Premature Ejaculation (PE) is a condition in which a man ejaculates earlier than he or his partner would like him to, causing distress to either or both partners. It is also known as rapid ejaculation, rapid climax, premature climax, or early ejaculation.

Many men occasionally ejaculate sooner during sexual intercourse than they or their partner would like. As long as it happens infrequently, it is not a cause for concern. If this happens during most of their sexual encounters it may cause significant distress and can affect sexual satisfaction in him as well as his partner. PE is a condition that can be treated very effectively with medications, psychological counselling and sexual techniques that delay ejaculation, with a combination of treatments working best.

PE is considered the commonest sexual problem and according to different studies 20-40% of men are deemed to have this problem. It is especially common in South Asia including Sri Lanka, with recent research in Britain among men of Sri Lankan and other South Asian origin living there indicating this.

The average time from penetration to ejaculation is five to six minutes and according to recent guidelines, to be considered as having PE, the time from penetration to ejaculation (ejaculatory latency time) should be less than one minute. Men with ejaculatory latency time less than two minutes also need treatment if the condition causes significant distress. PE can be broadly classified as lifelong (primary) or acquired (secondary). Men with lifelong PE experience rapid ejaculation in all sexual encounters including masturbation and with all partners. Men with secondary premature ejaculation develop the problem later in life after having a normal ejaculatory latency time previously. Both conditions can be treated.

Causes of PE

It was previously thought that this condition is primarily due to psychological factors, but now it has been determined that it is more complicated and involves a complex interaction of both psychological and biological factors. Therefore, proper evaluation by a doctor is needed to identify the underlying cause.

Psychological causes

Early sexual experiences may establish a pattern that can be difficult to change later in life, such as situations in which the person may have hurried to reach climax to avoid being discovered or guilty feelings that increase the tendency to rush through sexual encounters. Some of the psychosexual issues leading to PE can be less obvious.

Other factors that can play a role in causing PE include erection issues (erectile dysfunction), anxiety and relationship problems. According to a recent study done among Sri Lankan diabetic men, 70% of those with early erectile dysfunction also had PE. Men who are anxious about obtaining or maintaining their erection during sexual intercourse may form a pattern of rushing to ejaculate before losing the erection. The cause of erectile problem can be psychological or biological. Often, it is due to a combination of both. Men who have PE, secondary to erectile problems need careful evaluation to identify the latter cause. Treating erectile problem will often cure PE as well.

Many men with PE are anxious about their sexual performance and emotional or mental strain in any area of a person’s life can also play a role, often limiting the ability to relax and focus during sexual encounters.

If a person has previously had satisfying sexual relationships in which PE happened infrequently or not at all, it is likely that interpersonal issues between him and his current partner are contributing to the problem.

Biological causes

A number of biological factors may contribute to PE, including, abnormal hormone levels, abnormal levels of brain chemicals called neurotransmitters, abnormal reflex activity of the ejaculatory system, certain thyroid problems, inflammation and infection of the prostate or urethra and genetic factors.

Rarely, PE is caused by nervous system damage resulting from surgery or trauma withdrawal from narcotics or a drug called trifluoperazine (Stelazine) that is used to treat anxiety and other mental health problems.

Although both biological and psychological factors are likely to play a role in most cases of PE, a biological cause is more likely if it has been a lifelong problem (primary PE).

Complications

While PE does not increase the risk of serious health problems, it can be a symptom of underlying medical problem like over-activity of the thyroid gland and other biological conditions. Longstanding PE can affect the sexual as well as personal life of the patient. The common complications of PE include relationship distress, lack of intimacy, lower self esteem and marital disharmony. In men who ejaculate before penetration, fertilization can be difficult or impossible unless PE is effectively treated.

Treatment

All men need careful evaluation before treatment to achieve better outcomes. The treatment options include sexual therapy, medications and psychotherapy. For many men, a combination of these treatments works best.

Consultations with the doctor will improve the person’s sexual confidence, while addressing negative emotions and reducing anxiety levels. Sexual myths will be addressed to aim at increasing perception of control. The outcome is better if the person sees the doctor with his partner as some female sexual dysfunctions, attitudes and behaviours can also lead to PE.

(The writer is a specialist is Sexual Medicine)

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