UNDERSTANDING AND COPING WITH
PREMATURE EJACULATION
 
RELATED KEYWORDS: premature ejaculation, PE, rapid sexual release, primary and secondary premature ejaculation, performance anxiety, primary PE, secondary PE, rapid ejaculator, premature ejaculator, sexual dysfunction
 
AUTHOR: WARREN J. RINGOLD, MD, Chief of Department of Family Medicine, Oakwood Hospital, Dearborn, Michigan
 
INFORMATION: Premature ejaculation or PE is the most common sexual dysfunction among men who are under the age of 40. There are numerous definitions for premature ejaculation. Quite simply it is when male ejaculation occurs prior to the time that would please both partners. This definition places no blame on either partner. In some instances a man might ejaculate in one minute; yet, his partner might have an orgasm in that time frame. Obviously this pleases both partners. However, if a man ejaculates within one minute and his partner takes seven minutes to have an orgasm, then both partners would not be pleased. The American Urological Association has adopted a definition for premature ejaculation. It states that “premature ejaculation is ejaculation that occurs sooner than desired, either before or shortly after penetration, causing distress to either one or both partners”.

Interestingly because many women are unable to have an orgasm with vaginal intercourse regardless of how long the partner can maintain an erection, the problem actually can represent delayed orgasm for the woman rather than premature ejaculation for the man. Because of all of these variables it is very important for the physician to ask enough appropriate questions to enable a proper diagnosis.
 
WHAT HAPPENS DURING PREMATURE EJACULATION: Ejaculation is actually a reflex. This means that it is much like what happens when a doctor taps your knee with a reflex hammer. No amount of concentration can prevent your knee from extending upward if the hammer strikes the right spot. It is the same with ejaculation. Once a man reaches a certain level of stimulation, the ejaculatory reflex begins, and it cannot be stopped. For some unknown reason, men who ejaculate quickly are brought to a high level of sexual arousal and penile stimulation far too quickly. Again when this level is reached it cannot be “willed away”. Investigators are unable to find any organic reason for a man to ejaculate quickly. Some investigators suggest that PE is purely a psychological problem. Personally I do not agree with this theory. I believe that men who ejaculate quickly have a different physiological system that results in a state of over stimulation or hyper excitability of the male genitalia. In any event there are a number of theories as to cause; nonetheless, none of them has been proven, and all of the theories are nothing more than hypothetical thoughts.
 
HOW MANY MEN HAVE THIS PROBLEM: Various studies suggest that between 30% and 70% of men suffer from premature ejaculation. The reporting data might not be accurate because many men are embarrassed and will not discuss the problem openly and honestly with a physician. In my interview of over 200 men, all of them reported having had premature ejaculation at sometime or other in their lives. The problem occurs rarely for some men, but for others it occurs every time they try to have sexual relations. For the latter group this can cause significant psychological problems. The problems can range from anxiety and embarrassment all the way to complete avoidance of sexual relationships.

CONSEQUENCES OF PREMATURE EJACULATION: Although the main consequences are directed at the relationship, the most serious consequence is the inability to impregnate one’s spouse. This occurs when the male ejaculates prior to penetration and no sperm is deposited within the vaginal vault of the female. When the relationship is evaluated, it is found that the majority of men and women are unable to discuss the problem. This results in extreme frustration for both the woman and the man. Often times the woman will feel that the man is being inconsiderate, and that he is not at all concerned about her sexual needs. Many of these women feel that a man could control his orgasm if he tried harder. If a man cannot communicate about this issue as is so often the case, he is then unable to dispel his partner’s thoughts and his mate goes on believing he is stingy and self centered. This results in a significant loss of intimacy.
 
WHAT CAN I DO TO HELP MY PREMATURE EJACULATION: When a man presents to my clinic, I will ask him about his sexual history. I try to inquire about premature ejaculation in a sensitive fashion so as not to intimidate the patient. I will then try a nutritional approach using supplements that increase the level of serotonin. Increasing serotonin can help inhibit the reflex that causes ejaculation. If this method is not successful, then I will order a medication that is normally used for depression. The medication is from a class of drugs called SSRI’s or selective serotonin reuptake inhibitors. These anti depressants can have a side effect of delaying orgasm through a similar route by raising serotonin levels.
 
There are also various desensitizing creams or ointments that make the head of the penis less sensitive and thus reduce excitability. These items are often reported to lessen the pleasure associated with sexual intercourse. This makes this option less satisfactory for many men. In my personal experience some men can simply take the supplement or prescription a few hours prior to anticipated sexual activity whereas other men have to use their item of choice on a daily basis. I try to individualize treatment according to the needs of the particular patient.
 
CONCLUSION: Premature ejaculation occurs in a large percentage of men. It is especially prevalent in men under 40 years of age. It can interfere with a sexual relationship significantly if a couple is unable to communicate openly and honestly about sexual feelings. It can lead to a sexless relationship or a relationship that cannot produce children in its worst form. There is no absolutely documented cause for this difficult phenomenon. There are supplements that can help as well as prescription medications. Both men and women should be able to talk to their physician if premature ejaculation is interfering with the health of their sexual relationship. There is help for men suffering from PE; however, their doctor is not a mind reader. The problem must be discussed openly.  The goal for all couples should be a healthy and satisfying sexual relationship.  Sexual partners can only understand premature ejaculation if it is discussed openly.  The more frequently partners discuss sexual topics, the easier it becomes.  Thus, I strongly encourage communication.
 
For more information on this topic please refer to RingoldMD.com.  I hope that this article helps both men and women who are in a loving relationship being hurt by premature ejaculation.