Premature Ejaculation

Premature Ejaculation Evaluation at Southland Urology

Premature ejaculation (PE) is a common male sexual health issue where a man ejaculates sooner than he or his partner would like during sexual intercourse. It can significantly impact a man’s confidence and a couple’s relationship. While frustrating, it is a highly treatable condition that can often be managed through a combination of psychological, behavioral,

Understanding Premature Ejaculation

What is Premature Ejaculation?

Premature ejaculation, or PE, is one of the most common male sexual dysfunctions. It is a persistent pattern of ejaculation that occurs with minimal sexual stimulation before, during, or shortly after penetration and before the person wishes to. This can cause significant distress, anxiety, frustration, and lead to the avoidance of sexual intimacy. PE is not a matter of a specific time limit, as the definition is based on the individual’s or couple’s sense of control and satisfaction. It is often categorized as either lifelong (primary), where it has been a problem since the first sexual encounter, or acquired (secondary), where it develops after a period of normal ejaculatory function.

Causes of Premature Ejaculation

The causes of PE are not always clear, but they are generally thought to involve a complex interplay of both psychological and biological factors. Psychological factors can include stress, anxiety about sexual performance, relationship problems, depression, or a history of early sexual experiences that may have conditioned a pattern of rushing to ejaculate. On the biological side, potential causes can include abnormal levels of certain brain chemicals (neurotransmitters), particularly serotonin, as well as irregular hormone levels. Other physical factors like prostate problems, thyroid issues, and erectile dysfunction can also contribute to or be associated with PE.

Diagnosis

A diagnosis of premature ejaculation is typically made by a healthcare provider based on a detailed medical and sexual history. The doctor will ask about the man’s ejaculatory latency time (how long it takes to ejaculate after penetration), his ability to delay ejaculation, and the level of distress the condition causes him or his partner. A physical exam and blood tests may be performed to check for hormonal issues or other underlying medical conditions, such as a prostate infection. It is also common for the provider to discuss lifestyle factors, relationship dynamics, and psychological stressors to get a complete picture of the situation.

Non-Surgical Treatment Options

The majority of PE cases can be effectively managed with non-surgical treatments. Behavioral techniques are a common first-line approach. The “stop-start” method involves stimulating the penis to the point of near-ejaculation, then stopping until the feeling subsides, and repeating the process to build ejaculatory control. The “squeeze” technique, developed by Masters and Johnson, is similar, but involves a firm squeeze on the tip of the penis to reduce the urge to ejaculate. Topical anesthetic creams or sprays containing lidocaine can be applied to the penis to reduce sensitivity and prolong intercourse. Oral medications, particularly selective serotonin reuptake inhibitors (SSRIs), are often prescribed off-label to delay ejaculation. Counseling or sex therapy can also be highly effective, especially when psychological factors are at play, helping men and their partners address anxiety, communication issues, and relationship dynamics.

Surgical Options

Surgical treatments for premature ejaculation are considered a last resort and are not widely recommended by leading medical organizations due to a lack of long-term data and potential for serious, irreversible side effects. The most discussed procedure is a selective dorsal neurectomy (SDN), an irreversible surgery that involves cutting some of the nerves in the penis to reduce sensitivity. While some studies have shown an increase in ejaculatory latency time, potential complications include permanent numbness, erectile dysfunction, and psychological distress. Another, less invasive surgical option is hyaluronic acid (HA) gel injection into the penis, which can act as a physical barrier to nerve signals. However, this is also not an approved treatment and carries risks. Due to the high success rate of non-surgical options, surgery for PE is a highly controversial and rarely-used treatment approach.