What is premature ejaculation?

Premature ejaculation describes the condition where a man ejaculates (or comes) too soon. Sometimes this happens even before any direct stimulation of the penis occurs. Just thinking about a sexually stimulating situation can trigger ejaculation. However it is more common for ejaculation to occur either during or very soon after penetration. Premature ejaculation is one of the most common sexual problems affecting men. Most men will experience premature ejaculation at some time. It can become a problem when this situation is repeated in most sexual situations. Studies have shown that it is highly prevalent across all socio-economic groups and more than 40% of men are affected.

Just how soon is too soon?

Ejaculation often mostly occurs within two minutes of penetration. Some men last much longer and some come much more qUickly. The important point to remember is that if ejaculation occurs sooner than the man and/or his partner wishes and this is causing distress in the sexual relationship, then it can be regarded as 'premature' or 'rapid'.

At what age does premature ejaculation occur?

Premature ejaculation can occur at any age and under any situation, but it is more commonly a problem for the younger man. The occurrence of premature ejaculation is more related to the novelty of the sexual experience (new partner or different situation) than to the man's age.

What causes premature ejaculation?

There are some conditions that may interfere with the ejaculatory process, such as changes in the prostate gland, arteriosclerosis, diabetes and neurological disorders, but most cases are caused by failure to control the ejaculatory response. Early pioneers of sexuality studies believed early sexual experiences were important in the shaping of future ejaculatory habits. They thought that because of initial nervousness and haste. unsatisfactory early sexual experiences would 'programme' a pattern of learned rapid ejaculation later on (a form of negative conditioning). Inappropriate venues and circumstances e.g., backseats of cars, fear of discovery and one-night stands may contribute to establishing a pattern of rapid ejaculation.

Psychosocial events that may contribute to premature ejaculation include:

• Partner's illness
• Occupational stress/financial stress/shift work
• Family problems/elderly relatives/bereavementjchildren
• Guilt/Sexual orientation
• Lack of experience/opportunity
• Poor housing!overcrowding
• Performance anxiety/fear of failure/ expectations
• Lack of sexualjinterpersonal skills

A common reason for premature ejaculation is relationship disorders. Some of the components of relationship distress are: sexually demanding partners, unrealistic expectations, discrepant needs and desires in a relationship. dissatisfaction, lack of communication and trust, and affairs, partners who also have a sexual dysfunction, and an excessive desire to please a partner. Derogatory remarks made at the time tend to make matters worse and can lead to a cycle of failure and anxiety.

Current Treatments For Premature Ejaculation

The key aim of therapies for PE should be to improve control over ejaculation. Improvement in control over ejaculation may be associated with improved sexual satisfaction for the man and his partner and/or a reduction in feelings of personal distress or interpersonal difficulty due to timing of ejaculation. Many men can be helped to delay ejaculation, using self-help methods. but some may require the help of an expert practitioner. Always discuss the problem with your partner first, to find out what their needs and wishes may be. A simple self-help method that can be effective is called the 'stop/start technique'. This can be done either by the man alone or with his partner whichever is preferable.

• Step 1: Gradually start stimulation of the penis. stopping just before you think you are about to ejaculate.
• Step 2: Rest, no stimulation for 30-60 seconds.
• Step 3: Begin stimulation of the penis again. stopping or reducing stimulation until the probability of ejaculation has passed.
• Step 4: Repeat above steps four or five times. until you begin to recognise the point of ejaculation. Allow ejaculation to occur.

This masturbation technique can be modified for your partner and is called the squeeze technique. Your partner masturbates you up to the point of no return. then firmly squeezes the penis where the glans (the knob) joins the shaft using the thumb and forefinger. The sensation of just being about to come will die down. There may be some softening of your erection. until stimulation begins again. This is a bit more difficult to organise and a considerable commitment is required from the couple for these techniques to have any chance of success.

Currently available treatments for PE include behavioural therapy. topical treatments. condoms and some drugs. The most common current treatment for PE is probably the use of behavioural techniques. which are practical exercises designed to teach the patient to control ejaculation based on the idea that responses to sexual excitement and the ejaculatory reflex can be modified. Topical creams or sprays that have an anaesthetic effect are also used and are effective in some men. but impair sensation and may decrease satisfaction with the sexual experience. A number of potential new treatments. both oral and topical. are currently under investigation and may offer new options for men with PE.

PRlllGY® (Dapoxetine) is the first oral prescription medication approved for the treatment of PE. It is a unique. short-acting, selective serotonin reuptake inhibitor (SSRI). designed to be taken when needed, i.e. 1-3 hours before sexual intercourse is anticipated, rather than every day. Dapoxetine is a prescription only medicine; therefore patients wishing to take it need to obtain a prescription from their doctor. It can interact with some medications. including antidepressants and certain painkillers such as aspirin and non-steroidal anti-inflammatory drugs. Infrequently. syncope (fainting) and orthostatic hypotension (a fall in blood pressure when a person stands up). which may lead to a feeling of light-headedness. are observed as side effects. Patients with conditions including mental health problems. bleeding disorders. liver or kidney problems. or epilepsy. should discuss these with their physician before taking. Only a doctor can ensure that Dapoxetine is appropriate for an individual patient and that it is prescribed in a safe and effective manner.

About ESHA
The European Sexual Health Alliance (ESHA) is an umbrella organisation for patient support groups across Europe. The main role of this patient focused organization is to assist patients suffering from sexual dysfunction. to inform them about the solutions available as well as to provide awareness and understanding of the condition to their partners, media and other interested parties.

ESHA's purpose is to help every couple affected by sexual dysfunction to communicate openly about their sexual concerns in order to find a solution that improves the patient's sexual function and the couple's quality of life.