the shaft, and maintain the squeeze for several seconds, until the urge to ejaculate passes.
Also, anesthetic creams and sprays that contain a numbing agent, such as lidocaine or prilocaine, are sometimes used to treat premature ejaculation. These products are applied to the penis a short time before sex to reduce sensation and thus help delay ejaculation. A lidocaine spray for premature ejaculation (Promescent) is available over-the-counter.
Although topical anesthetic agents are effective and well-tolerated, they have potential side effects. For example, some men report temporary loss of sensitivity and decreased sexual pleasure. In some cases, female partners also have reported these effects. In rare cases, lidocaine or prilocaine can cause an allergic reaction.
Many medications may delay orgasm. Although none of these drugs is specifically approved by the Food and Drug Administration to treat premature ejaculation, some are used for this purpose, including antidepressants, analgesics and phosphodiesterase-5 inhibitors.
These medications may be prescribed for either on-demand or daily use, and may be prescribed alone or in combination with other treatments.
* Antidepressants.
A side effect of certain antidepressants is delayed orgasm. Unwanted side effects of antidepressants may include nausea, dry mouth, drowsiness and decreased libido.
* Analgesics
Tramadol (Ultram) is a medication commonly used to treat pain. It also has side effects that delay ejaculation. It may be prescribed when SSRIs haven't been effective. Unwanted side effects may include nausea, headache and dizziness.
*Phosphodiesterase-5 inhibitors
Some medications used to treat erectile dysfunction, such as sildenafil (Viagra, Revatio), tadalafil (Cialis, Adcirca) or vardenafil (Levitra, Staxyn), also may help premature ejaculation. Unwanted side effects may include headache, facial flushing, temporary visual changes and nasal congestion.
* Counseling
This approach, also known as talk therapy, involves talking with a mental health provider about your relationships and experiences. These sessions can help you reduce performance anxiety and find better ways of coping with stress. Counseling is most likely to help when it's used in combination with drug therapy.
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