What are the possible reasons for premature ejaculation, i.e. psychological, physiological?

Doctor's Answers (2)

Dr Ronny Tan Ban Wei

"Urologist fellowship trained in Andrology & Prosthetic Urology"

Premature ejaculation refers to the inability to delay ejaculation during sexual activity resulting in distress to the patient, his partner or the couple as a whole.

PE is broadly classified as:

1. Lifelong PE

2. Acquired PE

3. Variable PE

4. Subjective PE

In men who have lifelong PE, they have a short IELT (intravaginal ejaculatory latency time) since their first sexual experience.

IELT basically refers to the time from vaginal penetration to ejaculation.

Men with acquired PE presents with decreasing IELT (i.e. shortened time from penetration to ejaculation) and this can be caused by erectile dysfunction, urinary tract infections e.g prostatitis, cystitis, seminal vesiculitis.

Having said that, PE can also be due to stress from performance, anxiety during sex, relationship issues or even stress from work.

Variable PE just means that there are good days and bad days and is more commonly due to stress.

In men with subjective PE, it is the expectation of the patient and the perception that he should last for a longer than expected time during sex.

Patients with PE should seek medical attention as this condition can be treated with prescription medications and behavioural modifications. PE can jeopardise relationships and men should not wait if there are signs that their relationship is at risk.

After all, it is all about timing, isn't it?

Dr Beng Yeong Ng

"Psychiatrist with over 20 years of experience"

Persons with premature ejaculation (also called rapid ejaculation) finds it difficult to delay ejaculation for more than one minute after penetration. Two main types have been described. First, lifelong (primary). This occurs all or nearly all of the time beginning with the first sexual encounters. Second, acquired (secondary). This develops after the person had previous sexual experiences without ejaculatory problems.

Many men report having symptoms of premature ejaculation, but the symptoms do not meet the diagnostic criteria for premature ejaculation. Instead these men might have natural variable premature ejaculation, where periods of rapid ejaculation are interspersed with periods of normal ejaculation.

With regards to the underlying causes, brain chemistry is the main factor. Men who have low levels of the chemical serotonin (a neurotransmitter) in their brains tend to take a shorter time to ejaculate.  Psychological and emotional factors do play a part too. First, stress and emotional strain in any area of a person’s life can play a role in premature ejaculation, limiting one’s ability to relax and focus during sexual encounters. Second, performance anxiety. Many men with premature ejaculation also have problems with anxiety — either specifically about sexual performance or related to other issues.  Third, relationship problems. interpersonal issues between a person and his current partner are contributing to the problem. Fourth, guilty feelings that increase a man’s tendency to rush through sexual encounters. Fifth, erectile dysfunction. A man may be at increased risk of premature ejaculation if he occasionally or consistently has trouble getting or maintaining an erection. Fear of losing his erection might cause him to consciously or unconsciously hurry through sexual encounters. It can be a hard habit to break.  

In terms of interventions, both medication and psychosocial interventions have been described. In terms of medications, the following treatment options are commonly used: First, use of Dapoxetine.  Dapoxetine is a selective serotonin reuptake inhibitor specifically designed to treat premature ejaculation. It is an oral tablet that can be taken 1 to 3 hours prior to engaging in sexual activity, once a day. Second. Use of other SSRI (serotonin specific reuptake inhibitors) medications. This would be an off label use of the SSRIs and commonly used examples include paroxetine and sertraline. An older antidepressant clomipramine has also been found to be effective in slowing down ejaculation but many patients find the side effects (sedation and dry mouth) difficult to tolerate. Third, use of EMLA cream.  Anesthetic creams and sprays that contain a numbing agent, such as benzocaine, lidocaine or prilocaine, are sometimes used to treat premature ejaculation. These products are applied to the penis 10 to 15 minutes before sex to reduce sensation and help delay ejaculation. A lidocaine-prilocaine cream for premature ejaculation (EMLA) is available by prescription.

In terms of psychosocial interventions, quite a few treatment approaches can be considered. First, behavioural therapy is also useful in many cases. Commonly used strategies include stop start technique, squeeze technique, ‘quiet vagina technique’.  Second, cognitive therapy which focus more on the persons thoughts and assumptions regarding his sexual behaviour and performance. Third, relationship therapy to resolve interpersonal issues and other psychological conflicts.

If you have concerns with premature ejaculation, it will be good to seek treatment from a urologist or a psychiatrist who has experience in managing people with sexual concerns.

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