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Premature Ejaculation

(Rapid Ejaculation)

Definition

Ejaculation occurs when a man reaches sexual climax and semen is ejected from his penis. Premature ejaculation is:

Causes

Many men experience premature ejaculation at one time or another. For example, some men experience it after not having had sex for a long period of time. Premature ejaculation is only a problem when it becomes a persistent condition.
Ejaculation occurs automatically after a certain degree of sexual stimulation. Persistent premature ejaculation usually results from a man's inability to recognize that he is about to ejaculate. This inability prevents him from taking steps to delay the process.
Psychological factors may contribute to premature ejaculation. This may include difficulty in the relationship with a partner, guilt about sex, or fears related to sex.
In rare cases, premature ejaculation can be caused by:
The Prostate
Anatomy of the Prostate Gland
© 2011 Nucleus Medical Media, Inc.

Risk Factors

Factors that may increase your chance of premature ejaculation include:

Symptoms

The primary symptom is persistent episodes of premature ejaculation during sex.

Diagnosis

Most men experiencing premature ejaculation will notice the condition themselves. The doctor will ask about your symptoms and medical history. A physical exam will be done.
The doctor may search for an underlying medical cause if:

Treatment

Treatments may include:

Behavior Therapy

This aims to improve your ability to:
  • Recognize when you are about to ejaculate
  • Take steps to delay it
It may include:
  • Biofeedback—electrical feedback that helps you learn to control the muscles that cause ejaculation
  • Start and stop method—stopping sexual stimulation for 30 seconds when nearing climax, then resuming
  • Squeeze method—same as start and stop method, but includes gently squeezing the base of penis before the 30-second stop period
  • Sexual positions—trying different sexual positions that may allow greater control over the muscles that cause ejaculation

Psychological Counseling

Counseling may be offered for an individual or for a couple. It is aimed at identifying and treating:
  • Fears or guilt
  • Interpersonal problems with your partner that may contribute to the condition

Medication

In some cases, a doctor may prescribe a desensitizing cream. It can be applied to the penis to lessen sexual stimulation.
In other cases, a doctor may prescribe an antidepressant. Some antidepressants have been found to prolong the interval from intromission to ejaculation. However, these drugs do not cure the underlying cause of premature ejaculation.

Prevention

To help reduce your chance of premature ejaculation:

RESOURCES

Urology Care Foundation http://www.urologyhealth.org

Family Doctor—American Academy of Family Physicians http://familydoctor.org

CANADIAN RESOURCES

Health Canada http://www.hc-sc.gc.ca

Sex Information and Education Council of Canada http://www.sieccan.org

References

Montague DK, Jarow J, et al. AUA guideline on the pharmacologic management of premature ejaculation. J Urol 2004; 172:290-294.

Premature ejaculation. Family Doctor—American Academy of Family Physicians website. Available at: http://familydoctor.org/familydoctor/en/diseases-conditions/premature-ejaculation.html. Updated April 2014. Accessed September 1, 2015.

Premature ejaculation. Urology Care Foundation website. Available at: http://www.urologyhealth.org/urology/index.cfm?article=122. Accessed September 1, 2015.

Premature ejaculation. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated August 17, 2015. Accessed September 1, 2015.

Pryor JL, Althof SE, et al. Efficacy and tolerability of dapoxetine in treatment of premature ejaculation: an integrated analysis of two double-blind, randomised controlled trials. Lancet 2006; 368:929-927.

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