Premature ejaculation

Premature Ejaculation (PE) is a common male sexual dysfunction characterized by ejaculation that occurs too quickly, typically before or shortly after sexual penetration. This can lead to distress, frustration, and potentially impact sexual satisfaction for both individuals in a sexual relationship.

Classification

PE is broadly classified into two categories: lifelong (primary) and acquired (secondary). Lifelong PE begins all or nearly all of the time, beginning with the first sexual encounters. Acquired PE develops after having previous sexual experiences without ejaculatory problems.

Pathophysiology

The exact cause of PE is not well-understood. It's likely a combination of psychological factors such as anxiety, guilt, or tension and biological factors such as abnormal hormone levels, certain thyroid problems, inflammation and infection of the prostate or urethra, and inherited traits.

Clinical Presentation

The principal feature of PE is the inability to delay ejaculation for more than one minute after penetration. However, the problem can occur in all sexual situations, even during masturbation. Men with PE often report emotional and relationship stress.

Diagnosis and Treatment

PE is typically diagnosed through a detailed sexual history, which includes the frequency of PE, sexual response, techniques to delay ejaculation, and how PE affects sexual activity and relationships.

Treatment involves a combination of techniques, primarily behavioural therapy, counselling, and medication. Behavioural techniques such as the "start-stop" method or the "squeeze" technique may be effective. Psychotherapy or counselling can help reduce performance anxiety and resolve interpersonal issues that contribute to PE. Certain medications, including some antidepressants, analgesics, and phosphodiesterase-5 inhibitors, may be used to delay ejaculation. Topical anaesthetics may also be used.

Prognosis

With treatment, most men with premature ejaculation can expect an improvement in their sexual endurance. Lifelong PE tends to be more difficult to treat than acquired PE.

See Also

• Sexual dysfunction
• Ejaculation
• Sex therapy

References

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