Premature ejaculation occurs when a man experiences orgasm and «pushes» sperm shortly after onset of sexual activity and with minimal stimulation of penis. Premature ejaculation was also called ejaculatio praecox. There is no single definition of «prematurity» of ejaculation, but experts from International Society of Sexual Medicine have approved a definition that includes «»ejaculation, which always or almost always occurs before or after about one minute.
Although men with premature ejaculation suggest that they have less control over ejaculation, it is not clear whether this is true, and many or most men at average also report that they want sexual intercourse to last longer. Typical duration of time before ejaculation in men is approximately 4 – 8 minutes.
Premature ejaculation can cause severe emotional state in men and problems in relationships. Some men may avoid sexual relations because of complexes associated with premature ejaculation. Compared to men, women consider premature ejaculation less problematic, but some Canadian Pharmacy studies show that premature ejaculation also causes distress in female partner.
Causes of Premature Ejaculation
Causes of premature ejaculation remain unclear. Many theories have been suggested, including theory that premature ejaculation is the result of rapid masturbation in adolescence, so as not to be caught by an adult, anxiety, unresolved oedipal conflict, passive aggressiveness, and too little sex; but there is little evidence to support any of these theories. Some physiological mechanisms hypothetically may contribute to premature ejaculation, including serotonin receptors, genetic predisposition, increased sensitivity of male penis and atypical nerve conduction.
Scientists have long suspected a genetic link with certain forms of premature ejaculation. In one study, 91% of men who experienced premature ejaculation throughout their life also had close relative with lifelong premature ejaculation. Other researchers note that men who have premature ejaculation have faster response from pelvic muscles. Premature ejaculation can be caused by prostatitis, or be a side effect of the drug.
Mechanism of Premature Ejaculation
Physical process of ejaculation requires two actions: emission and eruption. Emission is the first phase. It includes precipitation of fluid from the vas deferens, seminal vesicles and prostate into posterior urethra. The second phase is «eruption» phase. It involves closure of neck of bladder, followed by rhythmic contraction of urethra with participation of pelvic perineum and bulbous muscle and intermittent relaxation of external urethral sphincter.
Sympathetic motor neurons control phase of emission of ejaculation reflex, and eruption phase is performed by somatic and vegetative motor neurons. These motor neurons are located in thoracolumbar and lumbosacral spinal cord and are coordinated when there is sufficient sensory input to reach ejaculatory threshold in central nervous system.
In Kinsey Reports of 1948, it was assumed that three-quarters of men ejaculate within two minutes after penetrating more than half of their sexual contacts. Current data support the view that average time of intravaginal ejaculation delay (IELT) in men aged 18 to 30 years is six and a half minutes. If the disorder is defined as IELT percentile below 2.5, premature ejaculation may be less than two minutes.
Nevertheless, it is quite possible that men with abnormally low IELT may well be happy with life and not report lack of control. Conversely, men with higher IELT rates may feel that they have premature ejaculation, and experience harmful side effects, usually associated with premature ejaculation, and even benefit from treatment.
Treatment of Premature Ejaculation
Several procedures have been tested for treatment of premature ejaculation. The combination of drug and non-drug therapies is often the most effective way.
Many men try to treat premature ejaculation themselves, trying to distract themselves, for example, trying to focus their attention on non-sexual stimuli. There is little evidence that this technique is effective, moreover, this is connected with distraction of attention of both partners from sexual satisfaction. Other methods of self-treatment include slower penetration during intercourse, pulling out penis completely, ejaculation before sexual intercourse on purpose, and use of more than one condom. Use of more than one condom is not recommended, since friction often leads to breakage of condoms. Some men report that these methods were useful to them.
By the 21st century, most men with premature ejaculation can cure themselves on their own, or with a partner using self-help, and only individuals facing extremely serious problems consult sexologists, with success rate of 75 to 80%.
