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Premature Ejaculation

Premature Ejaculation –Causes, Diagnosis and its Treatment

 

Introduction

Premature ejaculation is a sexual condition, wherein a person can’t control his ejaculation and reaches climax almost immediately after the sexual intercourse begins. Sometimes, ejaculation can also happen even before the initiation of intercourse and may require minimal stimulation of penis. One of the most prevalent sexual dysfunction, premature ejaculation is known to have afflicted majority of men at some point in life. However, there are some men who continue to struggle with premature ejaculation for the entirety of their life. Although it doesn’t have any lasting effect on the physiology and psychology of the person affected, it can certainly impact the lifestyle and self-confidence of the person suffering from it.

Risk factors

Premature ejaculation in itself doesn’t impose much risk on the over-all health of a person. But, it is merely a symptom and not a disorder in itself. Thus, it can be an indicator of one to many physical or mental disorders, which can cause early or rapid ejaculation. In couples trying to get pregnant, premature ejaculation can be the primary barrier in conceiving. As ejaculation can happen within one minute of initiation of sexual activity (with a cut-off of 15 seconds), it is very difficult for the semen to be ejaculated inside the vagina every single time of intercourse. As premature ejaculation also causes dissatisfaction in both partners, the female partner can also fail to achieve the proper vaginal condition which can enhance the chances of pregnancy.

Causes

It is very difficult to identify the root cause of premature ejaculation without full cooperation of the patient. Although specific causes of PE remain mostly unclear, following causes can contribute to intermittent premature ejaculation:

  • Hormonal imbalance: Excessive release of androgens can over-sensitize the genital areas, making ejaculatory response premature with the minimal possible penile stimulation.
  • Neural or vascular anomalies: The nervous and vascular network in the penis can be highly sensitive in some men which can respond to the slightest stimulation and cause early ejaculation.
  • Side effects to medicine: Certain drugs and medications taken orally or topically can also hinder with the typical ejaculatory response of a person. These effects may be temporary or permanent in nature, depending upon the intensity of medical treatment taken.
  • Anxiety or depression: This is considered to be the most potent cause of premature ejaculation. Without a stable or happy state of mind, it is difficult for many to achieve or sustain erection. And even if participation in sexual intercourse is managed, premature ejaculation can often occur due to an anxious or depressed state of mind.
  • Spinal or pelvic injury: Trauma or injury to the pelvic area can either desensitize or over-sensitize the penis. This may also be a major cause of premature ejaculation.
  • Prostatitis: Premature ejaculation is also quite common in men suffering from tumors, cancerous growths or other dysfunction in the prostate gland.
  • Genetic predisposition: Although the direct genetic linkage is not clear, men suffering from chronic premature ejaculation also have a family history of close relatives suffering from this problem.

Diagnosis

Premature ejaculation is diagnosed with the help of patient’s medical history and physical examination. The disorder is broadly categorized into two categories upon diagnosis –

  • Primary premature ejaculation: In this case a person has always suffered from the problem of premature ejaculation and the condition may further be complicated by other sexual disorders such as erectile dysfunction. Such patients likely have physiological anomalies and experience premature ejaculation with all partners in all situations.
  • Secondary premature ejaculation: In this type of premature ejaculation, the patient is known to have normal ejaculatory response once and have acquired the problem of PE at a certain point in life. The underlying causes are most likely psychological or pertaining to a pelvic injury. Secondary premature ejaculation can also be situation specific or partner specific and may also gradually normalize.

Treatment for Premature Ejaculation

As a specific cause of premature ejaculation is difficult to determine and the intensity of the problem can also vary depending upon situations, various treatment options are available. The most effective treatment for premature ejaculation is sex-therapy. Keegle exercises are recommended to develop a better control over the pelvic muscles and therefore control the time of ejaculation. Yet another type of control method recommended is the ‘stop and start’ technique wherein the couple is required to stop as the man nears the point of ejaculation. Once the ejaculatory response subsides, sexual intercourse can be continued.

Behavioral reconditioning and psychoanalysis are also recommended treatment measures to resolve anxiety and depression related causes of premature ejaculation.Oral medications containing SSRIs i.e. Selective Serotonin Reuptake Inhibitors are also commonly used for treating PE, but are known to have other debilitating side effects if used in long term. Topical medicines to reduce sensation in penis such as topic anesthetic sprays are also used as an effective alternative treatment.