Premature Ejaculation

What is Premature Ejaculation?

Premature ejaculation is a common medical condition when a man ejaculates too quickly after penetration without the feeling of control. This can lead to distress in his life as well as his partners. Most studies find that 20-30% of men suffer from premature ejaculation, making it the most common sexual dysfunction in men. Although it is difficult to define premature ejaculation by standard medical metrics, if you feel that you have premature ejaculation so do we.

What Defines Premature Ejaculation?

It is hard to define premature ejaculation but the formal definition by the International Society for Sexual Medicine (ISSM) is probably the most useful and widely accepted to date. It defines premature ejaculation as:

  • Ejaculation that always or nearly always occurs prior to or within about 1 minute of vaginal penetration from the first sexual experience (lifelong PE) or:

A clinically significant and bothersome reduction in latency time, often to about three minutes or less (acquired PE):

  • The inability to delay ejaculation on all or nearly all vaginal penetrations; and
  • Causes negative personal consequences, such as distress, bother, frustration, and/or avoidance of sexual intimacy.’

It is important to note that all currently used medical definitions of premature ejaculation involve vaginal intercourse. However, the same definition will apply to all men who ejaculate prematurely while having anal sex.

Why 60 seconds?

A population study tried to quantify the duration of intercourse for the “average” couple.  The time from when a man inserts his penis into his partner’s vagina until he ejaculates is called the “intravaginal latency time” (IELT).  In this population study, the average IELT was 5 minutes and 24 seconds.  Using statistical analysis, they calculated that 97.5% of men have an IELT of greater than 60 seconds – so the 2.5% who ejaculate in less than 60 seconds are two standard deviations below the mean, and therefore, are considered outside the norm.

In our view, the definition of Premature Ejaculation is:

Premature ejaculation is when a man has a tendency to ejaculate quickly after penetration, without the feeling of control, and where it causes distress to him and or his partner.

What Causes Premature Ejaculation?

Premature ejaculation is rarely localized to a single cause – listed are some potential causes:

Psychological
Early studies on premature ejaculation suggested that it is a trained sexual response by men who secretively masturbated as adolescents and were trained to finish quickly. When they moved onto mature sexual relationships, this behavior was then reinforced. There is no scientific data to support this as this is remains a unproven theory

Neurobiological
The neurotransmitter serotonin (5HT) plays a key role in the ejaculatory response. Low levels of serotonin in the brain may lead premature ejaculation. As you can imagine, increasing serotonin levels in specific parts of the brain can delay ejaculation.

Penile Sensitivity
The ejaculatory spinal cord pathway is located at the frenulum (the back of the tip of the penis). If a man has increased sensitivity at the frenulum, it is likely that he will ejaculate too fast.

What Treatment Options are available for Premature Ejaculation? 

At Tower Men’s Health, our physicians focus our diagnostic and treatment plan around behavioral, neurologic, and hormonal modifications. 

  • Behavioral Therapy:

Some patients respond to techniques such as starting and stopping – which involves interrupting intercourse to decrease stimulation to the penis in hopes of delaying ejaculation. In addition, patients have used various techniques such as increasing ejaculatory threshold through recent ejaculation and changing sexual positions. Although effective at times, most patients report limited sexual satisfaction with these methods. 

  • Topical medications:

Numbing agents can be used to delay ejaculation as many men have found this to be quite successful. It makes sense that if the penis is less sensitive, it will take more stimulation in order to trigger ejaculation. The two medications we use the most are EMLA cream and Promescent. However, many men do not like this treatment option as they will have difficulty getting and/or maintaining their erection, because of the numbness. The agent must also be washed off prior to intercourse or a condom must be worn to make sure the partner is not also desensitized. 

  • Oral medications:

If topical agents are not providing a satisfactory response, some men respond well to low doses of the antidepressants known as selective serotonin reuptake inhibitors (SSRIs), that increase serotonin levels in the brain, an in doing so increase time to ejaculation. These are prescribed off-label, with some side effects. Given that these pills have been around for over a few decades years, they are relatively safe, but are not FDA approved for the treatment of premature ejaculation.

Have a question or want to schedule an appointment?

Board-certified, fellowship-trained urologists staff Tower Men’s Health. We will pair you with one of our many experienced physicians to help address any concerns you may have and help you on your journey towards improved quality of life. Feel free to reach out to the physicians at Tower Men’s Health at 310-854-9898.