PREMATURE EJACULATION

Premature ejaculation is the most common ejaculation problem. It's where the male ejaculates too quickly during sexual intercourse.

Average time taken to ejaculate during intercourse was around 5 to 6 minutes. There is no definition of how long sex should last.However, it is up to each couple to decide if they are happy with the time taken.

Occasional episodes of premature ejaculation are common and are not a cause for concern. However, if you're finding that around half of your attempts at sex result in premature ejaculation, it might help to get treatment.

What are the causes of premature ejaculation?

Various psychological and physical factors can cause a man to suddenly experience premature ejaculation.Common physical causes include prostate problems, thyroid problems,using recreational drugs and others.Common psychological causes include depression, stress, relationship problems, anxiety about sexual performance (particularly at the start of a new relationship, or when a man has had previous problems with sexual performance)

It's possible, but less common, for a man to have always experienced premature ejaculation since becoming sexually active. A number of possible causes for this are:

• Conditioning– it's possible that early sexual experiences can influence future sexual behaviour. For example, if a teenager conditions himself to ejaculate quickly to avoid being caught masturbating, it may later be difficult to break the habit
• A traumatic sexual experiencefrom childhood – this can range from being caught masturbating to sexual abuse
• A strict upbringing and beliefs about sex
• Biological reasons– some men may find their penis is extra sensitive

Treating premature ejaculation:  There are a number of things you can try yourself before seeking medical help.It can sometimes help to:

• masturbate an hour or 2 before having sex
• use a thick condom to help decrease sensation
• take breaks during sex
• take a deep breath to briefly shut down the ejaculatory reflex
• have sex with your partner on top (to allow them to pull away when you are close to ejaculating)
• Applying numbing agent 20 minutes before having sex

Couples therapy: If you're in a long-term relationship, you may benefit from having couples therapy. During these sessions, the therapist will:

• encourage couples to explore any relationship issues they have, and give them advice about resolving them
• show the couple techniques that can help you unlearn the habit of premature ejaculation (the 2 most popular techniques are the "squeeze"techniqueand "stop-go" techniques)

In the squeeze technique, your partner masturbates you, but stops before the point of ejaculation and squeezes the head of your penis for between 10 to 20 seconds. They then let go and wait for another 30 seconds before resuming masturbation. This process is carried out several times before ejaculation is allowed to occur.

The stop-go technique: Once you feel more confident about delaying ejaculation, you and your partner can begin to have sex, stopping and starting as required.

These techniques may sound simple, but they require lots of practice.

Medical Treatment:

Dapoxetine:  An SSRI specifically designed to treat premature ejaculation, known as dapoxetine. It acts much faster than the SSRIs mentioned above and can be used on demand.You’ll usually be advised to take it between 1 and 3 hours before sex, but not more than once a day. Common side effects include headaches, dizziness or feeling sick. Your response to the treatment will then be reviewed after 4 – 6 weeks and again every 6 months

Dapoxetine is not suitable for all men diagnosed with premature ejaculation. For example, it is not recommended for some men with heart, kidney and liver problems. It can also interact with other medicines, such as other antidepressants.

Antidepressants (SSRIs):  Selective serotonin reuptake inhibitors (SSRIs) are designed to treat depression, but they also delay ejaculation. SSRIs used for this purpose include paroxetine, sertraline and fluoxetine

Some men may experience an improvement as soon as treatment begins. However, you'll usually need to take the medicine for 1 to 2 weeks before you notice the full effects.

Side effects of SSRIs are usually mild and should improve after 2 to 3 weeks. They include fatigue, feeling sick and being sick, diarrhoea and excessive sweating.

Phosphodiesterase-5 inhibitors:  Phosphodiesterase-5 inhibitors, such as sildenafil (Viagra), are a class of medicine used to treat erectile dysfunction. They may also help with premature ejaculation.

Topical anaesthetics: The use of topical anaesthetics such as lidocaine or prilocaine can help but may be transferred and absorbed to the vagina, causing decreased sensation.

Condoms:Condoms can also be used and are effective, particularly when combined with local anaesthesia.