Ejaculation is the release of semen from a man’s body. Premature Ejaculation (PE) is when ejaculation occurs sooner than a man and/or his partner likes during sexual intercourse. PE is known to occur occasionally and can be because of a myriad of reasons including stress and anxiety. PE that occurs occasionally is often referred to as premature climax or rapid ejaculation. A diagnosis of PE is made when ejaculation occurs consistently within one minute of sexual penetration and the man or his partner (or both) is not happy with the time it takes him to ejaculate. This is because once the man ejaculates, he can’t continue having sex.
That said, as an erection goes flaccid after ejaculation occurs, it is not immediately obvious if the problem is premature ejaculation or erectile dysfunction. Thus, ED should be investigated and treated, if appropriate, first. PE may not be a problem once the ED has been treated.
If you find your ejaculation time or that of your partner is causing you distress, please note that this can be helped with treatment.
The Central Nervous System (CNS) controls ejaculation. When a man is sexually stimulated, for instance, through sexual thoughts or direct contact with the penis, signals are sent to the spinal cord and brain. When a certain level of excitement is reached, further signals are sent from the man’s brain to his reproductive organs. This ultimately leads to semen being released from the penis.
When a man is sexually excited, the muscles in his penis relax. This allows an inflow of blood into the penile arteries. In the penis, there are two chambers called the corpora cavernosa that get filled up with blood too. As these chambers fill up, the penis grows rigid, thus forming an erection. An erection becomes flaccid when the penile muscles contract and the accumulated blood flows out through the penile veins.
Emission occurs when sperm moves to the prostate from the testicles via the vasa deferentia. Vasa deferentia is the plural for vas deferens. Once at the prostate, sperm mixes with seminal fluid to make semen.
Contraction of the muscles at the base of the penis forces semen out of the penis. This is also called expulsion.
This is where you have always had PE. This tends to have a psychological cause, for example, from a traumatic sexual experience as a child
this is where you recently started experiencing PE. This can have either a psychological or a physical cause (or both). Physical causes include (but is not limited to) excessive alcohol consumption and inflammation of the prostate gland.
It has also been suggested that men with low levels of the chemical Serotonin tend to take a shorter time to ejaculate.
Emotional factors like stress and depression have also been noted to influence the time to ejaculation.
What is the incidence of Premature Ejaculation?
PE is a relatively common issue for men and occurs in 30 – 40% of men at one point or the other in their life. Whilst ageing can cause changes in erection and ejaculation, it does not directly cause PE. PE can occur at any age.
What are the causes of Erectile Dysfunction?
As stated already, an erection goes flaccid after a man ejaculates. This makes it difficult to determine if the problem is PE or ED. Thus, for this article, it is important to understand the causes of ED too.
Just like PE, ED can have physical and/or psychological causes. ED can also be a side-effect of some drugs like antihypertensives, antidepressants, antipsychotics, cytotoxic drugs and/or recreational drugs, including alcohol. Concerns about work, money, relationship, family, and even worrying about not getting an erection can all be factors that contribute to ED.
The physical problems that may result in ED include any or all of the following:
conditions that alter the flow of blood to the penis – vasculogenic
conditions that affect the nervous system ie your brain, nerves and spinal cord – neurogenic
conditions affecting hormone levels – hormonal
conditions that affect the physical structure of the penis – anatomical
Some other physical causes not listed above include heart disease, diabetes and raised blood pressure. A physical cause for ED may manifest itself as an inability to get an erection under any circumstances. Other physical causes include injury to penile tissue and/or hormonal problems.
A psychological (or stress related) cause of ED may manifest itself as being able to get an erection sometimes, but not all the time. For instance, a man may be able to get an erection when he masturbates but not when he wants to have sexual intercourse with his partner.
Psychological causes of ED include anxiety and depression.
Like PE, it is possible for some people to have both a physical and a psychological cause for their ED. For instance, a man with diabetes may find it difficult to get an erection. This could lead to him becoming anxious. Thus, the combination of diabetes and anxiety could lead to an episode of ED.
There are a number of emotional issues that may also affect a man’s physical ability to achieve and/or maintain an erection that remains firm for long enough for him to have satisfactory sexual intercourse. These emotional issues include (but are not limited to):
lack of sexual knowledge
past sexual problems
history of sexual abuse
being in a new relationship
Will Premature Ejaculation stop on its own?
There is no simple direct answer to this question. Whether or not PE can or will resolve on its own is dependent on the cause of the PE in the first place.
Caused by Erectile Dysfunction
If ED is the problem, once the cause of the ED has been determined and treated, then PE is expected to resolve on its own.
If a physical cause is inhibiting the emission of sperm or the expulsion of semen, then that physical cause needs to be treated first before the PE can resolve.
If the PE has a psychological cause, then treatments like psychological therapy, behavioural therapy and even drugs, can be used. Psychological therapy helps to address any negative feelings and emotions the man may be feeling. Couples’ counselling and/or sex therapy has been known to help too.
Behavioural therapy uses exercise to help the man build a tolerance to delay ejaculation. Examples of such behavioural exercises include the squeeze method and the stop-start method.
With the squeeze method, the man’s partner stimulates his penis until just before ejaculation. Then the partner squeezes the penis firmly so that the erection partly becomes flaccid. The aim of this method is to enable the man to become aware of the sensations that lead to him climaxing so that he is better able to control and delay his own climax.
With the stop-start method, the man’s partner also stimulates his penis until just before he ejaculates. The partner stops at this point until the urge to climax eases away. As the man regains control, his partner starts stimulating his penis again. This method can be done three times a week until the man gains more control.
If PE has a hormonal cause, medications that affect serotonin levels can be used to treat PE. One such medication used in the UK is known as Priligy (Dapoxetine). To be an effective treatment for PE, Dapoxetine is thought to be involved in inhibiting the neuronal reuptake of serotonin and the subsequent potentiation of the neurotransmitter’s action at pre- and postsynaptic receptors. In studies using rats, Dapoxetine was shown to inhibit the ejaculatory expulsion reflex at a supraspinal level.
According to the Urology Care Foundation, 95 out of 100 men who follow the techniques listed above will recover from PE. However, should PE continue, it is recommended that the man continues to work with his healthcare professional to further explore other causes or treatment options.
Before seeking medical help, there are several things a man can try on his own to see if they would help. These include:
Masturbating an hour or two before having sexual intercourse
Use of a thick condom to try to reduce sexual sensations
Taking a deep breath just before he ejaculates to briefly shut down the ejaculatory reflex
Having intercourse with the sexual partner sitting on top of him so that they can pull away before ejaculation occurs and
Taking breaks during sex and using other things to distract yourself
When should you seek medical help?
If the above self-help techniques do not help to improve PE and it persists for a few weeks, you or your partner should consider speaking with your GP (or at least make an appointment at a sexual health clinic) if your PE persists for more than a few consecutive weeks. This will give your doctor the chance to assess your general health to ensure that your PE is not a sign of a more serious health condition, for example, heart disease.
At your appointment, the doctor or nurse will ask you about your general health and well-being and any problems you may be having. They will carry out some basic health checks like checking your blood pressure, heart and lungs. Your genitals may be examined so that a physical cause can be ruled out.
Here at Assured Pharmacy, we have our own in-house doctor with whom you can have a remote consultation to start the process. Depending on your individual circumstances, you may need to have a physical examination.
Assured Pharmacy is not liable for the currency or accuracy of the information contained in this blog post. For specific information about your personal medical condition, please contact our doctors or pharmacists for advice on [email protected]