Premature ejaculation (PE) is a common sexual dysfunction affecting a significant number of men worldwide. It is characterised by uncontrollable ejaculation occurring shortly after or even before sexual penetration, leading to dissatisfaction and frustration for both partners. Unlike erectile dysfunction, which involves difficulty in achieving or maintaining an erection, premature ejaculation is centered around the inability to delay ejaculation long enough to satisfy sexual partners.
To effectively address PE, individuals may benefit from consulting a urologist, psychologist, or psychiatrist, as the condition can be influenced by both physical and mental health factors. For example, anxiety and conditions like OCD (obsessive-compulsive disorder) are often linked to premature ejaculation, as stress and obsessive thoughts can heighten tension and impact control over ejaculation. Additionally, a neurologist may be consulted if there is a need to assess underlying neurological factors that could contribute to PE, as well as other concerns like migraine or insomnia, which may also affect sexual function.
In some cases, deficiencies in nutrients like Vitamin B12 can impact overall energy levels and neurological health, which could indirectly contribute to premature ejaculation. Differentiating between PE and occasional instances of rapid ejaculation is crucial, as the latter can occur in most men at some point without indicating a medical concern.
It’s essential to note that premature ejaculation can manifest differently for each individual, and the severity of symptoms may vary. Premature ejaculation is often categorized into two types: lifelong (primary) premature ejaculation and acquired (secondary) premature ejaculation. Lifelong premature ejaculation occurs from the first sexual encounter and persists throughout a person’s life, while acquired premature ejaculation develops after a period of normal sexual functioning and is often attributed to psychological or situational factors.
Also Read: Delayed Ejaculation – Causes & Treatment
Premature ejaculation can have significant effects on both individuals and their partners, impacting various aspects of their physical and emotional well-being. It can impact relationships negatively and also lower one’s self-esteem. It also causes emotional distress and psychological repercussions including anxiety, stress, and depression. PE can also lead to avoidance behaviours related to sexual intimacy to cope with their condition in fear of embarrassment. Despite its prevalence, premature ejaculation remains a topic that many individuals feel uncomfortable discussing openly. However, understanding and addressing this issue is essential for individuals and couples to lead fulfilling sexual lives.
How does a Healthy Erection happen?
An erection is a physiological process that involves a complex interaction between the nervous system, blood vessels, hormones, and muscles.
- Brain Stimulation: Sexual arousal begins in the brain when a person experiences sexual thoughts, fantasies, or physical stimulation. These stimuli trigger the release of neurotransmitters, such as dopamine and serotonin, which play a role in activating the sexual response.
- Nerve Signals: Once aroused, the brain sends signals through the nervous system to the arteries and muscles in the penis. These signals stimulate the release of nitric oxide, a chemical that relaxes the smooth muscle tissue in the walls of the penile arteries.
- Increased Blood Flow: As the smooth muscles relax, the arteries in the penis dilate, allowing more blood to flow into the erectile tissue known as the corpus cavernosum. The increased blood flow fills the spongy tissue of the corpus cavernosum, causing the penis to become engorged and expand, resulting in an erection.
- Pressure Build-Up: As blood fills the erectile tissue, the pressure inside the penis increases, compressing the veins that normally drain blood from the penis. This compression prevents blood from leaving the penis, helping to maintain the erection.
- Erection Maintenance: Once an erection is achieved, it is typically maintained through a combination of continued sexual stimulation and the release of hormones, such as oxytocin and adrenaline, which help sustain blood flow to the penis.
- Erection Resolution: After ejaculation or when sexual arousal diminishes, the nervous system releases other neurotransmitters that cause the smooth muscles in the penis to contract. This contraction reduces blood flow to the penis and allows the blood trapped in the erectile tissue to drain, resulting in the loss of erection.
Also Read: How does erection occur?
Causes of Premature Ejaculation
Premature ejaculation can stem from a variety of biological, psychological, and lifestyle factors, which may contribute to the condition either individually or in combination. Biological factors play a significant role in the development of premature ejaculation. Genetic predispositions and hormonal imbalances, including low levels of serotonin, dopamine, or testosterone, can impact ejaculatory control. Serotonin, in particular, is crucial in delaying ejaculation, and dysregulation of neurotransmitters in the brain may contribute to premature ejaculation. Hypothyroidism and imbalances in Vitamin D or Vitamin B12 can also affect energy levels and neurological function, influencing ejaculatory control.
Psychological factors are also key contributors. Anxiety, OCD (obsessive-compulsive disorder), and performance concerns can elevate arousal levels and contribute to premature ejaculation. Individuals with high anxiety may benefit from consulting a psychologist or psychiatrist for cognitive-behavioral therapy, which can help address underlying stressors related to sexual performance. Relationship stress, unresolved emotional issues, and past traumatic experiences, such as sexual trauma or abuse, can also heighten anxiety and disrupt ejaculatory control. Additionally, lifestyle factors, like chronic insomnia and stress, may exacerbate anxiety and reduce overall resilience, impacting sexual health.
