Premature Ejaculation Unveiled: Symptoms, Causes, and Treatments

Premature ejaculation (PE) is the most common sexual problem of men- affecting about 20-30%  men worldwide. It can impact relationships and this can cause stress for the man and his partner, but understanding its symptoms, causes, dosage and treatments may help a person who is suffering from PE. You may feel self-conscious if you have experienced Premature ejaculation, but you’re not alone. Studies show that PE is the most common sexual complaint among men. There are various treatment options for premature ejaculation. To find the best one for you, it's essential to understand the cause and possible treatments.

What is Premature ejaculation? 

Premature Ejaculation is the inability to control or delay ejaculation for more than a minute after sexual intercourse, PE is when man ejaculates sooner  than he would want during sexual activity. It can happen in all sexual activities. In the United States, about 1 in 3 men aged between 18 to 60 years old are suffering from PE. Sometimes Erectile Dysfunction (ED) & Premature Ejaculation (PE) are interlinked with each other. ED is when men are not able to maintain an erection which is sufficient for sex. After ejaculation, an erection goes away, making it tough to know if the issue is PE or ED. It’s recommended to treat ED first, as PE may not be a problem once ED is managed. 

Symptoms of Premature Ejaculation

The American Urological Association has set criteria to diagnose Premature Ejaculation. These criteria include:

• Premature ejaculation is characterized by ejaculating in 2 minutes or less
• It involve inability to delay ejaculation
• A shorter time than previously experienced. 
• It often lead to emotional distress and anxiety 

These elements can crucially affect a person’s quality of life and sexual well-being. Several researchers have noted that about 80-90% of men with lifelong PE ejaculate within 60 sec and the remaining within 2 min. 

How Does Ejaculation Work?

Ejaculation is the process run by the nervous system and ejaculation is a sudden pleasurable release of fluid or semen through the penis. This process is influenced by hormones and an individual's feelings. When you are sexually aroused or come to a certain level of excitement, your brain sends signals to your reproductive organs to ejaculate.

Ejaculation occurs in two phases: emission and expulsion 

What causes premature ejaculation? 

The exact cause of PE is not known, but there are many reasons why a man may have PE. 

Serotonin and PE

Nervous system produced a natural substance called Serotonin. It helps control  sexual desire, emotion and mood. High levels of serotonin in the brain can help to increase the time to ejaculation. While low amounts can shorten the time to ejaculation, and lead to PE.

Psychological causes

Psychological, or mental health, issues can be involved with PE and may include:

• Anxiety & Depression: Mental health conditions play the key role in causing early ejaculation. Anxiety of sexual failure or conflicting emotions leads to PE. 
• Stress: High level of stress can lead to earlier ejaculation. 
• Performance stress: Performance anxiety or pressure felt by partners during intercourse and expectation or concern about satisfying a partner can lead to onset of PE
• Arousability: Sometimes individuals with high arousability ejaculate rapidly. 
• Alcohol misuse: High level of alcohol consumption can cause ED and PE
• Relationship issues: If you feeling uncomfortable or lose connection with your partners causes stress, anger and hurt can worse PE
• Past abuse: If someone faced trauma from sexual abuse may lead mental issue and its lead to contribute to PE
• Lack of Confidence: If person have lack of performance confidence or negative body image may lead to PE
• Personality Disorder: Various personality disorder, such as obsessive-compulsive personality traits and anxiety may lead to PE

Physical causes

• Nerve damage: Spinal cord injuries or multiple sclerosis, such conditions leads to PE
• Less Serotonin amount: Low level of serotonin substance in body may cause lifelong PE
• Medical conditions: people who are suffering from conditions like diabetes and thyroid or other health issue can lead to PE
• Sensitive penis: High level of sensitivity of the penis can cause early ejaculation
• Urologic issues: Conditions such as inflammation of prostate or abnormality in ejaculation can lead to PE

Other Issues

• PE and aging:  PE can occur at any age & is not directly caused by aging. Yet, ED can become more common with age, which may be due to lower testosterone levels. In older men, erections are less firm or don't last as long. The feeling and sensation before ejaculation might also be shorter, leading to earlier ejaculation. 
• PE and your partner: PE can harm your relationship with your partner, you may lose connection with your partner, causing shame, hurt and feeling of anger. PE can also affect your sexual partner. Exercise techniques, sex therapy, counseling and ED or PE drugs may be helpful for you and your relationship. It's best to learn to relax, as intercourse anxiety can worsen PE.

Drug induced 

Sometimes Premature ejaculation can be caused by drugs like cocaine, dopaminergic, amphetamine that unbalance the dopamine levels.

Classification of Premature Ejaculation 

PE can be classified in four major types:

• Primary or life-long PE: Ejaculation latency time (IELT)  less than 1 minute since first intercourse. 
• Secondary or acquired PE: IELT less than 3 minutes.
• Natural variable PE: Ejaculation occurs within a wide period of time. 
• Subjective PE: Lack of ejaculation control.

Treatments for premature ejaculation

There are many medication and non medication treatments available to treat premature ejaculation. These include: 

Medically Therapy 

There are a number of drugs, creams and spray available that control early ejaculation in men with PE.

Medication for Premature Ejaculation. 

Phosphodiesterase 5 inhibitors (PDE5Is): Medications like Sildenafil, Vardenafil, are best medication to treat Premature ejaculations.

• Topical anesthesia medicine: It helps to delay ejaculation, its help in reducing penile sensitivity. Medications like Anesthesia Lidocaine & Prilocaine Cream and Lignocad Lidocaine 2% Gel helps to delay PE.
• Dapoxetine: Dapoxetine is an important molecule to treat premature ejaculation PE and Dapoxetine is a potent selective serotonin reuptake inhibitor (SSRI) specifically developed to treat PE. Its effects can last up to 24 hours. 

Here are some Techniques to treat Premature ejaculation:

• Stop-start technique: The stop-start technique was introduced by semans in 1956, in this technique you revive the penis until right before ejaculation, then stop the feeling of arousability until the feel of ejaculation is gone.
• Squeeze technique:  In squeeze technique, you have to make little pressure on the head of the penis, this helps to decrease the level of arousability for a short time and leads to prevent premature ejaculation.  

Premature Ejaculation and Erectile Dysfunction (ED)

ED and PE are the most common problems which are faced by 30 million men in United States that affect a person's sexual performance. Studies say that PE and ED are interlinked to each other, 30-60% people who are suffering from ED also have PE. 

Can Viagra treat premature ejaculation?

Sometimes the treatment of ED can help to prevent PE, drugs like Vardenafil, Sildenafil and Dapoxetine may provide some benefits to persons who are facing premature ejaculation. However Viagra could be more beneficial for PE when there is ED is also a problem to a person. Combination of both treatments may be much better to treat Premature ejaculation. After taking drugs like Sildenafil, people experience better intercourse with harder erection and gain self confidence and boost more sexual satisfaction. 

Conclusion

Premature ejaculation (PE) is a common sexual issue that causes distress for both the patient and their partner. Its underlying mechanisms are complex, and diagnosis is primarily clinical. For years, behavioral techniques and psychotherapy have been the primary treatments. Additionally, topical anesthetic creams, TCAs, SSRIs, tramadol, alpha-1 adrenoceptor antagonists, and PDE-5 inhibitors have been commonly used. The development of newer medications like Dapoxetine shows promise in the management of PE.

References:

https://www.medicalnewstoday.com/

https://www.ncbi.nlm.nih.gov/