Premature Ejaculation

Premature ejaculation, or PE, is a common problem. It occurs when a man is not able to control his ejaculation and consequently ejaculates faster than his partner would like.

What is Premature Ejaculation (PE)

Premature ejaculation is that which always, or almost always, occurs before or up to 2 minutes after penetration.

This lack of control of delaying ejaculation in all or almost all penetrations, has negative consequences, both personal and for the couple, such as:

• Anxiety;
• Difficulty in interpersonal relationships;
• Frustration;
• Avoidance of sexual intimacy.

PE is the most frequent sexual dysfunction in men, but also the least diagnosed and treated. The shame and lack of knowledge that surround this subject, as well as the lack of medical orientation, contribute to this.

However, you are not alone - PE is common.

Types of PE

There are 4 types of premature ejaculation (PE):

1. Primary PE, that is, ejaculatory dysfunction that persists from the first sexual experience;

2. Acquired PE, when ejaculatory dysfunction begins gradually or suddenly, after a period of normal ejaculatory experiences;

3. Natural/situational variable PE, variation from normal sexual performance that may be related to a new partner, an uncomfortable situation or low frequency of sexual activity;

4. Subjective PE, subjective perception of rapid ejaculation, but with latency of penetration within or even above normal, not considered pathological.

Risk factors for premature ejaculation

PE is associated with imbalances in nerve impulses, and with genetic predisposition.  There is a clear association with deficiencies of a chemical called serotonin, but there is insufficient understanding of the relationship between PE and other factors. However, there are psychological factors to consider. 

Men with the following psychological profile have increased risks of premature ejaculation:

• Anxious or vulnerable to performance anxiety;
• Emotional instability and feelings of guilt;
• Depression;
• Subject to daily pressure and stress;
• Previous negative sexual experiences

Also known risk factors for secondary premature ejaculatory dysfunction are:

• Hormonal changes in testosterone and prolactin levels;
• Hyperthyroidism;
• Obesity; 
• Diabetes
• Inflammation of the prostate (prostatitis); 
• Alcoholism
• Opiate or antipsychotic withdrawal syndrome.
  
  

Symptoms of premature ejaculation

Symptoms related to PE include:

• Reduced levels of self-confidence;
• Anxiety and negative feelings, such as shame and distress;
• irritability
• Depression.

Associated with this symptomatic picture are usually the following factors:

• Reduced overall satisfaction in sexual relations;
• Difficulty of relaxation during sexual intercourse
• Less frequent sexual intercourse;
• Dissatisfaction of the partner;
• Deterioration of the marital relationship.
  
  

Diagnosis of Premature Ejaculation

Diagnosis of PE is based on:

• Performance of a detailed clinical history and physical examination;
• Use of specific diagnostic tools, such as TLEIV (intravaginal ejaculatory latency time) and questionnaires such as PEDT* (premature ejaculation diagnostic tool), which is widely used, and can help to  conclude whether or not you have PE.
  
  

Talking about PE can help you and your partner 

Men with PE often feel that they are letting their partner down and that the quality of their relationship would improve if they did not have PE.

Both men and their partners can feel trapped in a vicious circle. The longer the problem lasts, the more their anxiety increases, putting even more pressure on the sexual relationship. Physical, emotional and psychological issues can occur simultaneously. This is a very difficult situation for the man and his partner, but remember that a talk with a doctor or a pharmacist can help to change  the situation completely. It can be as simple as that, nobody needs to live with this stress all their life.

Treatment of Premature Ejaculation

Treatment of premature ejaculation may involve: 

• Behavioural measures;
• Psychotherapy
• Pharmacological therapy.

Treatment should begin by correcting the risk factors, namely, and where possible:

• Weight loss;
• Physical exercise; 
• Treatment of hyperthyroidism and/or other hormonal changes;
• Control of diabetes; 
• Treatment of prostatitis;
• Addiction to narcotic substances.

Psychotherapy, accompanied by a urologist or psychiatrist, also contributes to reducing anxiety levels, improving sexual performance and optimising the couple's relationship.

Measures to be applied in the daily life of those who suffer from premature ejaculation

As behavioural measures, relaxation techniques (such as yoga) and abstraction with non-sexual, non-stimulating thoughts can be used.

Stopping and resuming cyclical sexual contact (stop & start technique) or squeezing the glans (squeeze technique) when orgasm is near can also delay ejaculation.

Pre-coital masturbation (1 to 2 hours before) can prolong the jaculatory latency time to penetration, especially if premature ejaculation is of an acquired type.

There are also several brands of desensitized condoms on the market, which are designed to prolong pleasure by delaying ejaculation.

Pharmacological treatment

1. Topical treatments - These work by desensitising the penis, helping to delay ejaculation.

These are "on the spot" treatments, which are applied before penetration

Topical spray - This newer treatment option can be beneficial as it is usually fast acting and suitable for most men. The spray is easily applied, 5 minutes before intercourse, from small spray containers and is a local treatment. There is an approved spray for PE available on prescription.

2. Oral medication for PE - "Just in time" oral medication (i.e. medication to be taken only when needed) is available for PE on prescription which provides an alternative option to topical treatments. It usually needs to be taken 2-3 hours before intercourse.

Sources
iSaúde
MSDmanuals

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