Unhealthy lifestyle habits, such as excessive alcohol consumption, use of illicit drugs, or smoking, can impair neurotransmitter function and disrupt overall health, impacting both sexual performance and digestion system health. Nutritional deficiencies or diets high in processed foods and low in essential nutrients, like Vitamin B12 and cholesterol-modifying compounds, can impair neurological function. Supplements, such as Vitamin B12 tablets, may help address these deficiencies. Prolonged usage of acidity medications like Pantoprazole can cause Vit-b12 deficiency and can impair nerve health which is crucial for sexual health.
In some cases, certain medications for erectile dysfunction, like PDE5 inhibitors (e.g., sildenafil), may also impact ejaculatory control. It may be useful to consult a urologist or neurologist for further assessment, especially if symptoms persist despite lifestyle modifications. In advanced cases, imaging tests like a CT scan may be recommended to assess neurological factors, and tests for conditions like eosinophilia can help rule out other medical issues. Understanding and addressing this combination of biological, psychological, and lifestyle factors is essential to effectively managing premature ejaculation.
Diagnosis & Treatment of Premature Ejaculation
Diagnosing premature ejaculation involves a comprehensive evaluation by our doctors, typically a urologist or andrologist. During the initial consultation, the healthcare provider will inquire about the individual’s sexual history, including the frequency and duration of premature ejaculation episodes, any underlying medical conditions, medications, and lifestyle factors that may contribute to the condition. Open and honest communication about sexual concerns and experiences is crucial for an accurate diagnosis.
Premature ejaculation is typically diagnosed based on specific criteria outlined in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) or the International Classification of Diseases (ICD-10). These criteria often include consistent ejaculation that occurs within approximately one minute of penetration or even before penetration, accompanied by an inability to delay ejaculation and feelings of distress or frustration related to the condition.
Treatment for premature ejaculation typically involves a combination of behavioural techniques, counselling or therapy, medications, and lifestyle modifications. The goal of treatment is to improve ejaculatory control, enhance sexual satisfaction, and alleviate distress associated with the condition
Also Read: Erectile Dysfunction & Management
Behavioural Techniques:
- Start-Stop Technique: This technique involves stimulating the penis until the individual feels close to ejaculation, then stopping stimulation until the urge to ejaculate subsides. This process is repeated several times before allowing ejaculation, helping to increase awareness of arousal levels and prolonging the time to ejaculation.
- Squeeze Technique: Similar to the start-stop technique, the squeeze technique involves applying pressure to the base of the penis just before ejaculation to temporarily reduce arousal and delay ejaculation.
- Pelvic Floor Exercises (Kegels): Strengthening the pelvic floor muscles through exercises known as Kegels may help improve ejaculatory control and delay ejaculation.
Counselling and Therapy:
- Cognitive-Behavioral Therapy (CBT): CBT focuses on identifying and challenging negative thought patterns and beliefs related to premature ejaculation, helping individuals develop coping strategies and improve self-esteem.
- Sex Therapy: Sex therapy involves exploring sexual concerns and difficulties in a supportive and non-judgmental environment, often incorporating techniques to improve communication, intimacy, and sexual functioning within relationships.
Medications:
- Selective Serotonin Reuptake Inhibitors (SSRIs): SSRIs, commonly used to treat depression and anxiety, have been found to delay ejaculation and increase ejaculatory latency in some individuals. They are often prescribed off-label for the treatment of premature ejaculation.
- Topical Anesthetics: Topical anesthetics, such as lidocaine or prilocaine creams, can temporarily reduce penile sensitivity and delay ejaculation when applied to the penis before sexual activity.
- Phosphodiesterase Type 5 (PDE5) Inhibitors: While primarily used to treat erectile dysfunction, PDE5 inhibitors like sildenafil (Viagra) may also have a secondary effect of prolonging ejaculatory latency in some individuals.
Lifestyle Modifications:
- Healthy Diet and Exercise: Adopting a balanced diet rich in nutrients and engaging in regular physical activity can improve overall health and potentially enhance sexual function.
- Stress Management: Practicing relaxation techniques, such as deep breathing exercises or meditation, can help reduce stress levels and improve ejaculatory control.
- Limiting Substance Use: Avoiding excessive alcohol consumption, illicit drugs, and tobacco can help optimize sexual health and functioning.
How can we help you in managing Premature Ejaculation?
SOLVEMyHealth offers a comprehensive approach to helping clients manage premature ejaculation (PE) by leveraging its diverse team of experts, including doctors, sex therapists, counsellors, and lifestyle specialists. Through a multidisciplinary approach, SOLVEMyHealth addresses the various factors contributing to PE, such as biological, psychological, and lifestyle factors. Our medical professionals can assess the individual’s medical history, conduct examinations, and prescribe appropriate medications, such as selective serotonin reuptake inhibitors (SSRIs) or topical anesthetics, to address physiological aspects of PE.
Meanwhile, our sex therapists and counsellors provide personalized therapy sessions to explore and address underlying psychological factors contributing to PE, such as performance anxiety or relationship issues. Additionally, our lifestyle experts offer guidance on dietary changes, exercise routines, stress management techniques, and sleep hygiene practices to optimize overall health and improve ejaculatory control. By combining medical management, therapy, diet, and exercises, SOLVEMyHealth empowers clients to effectively manage PE and enhance their sexual satisfaction and overall well-being.
