Premature ejaculation (PE), also known as rapid or early ejaculation, is characterized by three main criteria: (1) lack of control over ejaculation, (2) a short time to ejaculation (typically within two minutes), and (3) psychological distress experienced by the individual and/or their partner. PE is fairly common, with up to one-third of men experiencing this issue at some point in their lives. Additionally, about 30% of men with PE also experience erectile dysfunction, which often leads to ejaculation occurring before achieving a full erection.

Premature Ejaculation: Common Contributing Factors

PE involves a multifaceted interaction of both biological and psychological factors.

Biological factors:

• Imbalanced or abnormal levels of neurotransmitters (brain chemicals).
• Hormonal imbalances including as low testosterone levels.
• Infections or inflammations affecting the urethra or prostate
• Genetic predispositions.

Psychological factors:

• Anxiety around starting or sustaining an erection can cause a habit of rushing to ejaculate to avoid potential loss of erection.
• Worries related to sexual performance or specifically about premature ejaculation.
• Early sexual experiences or a history of sexual trauma, possibly with unresolved emotions about intimacy.
• High levels of stress or general anxiety in life.
• Difficulties in communication with a partner or worries about meeting their sexual expectations.

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Effective Treatment for Premature Ejaculation

There are several treatment options for PE. For patients who also experience erectile dysfunction (ED) alongside PE, a combined approach may be most effective.

Phosphodiesterase (PDE) inhibitors

PDE inhibitors, such as Viagra and Cialis, may be beneficial for men with both PE and ED. Studies, including two meta-analyses, have shown that PDE5 inhibitors and selective serotonin reuptake inhibitors (SSRIs) are more effective than placebo for treating PE.

Other Kinds Ejaculatory Disorders: Understanding the Range of Conditions

SSRIs

Medications like citalopram, fluoxetine, paroxetine, sertraline, and escitalopram are often used to treat PE. It is recommended to start at a low dose and gradually increase it every three to four weeks as needed. Most patients begin to experience the full therapeutic effects of SSRIs within two to three weeks of treatment. However, symptoms are likely to return if the medication is discontinued. Some men can also use SSRIs on an as-needed basis before sexual activity. A meta-analysis suggests that paroxetine (Paxil) may be the most effective, potentially delaying ejaculation by up to nine minutes.

Tramadol: This pain-relief medication acts on opioid receptors and inhibits norepinephrine and serotonin reuptake. Tramadol is sometimes prescribed when SSRIs are not well-tolerated or effective. However, it must be used with caution due to the risks of side effects and potential addiction linked to opioids.

Behavioral therapies

Techniques such as squeeze therapy, start-stop methods, and mindful distraction can help delay orgasm. Additionally, wearing a condom may reduce sensitivity and contribute to better ejaculatory control.

Topical anesthetics

Topical treatments, such as an aerosolized lidocaine-prilocaine spray, have shown promising results in improving ejaculatory control, increasing ejaculatory latency, and enhancing sexual satisfaction when applied to the glans penis about five minutes before intercourse. Another option is alprostadil cream, applied to the penile meatus, which may also help in delaying ejaculation.

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Other ED-Related Concerns

• Anorgasmia or Anejaculation: The inability to achieve orgasm or ejaculate
• Retrograde ejaculation: Ejaculation occurs, but semen is redirected into the bladder rather than exiting through the penis.
• Delayed ejaculation: A prolonged time is required to reach orgasm and ejaculate.

Common factors contributing to these ejaculatory disorders include certain medications (particularly SSRIs, prostate medications like Flomax, and some blood pressure drugs), lower urinary tract symptoms or benign prostatic hyperplasia (BPH), and prostate surgeries. Hormonal imbalances, such as low thyroid levels or testosterone, can also play a role. Consulting a doctor experienced in ejaculatory disorders can help identify and address these issues.