Theory of Freud postulated that rapid ejaculation is a symptom of neurosis. Freud believed that a man unconsciously feels hostile towards women, so he ejaculates quickly, satisfying himself and frustrating his partner, who is unlikely to be able to quickly experience orgasm. Freudians claimed that premature ejaculation can be cured with the help of psychoanalysis. But even years of psychoanalysis can not help a patient with premature ejaculation. There is no evidence that men with premature ejaculation have extraordinary hostility towards women.
Sexologists have developed and applied several methods, including Kegel exercises (for strengthening pelvic floor muscles) and Masters’s and Johnson’s «stop-start» technique (to desensitize responses of male body) and «squeezing» technique (to reduce excessive excitement). To treat premature ejaculation, Masters and Johnson developed a «squeezing» method. Men were told to pay special attention to their pattern of excitement and learn to recognize how they feel shortly before the «point of no return», at the moment when ejaculation was inevitable. Having felt this, they had to give a signal to a partner who was supposed to squeeze balanus between the thumb and forefinger, suppressing ejaculation reflex and allowing a man to have sex longer.
Squeezing technique worked, but many couples found it burdensome. From the 1970s to the 1990s, sex therapists improved approach of Masters and Johnson, largely abandoned squeezing technique and focused on a simpler and more effective method called the «stop-start» method. During intercourse, as soon as a man feels that he is approaching orgasm, both partners cease to move until ejaculatory inevitability subsides, and at this moment it is possible to resume active sexual intercourse.
In order to increase person’s awareness of their sexual experience, people were encouraged to create a scale of excitation from 1 to 100. Successful filling of such a scale will include heart rate when (and if) a man squeezes the inner surface of the thighs and sensations in all parts of his body. By creating this scale, he will be more able to implement «stop-start» technique.
In addition to «stop-start» technique, other sexual adjustments help men develop and maintain control of ejaculation, among them: attention focus training, mind / body coordination exercises, masturbation exercises, deep breathing and full body massage. Sexopathologists believe that improved program teaches effective control of ejaculation in 90% of men. The My Canadian Pharmacy study concluded that sexual therapy has a remarkable therapeutic effect on premature ejaculation.
Drugs that increase transmission of serotonin signals in brain slow ejaculation and are successfully used to treat premature ejaculation. These include selective serotonin reuptake inhibitors (SSRIs), such as paroxetine or dapoxetine, and clomipramine.
Ejaculation delay usually begins within a week after start of treatment. Treatment increases delay of ejaculation in 6 – 20 times more than before taking medication. Men often report satisfaction with medications, and many people stop treatment within a year. However, SSRIs can cause various types of sexual dysfunction, such as anorgasmia, erectile dysfunction and decreased libido.
Dapoxetine is a short-acting SSRI that works when used when necessary to treat premature ejaculation. This drug is usually well tolerated. Tramadol, an atypical oral analgesic, seems to be effective.
Desensitizing local medications that are applied to the tip and «body» of penis can also be used. They are applied «as needed», 10 – 15 minutes before sexual activity and have fewer potential systemic side effects compared to pills. People sometimes prefer not to use local remedies due to decrease in sensitivity in penis, and also because of decreased sensitivity of the partner (due to the fact that the medicine penetrates into her body).
Insensitivity of penis and transfer of the drug to the partner is virtually eliminated by using local anesthetic sprays based on absorption technology, which allows active ingredient to penetrate surface of penis skin (stratum corneum) into sensory nerves that are in dermis. Several well-known medical institutions offer use of Promescent as a viable topical drug.
In 2005, researchers from Australian Center for Sexual Health in Sydney measured ability of sildenafil (a drug mainly used to treat erectile dysfunction) to treat patients experiencing premature ejaculation. Even if this drug did not significantly prolong ejaculatory delay, sildenafil reportedly «increased confidence, sense of control over ejaculation, and general sexual satisfaction» in subjects, and contributed to achieving second erection after premature ejaculation.