What is premature ejaculation?
Three elements are looked for together in the definition: ejaculation occurring markedly sooner than wanted, an inability to exert control over delaying it, and the situation causing personal distress or difficulty in the relationship. The decision is not made by looking at time alone.
Two main types are distinguished. In the lifelong (primary) type the problem has been present from the first sexual experiences. In the acquired (secondary) type it begins at a particular point after a period without difficulty; in this picture it is especially important to look for an underlying cause.
Causes and accompanying conditions
Premature ejaculation cannot be put down to a single cause. Alongside biological factors relating to the serotonin system involved in nerve transmission, learned patterns of behaviour and anxiety also play a part. In pictures that begin later, the following are investigated in particular:
- Accompanying erectile dysfunction: hurrying out of anxiety about losing rigidity can trigger premature ejaculation. Where the two occur together, the erectile dysfunction is addressed first.
- Infections such as inflammation of the prostate and urinary tract (prostatitis)
- Hormonal disorders, thyroid disease foremost among them
- Intense performance anxiety, depression and tension within a relationship
- Long periods of abstinence, or habitual patterns of rapid ejaculation
The assessment
The consultation covers when the problem began, whether it occurs in every encounter or only in particular situations, the medication you take and any accompanying complaints. A urological examination is performed; where the history calls for it, urine testing, prostate assessment or thyroid tests may be requested.
Whether erectile dysfunction accompanies it is assessed separately, because the order of treatment depends on that.
Treatment options
Treatment is usually planned by combining more than one approach:
- Behavioural methods: the stop-start and squeeze techniques aim to build awareness of and control over the ejaculatory reflex. They require regular practice.
- Prescription medication: oral options aimed at extending the time to ejaculation are assessed by the physician; how they are used (before intercourse or regularly) is decided individually.
- Topical treatments: sprays and creams that reduce sensitivity may be considered in selected cases; because of the risk of transfer to a partner, the instructions for use must be followed.
- Treating accompanying erectile dysfunction: where the two occur together, the erectile dysfunction is addressed first.
- Sexual counselling: where the anxiety component is prominent and difficulty within the relationship stands out, the process can be planned together as a couple.
Frequently asked questions
What counts as a normal time?
There is no single “normal time”. The diagnosis takes account of the sense of control and the distress experienced as much as the duration. The decision is therefore made through a detailed consultation, not by timing seconds.
Are sprays and creams enough on their own?
They can reduce the complaint in some people, but they do not remove the underlying cause. Where the instructions are not followed, unwanted effects such as numbness in a partner can occur. The choice should be made through a physician’s assessment.
Does the problem return if treatment stops?
Recurrence can be seen where only medication has been used and no behavioural work has been done. That is why medication is most often planned alongside behavioural methods.
Can premature ejaculation and erectile dysfunction occur together?
Yes, and it is a common situation. Anxiety about losing rigidity can lead to hurrying. Where the two occur together, the erectile dysfunction is usually addressed first after assessment.