Help & Advice


What is ejaculation?

Ejaculation occurs when sexual stimulation provides impulses that are sent up the spinal cord to the brain via the central nervous system. There are two phases of ejaculation.  In the first phase (known as emission), sperm and secretions combine to form semen.  When emission is complete, ejaculation cannot be stopped.  In the second phase, muscles in the penis and urethra contract to push semen out of the penis (ejaculation).  Orgasm and typically the decline of an erection occur as a result.

What is premature ejaculation?

Premature ejaculation (PE) occurs when a man ejaculates during sexual intercourse earlier than he or his partner would like (typically less than a minute).  Complaints of PE are quite common as the average time from beginning of intercourse to ejaculation is five minutes.  Premature ejaculation is a condition affecting 20-30% of men of all ages making it one of the most common male sexual disorders. 

How do I know if I have PE?

True PE must meet the following criteria for diagnosis:

  • Nearly always ejaculate within one minute of penetration
  • Unable to delay ejaculation during intercourse nearly all of the time
  • Avoid sexual intercourse because of frustration and anxiety about early ejaculation

Note that if PE only occurs occasionally, that is normal and not a cause for concern.

PE may be divided into two types:

  • Primary - When a man has always had the problem
  • Secondary - When a man has had normal sexual experiences in the past but develops problems later in life.

What causes PE?

The exact mechanism of PE has not yet been established.  It is known that both psychological and physical factors are involved.

Psychological factors include:

  • Early sexual experience involving rushing (guilt or fear of being caught) may train a person to ejaculate quickly, a pattern not easily broken.
  • Patients with erectile dysfunction (ED) may train themselves to rush sex due to fear of losing an erection before ejaculation.  This instance, similar to above, establishes a pattern not easily broken.
  • Anxiety about
    • Sexual performance
    • Other issues (such as work or relationship)
  • Relationship trouble
    • If PE has not been a problem in other relationships, you may want to examine your current relationship for any troubles that could lead to this problem.

Physical factors include:

  • Abnormal levels of hormones such as testosterone or thyroxin
  • Abnormal levels of certain neurotransmitters such as serotonin
  • Problems with the reflexes involving ejaculation
  • Inflammation or infection of the urethra or prostate
  • Genetic problems
  • Nerve damage

What are the treatments for PE?

Behavioral techniques

  • Masturbating a few hours prior to anticipated sexual intercourse

Pause-Squeeze technique

  • This method involves stopping intercourse to squeeze the tip of the penis.  Such action should soften an erection and if continued overtime should train the brain to limit unwanted ejaculation

Medications

  • Anaesthetics (or numbing agents) can be applied to the penis to reduce the sensations felt during sexual intercourse
  • Oral medications that delay ejaculation
    • Priligy (dapoxetine) is a potent antidepressant to be taken as needed before sexual activities.  It works to delay ejaculation through its actions on chemicals in the brain.
  • Oral medications for erectile dysfunction (ED) such as Viagra have also been shown to be effective in PE

Counseling in those who need to work out psychological or relationship issues