Premature ejaculation

Sexual health is an integral component of overall well-being, yet conditions like premature ejaculation (PE) often go underreported due to embarrassment and social stigma. PE is defined as ejaculation that occurs sooner than desired, either before or shortly after penetration, with minimal stimulation. It may affect sexual satisfaction and relationship quality and is a source of considerable emotional distress for men and their partners.

Premature ejaculation is among the most common male sexual disorders, with both psychological and biological factors contributing to its onset. Understanding PE, seeking timely help, and adopting the right management strategies can significantly improve quality of life.

Premature ejaculation is a condition where a man ejaculates within one minute of vaginal penetration, or before he or his partner desires. It can occur during partnered sex or masturbation and may be lifelong (primary) or acquired (secondary).

Unlike erectile dysfunction, PE does not involve difficulty in achieving an erection but rather a lack of control over the timing of ejaculation. It is a treatable medical condition, not a reflection of masculinity or personal inadequacy.

PE is a common condition, with global estimates suggesting it affects 20–30% of men at some point in their lives. In India, studies indicate a prevalence rate of around 30% among sexually active men.

Despite being widespread, only a small proportion of affected individuals seek medical attention due to shame or misconceptions. Increased awareness and access to sexual health resources are essential to address the hidden burden of PE.

PE can be categorised into two main types:

1. Lifelong (Primary) PE:
   
   • Present from the first sexual experience
   • Often related to neurobiological or genetic factors
2. Acquired (Secondary) PE:
   
   • Develops after a period of normal sexual functioning
   • Often linked to psychological or medical conditions like erectile dysfunction, prostatitis, or stress

Some clinicians also refer to situational PE (occurs only in specific scenarios) and variable PE (inconsistent patterns).

PE may have multiple causes, often interlinked:

• Psychological Factors:
  
  • Performance anxiety
  • Stress or depression
  • Relationship issues
  • Sexual inexperience or past trauma
• Biological Factors:
  
  • Abnormal serotonin levels
  • Hormonal imbalances
  • Hypersensitive penis
  • Inflammation or infection in the prostate or urethra
• Lifestyle Factors:
  
  • Excessive alcohol consumption
  • Drug use
  • Poor sleep patterns

Understanding the root cause is crucial for determining the most appropriate treatment.

Common symptoms include:

• Inability to delay ejaculation beyond one minute of penetration
• Feeling of loss of control over ejaculation
• Distress or frustration related to sexual performance
• Reduced sexual satisfaction
• Relationship difficulties

PE may also co-occur with other sexual dysfunctions, such as erectile dysfunction or low libido.

PE is diagnosed based on the patient’s sexual history and reported symptoms. There are no lab tests specifically for PE, but assessment typically includes:

• Detailed sexual and medical history
• Physical examination
• Questionnaires like the Premature Ejaculation Diagnostic Tool (PEDT)
• Evaluation for underlying conditions such as prostatitis or thyroid problems

Open communication with a healthcare provider is key to accurate diagnosis.

Several treatment approaches are available depending on the type and cause of PE:

1. Behavioural Techniques:
   
   • Start-stop method
   • Squeeze technique
   • Kegel exercises to strengthen pelvic floor muscles
2. Psychological Counselling:
   
   • Cognitive-behavioural therapy (CBT)
   • Sex therapy
   • Addressing performance anxiety and relationship issues
3. Medications:
   
   • Selective serotonin reuptake inhibitors (SSRIs) like paroxetine or sertraline. (Panex 20mg tablet)
   • Topical anaesthetics such as lidocaine-prilocaine cream. (Prilox Cream)
   • Tramadol (under medical supervision)
4. Lifestyle Changes:
   
   • Limiting alcohol and tobacco use
   • Managing stress
   • Regular physical activity and sleep hygiene

Treatment is often most effective when multiple strategies are combined.

Some men explore alternative options for managing PE, including:

• Ayurvedic and herbal remedies: Ashwagandha, Shilajit, and Gokshura may support sexual health.
• Acupuncture: May help by improving blood flow and reducing anxiety.
• Mindfulness and meditation: Support stress reduction and body awareness.

While some men report benefits, alternative treatments should always be discussed with a doctor to avoid interactions or ineffective options.

Men may be more likely to experience PE due to:

• Anxiety or depression
• Infrequent sexual activity
• Erectile dysfunction
• Inflammation of the reproductive organs
• Genetic predisposition
• Poor body image or low self-esteem

Identifying risk factors allows for targeted interventions.

Untreated PE may lead to:

• Relationship conflicts
• Reduced intimacy or avoidance of sexual activity
• Lowered self-confidence
• Fertility issues (if ejaculation occurs before penetration)
• Comorbid anxiety or depression

Addressing PE early can help mitigate these negative impacts.

Living with PE can be challenging but manageable:

• Focus on emotional intimacy, not just performance
• Explore other forms of sexual expression with your partner
• Be patient and avoid self-blame
• Stay consistent with treatment plans
• Keep realistic expectations and celebrate progress

PE doesn’t define your masculinity or relationship worth. Support and treatment are available.
 

• Myth: PE only affects older men
  
  
  • Fact: It can occur at any age, even during adolescence
     
• Myth: It’s a psychological issue only
  
  
  • Fact: Biological and neurological causes also play a role
     
• Myth: Masturbation causes PE
  
   
• Fact: Masturbation habits do not directly cause PE
   

Consult a doctor if:

• PE persists for more than six months
• It causes significant distress or affects relationships
• You also have symptoms of erectile dysfunction
• Over-the-counter options have failed

Early intervention improves outcomes and reduces long-term complications.

• What type of PE do I have?
• What treatment options are best for me?
• Could my condition be caused by another health issue?
• Will medication affect my libido or erection?
• How soon can I expect to see improvement?
• Can my partner be involved in therapy?

Open dialogue ensures better understanding and adherence to treatment.

If your partner is coping with PE:

• Be empathetic and non-judgemental
• Avoid blame or criticism
• Communicate openly about needs and feelings
• Encourage professional help
• Participate in therapy if needed

Supportive partners make a crucial difference in recovery and emotional well-being.

Premature ejaculation is a common and treatable condition that can significantly affect emotional and sexual health. Whether lifelong or acquired, PE deserves the same medical attention as any other health issue. By combining medical treatment, therapy, lifestyle changes, and partner support, most men can manage and overcome PE effectively.

The key lies in awareness, early intervention, and removing the stigma around sexual dysfunctions.